However, that does not imply that removing coronary calcium will reduce coronary events. In fact, statin therapy by itself actually increases coronary artery calcification.
It turns out that calcified and fibrotic atherosclerotic plaques are not the plaques that rupture and cause thrombosis and myocardial infarction; in fact, the responsible plaques tend to be large, lipid-rich plaques with a thin cap (called thin cap fibroatheromas). Calcium can actually be protective in helping to form robust caps over plaques. There is a lot of work on characterizing cap-Calcium microstructure. Theoretically, removing calcium somehow using drug agents could have an adverse effect.
It is likely true that they tend to form where there are surface defects; this idea is decades old and a component of Virchow's triad.
I would be interested in reading more about this. Do you have any recommendation for a layman?
All the articles are very good.
There a lot of knobs at each step but that's basically it.