Pericoronary adipose tissue (PCAT) attenuation on coronary computed tomography angiography reflects coronary inflammation and predicts cardiovascular outcomes. Statins possess anti-inflammatory properties beyond lipid-lowering effects. We conducted a systematic review and meta-analysis to evaluate whether statin therapy reduces PCAT attenuation, thereby mitigating pericoronary inflammation. We systematically searched PubMed, Cochrane Library, Scopus, and ScienceDirect databases for studies published between January 2020 and September 2025 examining PCAT attenuation changes with statin therapy. Eligible studies included randomized controlled trials and cohort studies involving patients undergoing serial coronary computed tomography angiography with identical scan parameters at least 12 months apart. Quality assessment utilized the Newcastle-Ottawa Scale. Meta-analysis employed fixed-effects modeling, calculating mean differences with 95% confidence intervals. Statistical heterogeneity was assessed using I2 statistics. Three studies comprising 162 patients met inclusion criteria. Meta-analysis demonstrated statistically significant PCAT attenuation reduction following statin treatment (mean difference −3.02 HU; 95% CI: −4.69 to −1.35; p = 0.0004). Heterogeneity among studies was minimal (I2 = 4%, p = 0.35). All included studies achieved excellent methodological quality (8 stars on Newcastle-Ottawa Scale), with adequate follow-up duration exceeding 12 months and follow-up rates above 90%. Statin therapy significantly reduces pericoronary adipose tissue attenuation, indicating measurable anti-inflammatory effects on coronary vasculature. These findings support PCAT attenuation as a potential noninvasive biomarker for monitoring statin therapeutic response and coronary inflammation and provide quantitative evidence supporting the anti-inflammatory effects of statins on coronary vasculature. The magnitude of this effect may vary according to statin intensity, with more consistent reductions observed in high-intensity regimens.