A large clinical trial has found that a daily cholesterol-lowering pill cut the risk of major cardiovascular events by 30 percent in healthy adults 70 and older with no history of heart disease, diabetes or dementia — evidence that statins can benefit even the oldest patients typically excluded from earlier prevention trials.
Results of the STAREE trial were presented at the European Society of Cardiology Congress and published simultaneously in the New England Journal of Medicine. Researchers led by Monash University in Australia randomly assigned 9,971 participants, with a mean age of 74.7 and slightly more than half women, to receive either 40 milligrams of atorvastatin daily or a placebo. Over a median follow-up of 5.9 years, 6.0 percent of the atorvastatin group experienced a major cardiovascular event such as heart attack, stroke or heart failure, compared with 8.3 percent of the placebo group — a hazard ratio of 0.70.
No Gain in Disability-Free Survival
The trial's other primary outcome told a more mixed story. Disability-free survival, a composite measure of death, dementia and persistent physical disability, did not differ significantly between the two groups — 12.8 percent versus 13.6 percent — meaning the drug's cardiovascular benefit did not translate into a longer stretch of healthy, independent life over the study period. Side effects tied to muscles, liver function and blood sugar were somewhat more common among people taking atorvastatin, though serious adverse events overall were uncommon and balanced between groups, affecting roughly 2.7 percent of participants.
"The STAREE trial is the first large randomised controlled trial to examine whether statins can be used for primary prevention in older patients," said Sophia Zoungas, a professor at Monash University who led the study, according to the European Society of Cardiology. Earlier statin trials largely excluded people over 75 or those without existing risk factors, leaving doctors with limited data on whether starting the drugs later in life was worthwhile.
The findings arrive as clinicians increasingly weigh the trade-offs of starting preventive medications in later life, when a drug's benefits must be balanced against a shorter remaining lifespan and the burden of additional daily pills. Because STAREE showed a clear reduction in cardiovascular events without a matching gain in disability-free survival, researchers say the results are likely to sharpen rather than settle that conversation, and are expected to feed into forthcoming updates to cardiovascular prevention guidelines for older adults.
