CATEGORY: HEALTHY AGING & LONGEVITY
Does starting a statin after 70, with no heart disease to treat, actually pay off? Guidelines had left that open, because earlier statin trials rarely enrolled anyone that old. A trial called STAREE set out to answer it and came back with two answers. Over nearly six years a daily atorvastatin tablet cut major cardiovascular events by 30%, from 8.3% of people on placebo to 6.0% on the drug. It did not lengthen the time participants lived free of dementia and physical disability.1
Nearly Ten Thousand Australians, Tablets in the Mail
Researchers recruited 9,971 adults aged 70 and older through general practices across Australia. Their average age was 74.7 and 52% were women. None had known cardiovascular disease, diabetes or dementia. A random allocation, made centrally and concealed from everyone involved, decided who took atorvastatin and who took a placebo tablet of the same appearance. Credit for whatever separated the two groups therefore belongs to the drug. Atorvastatin is a widely used statin, a drug that lowers cholesterol by reducing how much of it the liver makes. The dose began at 20 mg and rose to 40 mg after a month if it was tolerated, and the tablets arrived at participants’ homes by post. Over a median of 5.9 years the team followed two co-primary outcomes. One was major cardiovascular events: cardiovascular death, nonfatal heart attack, stroke, or a procedure to open a blocked coronary artery. The other was disability-free survival, meaning how long each person lived without dying, developing dementia, or becoming persistently disabled. Australia’s National Health and Medical Research Council and the Heart Foundation of Australia paid for the work.
Two Fewer Events per Hundred People, and a Yardstick That Did Not Move
Major cardiovascular events struck 297 people on atorvastatin and 412 on placebo: 6.0% against 8.3%, a hazard ratio of 0.70 (95% confidence interval 0.61 to 0.82), or 30% lower risk. In absolute terms that is a little over two fewer events per hundred people treated across roughly six years. Picture a community hall holding 100 healthy people in their seventies. Over six years about eight would ordinarily have a major cardiovascular event; with the statin, about six would. LDL cholesterol, the kind that builds up in artery walls, fell 48 mg/dL in the statin group and 16 mg/dL on placebo. The second yardstick told a different story. Death, dementia or persistent disability reached 637 people on atorvastatin and 676 on placebo, 12.8% against 13.6%, a hazard ratio of 0.94 (0.84 to 1.05). That difference is small enough to be chance.
Why Fewer Heart Attacks Did Not Buy Independent Years
STAREE was built on the idea that preventing heart attacks and strokes late in life would translate into more years of independent living. That is why disability-free survival was a co-primary outcome and not an afterthought. The investigators wrote that the lower incidence of major, nonfatal cardiovascular events with atorvastatin “did not result in a corresponding improvement in disability-free survival.” Part of the explanation sits in the arithmetic of old age. About 80% of the deaths in the trial came from causes unrelated to the heart, and dementia and frailty have many drivers that a cholesterol drug never touches. Closing one road to disability leaves the others open. Lead investigator Sophia Zoungas said the trial offers older people reassurance that an effective measure exists for lowering heart attack and stroke risk, while noting that the evidence had previously been too thin to recommend statins for this age group.
Side Effects, and the Gap in the Older Evidence
The harms followed the familiar statin pattern. Muscle and joint complaints came from 32.0% of the statin group and 29.4% of the placebo group, liver and gallbladder problems from 3.3% versus 0.9%, and new diabetes-related events from 4.0% versus 2.7%. Serious adverse events were uncommon and identical in both arms at 2.7%. About 7.2% of participants left the trial because of side effects. A modest excess of mostly minor complaints, then, set against a real drop in heart attacks and strokes. Earlier evidence had hinted at as much without settling it: a 2019 pooled analysis of 28 randomized trials and 186,854 people found statins reduced major vascular events in every age group, but only 8% of those participants were over 75, and the authors flagged how little direct evidence existed for people that age without established heart disease.2 STAREE fills that hole, and on cardiovascular events it lands where the pooled data did. What it adds is the null result on disability-free survival.
Key Takeaways
- Atorvastatin lowered the risk of major cardiovascular events by 30% in healthy adults over 70: 6.0% versus 8.3% over nearly six years, or about two fewer events per hundred people treated.
- The same tablet did not extend the time people lived free of death, dementia or persistent disability, 12.8% versus 13.6%, a difference consistent with chance.
- Muscle, liver and blood sugar complaints were somewhat more common on the statin, while serious adverse events were equally rare in both groups.
- Nobody chose their own tablet, which is why the drop in heart attacks and strokes can be laid to the statin rather than to healthier patients opting in.
References
- Zoungas S, et al. Atorvastatin, cardiovascular events, and disability-free survival in older adults. New England Journal of Medicine. 2026; published online August 29, 2026:NEJMoa2607314. link
- Cholesterol Treatment Trialists’ Collaboration. Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials. The Lancet. 2019;393(10170):407–415. link