Atorvastatin cuts major cardiovascular events by 30% in healthy adults over 70, STAREE trial finds

Atorvastatin查看药品详情 reduced major cardiovascular events by 30% in people aged 70 years or older without known cardiovascular disease (搜索)搜索该疾病, diabetes, or dementia, but did not significantly improve disability-free survival, according to results from the STAREE trial presented in a Hot Line session at ESC Congress 2026 in Munich, Germany, and published simultaneously in the New England Journal of Medicine.

Statins are commonly prescribed to manage high cholesterol in people up to 75 years of age due to their proven benefits in reducing the risk of heart attack and stroke. However, until now, the risk–benefit of statins to prevent cardiovascular events in older adults without known cardiovascular disease (搜索)搜索该疾病, diabetes, or dementia was uncertain due to underrepresentation in major statin trials.

"An estimated 21,000 older Australians suffer from major cardiovascular events, like heart attack and stroke, each year," noted Lead Researcher Professor Sophia Zoungas, from the Monash University查看公司主页 School of Public Health and Preventive Medicine, Melbourne, Australia. "The STAREE trial is the first large randomised controlled trial to examine whether statins can be used for primary prevention in older patients to help them live longer in good health."

Trial design and population

STAREE was a double-blind, randomised controlled trial conducted among people aged 70 years and over with no history of clinical cardiovascular disease (搜索)搜索该疾病, diabetes, or dementia, recruited from Australian general practice with the help of almost 3,400 GPs. In total, 9,971 participants were randomised (1:1) to oral atorvastatin查看药品详情 40 mg daily or placebo. The study population had a mean age of 74.7 years, and 52% were women.

The two primary endpoints were major cardiovascular events, defined as cardiovascular death, nonfatal myocardial infarction, stroke, or coronary revascularisation, and disability-free survival, defined as survival free of dementia and physical disability.

Key efficacy findings

Over a median follow-up of 5.9 years, the risk of major cardiovascular events was reduced by 30% in the atorvastatin查看药品详情 group compared with the placebo group (6.0% vs. 8.3%; hazard ratio [HR] 0.70; 95% confidence interval [CI] 0.61 to 0.82; p<0.001).

In real terms, this means one major cardiac event such as a heart attack, stroke, or heart surgery could be prevented for every 37 older adults treated with daily statins over almost six years.

However, the risk of death, dementia, or persistent physical disability did not substantively differ between the two groups (12.8% vs. 13.6%; HR 0.94; 95% CI 0.84 to 1.05; p=0.25). The study found no statistically significant difference in dementia rates among those who received a statin and those who did not.

Safety profile

Muscle, liver, and diabetes-related adverse events were more frequent in the atorvastatin查看药品详情 group; however, all serious adverse events were uncommon, occurring in 2.7% of participants in both the atorvastatin and placebo groups.

Clinical implications and limitations

"With the world's population ageing at an unprecedented rate, answering fundamental questions about healthy longevity has become a universal imperative," explained Professor Zoungas. "The risk of heart attack and stroke is a concern for older people and knowing there is an effective measure for lowering that risk will be a huge reassurance to older people and their families. We hope to see updated guidelines to help clinicians make use of these new findings."

Prof James Chong, a cardiologist at Sydney's Westmead hospital, noted that if the research "leads to increased statin use globally, the absolute reduction of (heart-related) events can be significant." However, he cautioned that "it was an almost exclusively white population with the mean age around 75 years of age, so the results may not be as generalisable globally without further supporting evidence."

Prof Tom Marwick, a cardiologist at Hobart's Royal hospital, described the trial as a "well done, really important trial," adding that the findings "really close the book" on concerns about statins increasing dementia risk. He noted that patients were reluctant to adhere to therapy, with more than 15% of patients in the trial discontinuing their medication, and observed that although major heart events were reduced, disability-free survival was the same among participants whether they took the statin or the placebo. "We can reduce cardiovascular events, but the health burdens of ageing are less amenable," he said.