Sophia Zoungas said the STAREE trial gives older people and their families a reason for reassurance after Atorvastatin cut major cardiovascular events by 30% in adults aged 70 years and over. The same trial did not significantly improve disability-free survival, leaving the heart benefit and the dementia-related outcome on different paths.
STAREE enrolled 9,971 participants in Australia, with a mean age of 74.7 years and 52% women. Participants were randomized 1:1 to oral Atorvastatin 40 mg daily or placebo, and followed for a median 5.9 years.
Sophia Zoungas at ESC Congress
The results were presented in a Hot Line session at ESC Congress 2026 and published simultaneously in the New England Journal of Medicine. Zoungas said STAREE was the first large randomized controlled trial to examine whether statins can be used for primary prevention in older patients.
Major cardiovascular events were defined as cardiovascular death, nonfatal myocardial infarction, stroke or coronary revascularisation. In the trial, the risk was 6.0% with Atorvastatin and 8.3% with placebo, with an HR of 0.70, a 95% CI of 0.61 to 0.82 and p<0.001.
STAREE disability-free survival
Disability-free survival meant survival free of dementia and physical disability. The risk of death, dementia or persistent physical disability was 12.8% in the Atorvastatin group and 13.6% in the placebo group, with an HR of 0.94, a 95% CI of 0.84 to 1.05 and p=0.25.
That split finding is the practical reading for older adults weighing primary prevention: the statin lowered major cardiovascular events, but the trial did not show a significant gain in the combined outcome that included dementia and physical disability. Zoungas said, "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."
NEJM and guidelines
Muscle, liver and diabetes-related adverse events were more frequent in the Atorvastatin group, while serious adverse events were uncommon and occurred in 2.7% of participants in both groups. Zoungas also said, "We hope to see updated guidelines to help clinicians make use of these new findings".
Whether the cardiovascular benefit would be enough to change treatment guidelines for older adults is not answered in the source, so the immediate takeaway is narrower: older people considering statin use now have trial evidence showing a clear reduction in major cardiovascular events, but not a proven improvement in disability-free survival.
