Statins cut cardiovascular events by 30 per cent in healthy over-70s but do not extend disability-free survival

Atorvastatin reduced major cardiovascular events by 30 per cent in people aged 70 and over who had no known cardiovascular disease, but it did not extend survival free of dementia and disability. The findings come from STAREE, the STAtin therapy for Reducing Events in the Elderly trial, presented in a Hot Line session at the European Society of Cardiology Congress in Munich on 29 August 2026 and published simultaneously in the New England Journal of Medicine. It is the first large randomised trial of statins for primary prevention conducted specifically in people aged 70 and over.

STAREE was double-blind and placebo-controlled, with 1:1 allocation, and recruited through Australian general practice. It randomised 9,971 participants. Their mean age was 74.7 years and 52 per cent were women. All were aged 70 or over with no history of clinical cardiovascular disease, no diabetes and no dementia at entry. The intervention was atorvastatin 40 mg daily against placebo, and median follow-up was 5.9 years.

The trial had two co-primary endpoints. The first was major cardiovascular events, defined as cardiovascular death, non-fatal myocardial infarction, stroke or coronary revascularisation. These occurred in 6.0 per cent of participants taking atorvastatin against 8.3 per cent on placebo, a hazard ratio of 0.70 with a 95 per cent confidence interval of 0.61 to 0.82 and P less than 0.001. The absolute risk reduction was 2.3 percentage points, driven predominantly by non-fatal events.

The second co-primary endpoint was disability-free survival, defined as survival free of dementia and persistent physical disability. It was not met. Events occurred in 12.8 per cent of the atorvastatin group against 13.6 per cent on placebo, a hazard ratio of 0.94 with a 95 per cent confidence interval of 0.84 to 1.05 and P equal to 0.25.

Muscle, liver and diabetes-related adverse events were more common with atorvastatin, while serious adverse events were balanced overall. Funding came from the Australian National Health and Medical Research Council and the Heart Foundation of Australia, which makes STAREE a fully publicly funded trial with no pharmaceutical sponsor.

The principal investigator is Professor Sophia Zoungas of the School of Public Health and Preventive Medicine at Monash University in Melbourne. She said of the result: “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.”

People over 70 without established cardiovascular disease have been systematically excluded from statin trials. Guidelines in most countries consequently make only weak recommendations for this group, and prescribing varies enormously between health systems.

The split result is the point of the trial. Statins work on the vasculature in the very old, but a 2.3-percentage-point absolute reduction in cardiovascular events over six years did not translate into longer life free of dementia or physical disability, which is the outcome older patients most often say they care about.

STAREE was one of 59 studies whose results were unveiled for the first time at ESC Congress 2026, held from 28 to 31 August in Munich. The meeting drew 33,800 healthcare professionals from 170 countries across 12 Hot Line sessions and 30 Late-Breaking Science sessions. Professor Tomasz Guzik, Chair of the ESC Congress Programme Committee, summarised another theme of the meeting by saying that “artificial intelligence is no longer a future concept but a reality in everyday cardiovascular healthcare.”

STAREE feeds directly into primary-prevention statin guidance for adults aged 70 and over, and into the wider argument about whether trials in older people should be powered on event rates or on healthy life-years.