Statins cut events in the over-70s but do not extend disability-free survival

The edition in brief

Four randomised trials land together today, and three of them change something. STAREE randomised 9,971 community-dwelling Australians aged at least 70, free of cardiovascular disease, diabetes and dementia, to atorvastatin 40 mg or placebo. Over a median 5.9 years, major cardiovascular events fell from 15.5 to 10.9 per 1000 person-years (hazard ratio 0.70, 95% CI 0.61 to 0.82). The co-primary endpoint of death, dementia or persistent physical disability did not move (HR 0.94, 95% CI 0.84 to 1.05). Statins work in this age group; they do not extend independent life. AIR-STEMI randomised 1,823 patients with STEMI and multivessel disease to complete revascularisation guided by functional angiography or by conventional angiography. Events fell from 13.7% to 8.9% (HR 0.62, 95% CI 0.47 to 0.83), and contrast nephropathy or major bleeding also fell (HR 0.63). Physiology guidance was both more effective and safer. SINGLE-AF randomised 1,803 Korean patients with atrial fibrillation and a CHA2DS2-VASc score of 1 in men or 2 in women to a DOAC or no anticoagulation. The composite endpoint occurred in 0.5% versus 1.5% (HR 0.31, 95% CI 0.10 to 0.94), driven by stroke, with no excess major bleeding — the first randomised support for a class IIa recommendation. CMR GUIDE tested scar-guided defibrillator implantation at an ejection fraction of 36% to 50% and missed its primary endpoint (HR 0.76, 95% CI 0.37 to 1.58), though sudden cardiac death alone fell. TUXEDO-2, an Indian trial in 1,800 patients with diabetes and multivessel disease, found an ultra-thin biodegradable-polymer sirolimus stent noninferior to a durable-polymer everolimus stent. No new regulatory action appeared today.