Statins cut cardiovascular events after 70, but did not buy disability-free years

The edition in brief

In STAREE, 9,971 Australians aged 70 or over without cardiovascular disease, diabetes or dementia were randomised to atorvastatin 40 mg or placebo. Over 5.9 years, major cardiovascular events fell from 15.5 to 10.9 per 1,000 person-years (HR 0.70), but the co-primary endpoint of death, dementia or persistent disability did not change (HR 0.94, 95% CI 0.84–1.05). LIBREXIA-ACS, adding the factor XIa inhibitor milvexian 25 mg twice daily to antiplatelet therapy after acute coronary syndrome, stopped for futility in 14,194 patients: events 5.4% vs 5.1% (HR 1.05), with no excess intracranial or fatal bleeding. In IDEAL-AF, adding low-voltage zone ablation to pulmonary vein isolation in 209 patients with persistent AF and substantial atrial scar raised 12-month arrhythmia-free survival from 37% to 68%. A Chinese trial of pulmonary-artery denervation in 264 patients with pulmonary hypertension due to left heart disease halved clinical worsening (HR 0.49), on a composite led by softer endpoints. And NOTION-4 found that three months of a DOAC after TAVR, in patients without another indication, reduced leaflet thickening only while it was taken, while death, stroke or major bleeding at a year was 8.2% vs 2.3% with single antiplatelet therapy.