Design: Double-blind, randomised, placebo-controlled trial (STAREE), general practice
Population: 9,971 adults ≥70 years without CVD, diabetes or dementia (mean age 74.7)
Primary outcome: Major CV events; and death, dementia or persistent disability
Effect: MACE HR 0.70 (95% CI 0.61–0.82); disability-free survival HR 0.94 (0.84–1.05)

STAREE was a double-blind, placebo-controlled trial in Australian general practice. It randomised 9,971 community-dwelling adults aged 70 or over (mean 74.7) with no cardiovascular disease, diabetes or dementia to atorvastatin 40 mg daily or placebo, for a median 5.9 years.

Major cardiovascular events (cardiovascular death, non-fatal MI or stroke, coronary revascularisation) fell from 15.5 to 10.9 per 1,000 person-years (HR 0.70, 95% CI 0.61 to 0.82). The second primary endpoint, death, dementia or persistent physical disability, was not significantly reduced (21.6 vs 23.0 per 1,000 person-years; HR 0.94, 0.84 to 1.05). Serious adverse events were equal (2.7% each), though musculoskeletal, hepatobiliary and diabetes-related events were more common on atorvastatin.

For neurologists, this gives randomised evidence that statins reduce major vascular events, a composite that includes stroke, in older people, while showing no gain in survival free of death, dementia or disability over six years. Consider a statin for vascular prevention; do not offer it to prevent dementia.

In adults over 70 without cardiovascular disease, atorvastatin 40 mg reduced major cardiovascular events (a composite that includes stroke).
It did not reduce dementia, disability or death as a composite over about 6 years.
Do not present statins as dementia prevention.
Age alone is not a reason to withhold a statin for primary prevention.
Watch for muscle symptoms and new diabetes, which were more common on atorvastatin.

Why it matters

It gives clear randomised evidence on statins in older adults, and shows no gain in survival free of death, dementia or disability.

The statistics, in plain English

An HR of 0.70 for cardiovascular events means about 30% fewer events, about 4.6 fewer per 1,000 people each year. The dementia-disability-death HR of 0.94 has a 95% CI from 0.84 to 1.05, which crosses 1.0, so no effect is shown.