Design: Randomised, double-blind, placebo-controlled trial (STAREE)
Population: 9,971 community-dwelling adults ≥70 without CVD, diabetes or dementia
Primary outcome: Major cardiovascular events; death, dementia or persistent disability
Effect: CV events HR 0.70 (0.61–0.82); disability-free survival HR 0.94 (0.84–1.05)

STAREE, published in August, randomised 9,971 Australians aged 70 or over, living in the community without cardiovascular disease, diabetes or dementia, to atorvastatin 40 mg daily or placebo. Mean age was 74.7.

Over a median 5.9 years, the composite of cardiovascular death, myocardial infarction, stroke or coronary revascularisation occurred at 10.9 vs 15.5 per 1,000 person-years (hazard ratio 0.70, 95% CI 0.61–0.82). The second primary outcome — death, dementia or persistent physical disability — did not differ (hazard ratio 0.94, 95% CI 0.84–1.05). Serious adverse events were 2.7% in both arms, though musculoskeletal, liver and diabetes-related events were more common with atorvastatin.

For neurologists, this settles one question and leaves another open. A statin is worth offering older patients for stroke and cardiac prevention. It should not be presented as a way to prevent dementia or preserve independence.

Offer atorvastatin for primary prevention in people over 70 when the aim is fewer strokes and heart attacks.
Do not present statins as dementia prevention; dementia-free and disability-free survival did not improve.
Watch for muscle symptoms, liver enzyme rises and new diabetes, which were more frequent on atorvastatin.
Serious adverse events were no more common than placebo overall.
About 4–5 fewer cardiovascular events per 1,000 people treated each year.

Why it matters

It separates two reasons often given for statins in older people and supports only one of them.

The statistics, in plain English

The hazard ratio of 0.70 means about 30% fewer cardiovascular events; in absolute terms, 4.6 fewer per 1,000 person-years. For disability-free survival, the interval 0.84–1.05 includes 1, so there was no clear effect.