STAREE: atorvastatin after 70 cuts major vascular events, not dementia or disability

Design

Randomised, double-blind, placebo-controlled trial

Population

9,971 adults aged ≥70 without cardiovascular disease, diabetes or dementia

Primary outcome

Major cardiovascular events; disability-free survival

Effect

CV events HR 0.70 (0.61–0.82); disability-free survival HR 0.94 (0.84–1.05)

STAREE, in NEJM, randomised 9,971 community-dwelling Australians aged 70 or over (mean 74.7) without cardiovascular disease, diabetes or dementia to atorvastatin 40 mg or placebo in general practice. There were two primary endpoints: major cardiovascular events, including stroke, and disability-free survival, defined as freedom from death, dementia and persistent physical disability.

Over a median 5.9 years, major cardiovascular events fell from 15.5 to 10.9 per 1,000 person-years (HR 0.70). Disability-free survival did not change (HR 0.94, with an interval crossing 1). Serious adverse events were similar, but musculoskeletal, liver and diabetes-related events were more common with atorvastatin.

For neurologists, two answers matter. A statin in this age group reduced a composite of vascular events that included stroke. But it did not reduce dementia or disability over six years, so patients should not be told a statin will protect their memory.

Offer a statin to healthy over-70s on the grounds of cardiovascular and stroke prevention, weighed against side effects, life expectancy and the patient's priorities.

• Discuss a statin for primary prevention with healthy adults over 70, based on the cardiovascular benefit
• Do not offer a statin to prevent dementia; this trial found no effect on dementia or disability
• Ask about muscle symptoms and check glucose during follow-up, as these were more frequent
• Weigh life expectancy, frailty and the patient's priorities in the decision

Why it matters

It strengthens the case for statins after 70 for vascular prevention, but not for protecting cognition.

Don't overread it

Disability-free survival did not change, so this trial does not show that statins help people live longer or better.

The statistics, in plain English

An HR of 0.70 means 30% fewer cardiovascular events, about 4.6 fewer per 1,000 people each year. The disability-free survival HR of 0.94 has an interval from 0.84 to 1.05, which includes no effect.

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