If you’re over 70, healthy and your doctor has hemmed and hawed about whether you should take a statin, there’s a reason. Until last month, nobody had run a large trial to find out.
Statins are among the most prescribed drugs in America. The evidence for them is overwhelming in people who’ve had a heart attack and strong in middle-aged people who haven’t.
But the big trials mostly stopped enrolling at 75, and the U.S. Preventive Services Task Force said in 2022 that the evidence for starting one at 76 or older was “insufficient.”
That gap just got filled. I’m 71, so I read this one closely. Here’s what it found, what it didn’t, and what to ask before you fill the prescription.
The trial
The STAREE — Statins for Reducing Events in the Elderly — study was recently published in the New England Journal of Medicine and presented at the European Society of Cardiology’s congress in Munich.
It’s the first large randomized trial of statins for primary prevention in people 70 and older.
Researchers at Monash University in Australia recruited 9,971 people from general practices. Everyone was at least 70, the average age was nearly 75, and 52% were women.
None had a history of cardiovascular disease, diabetes or dementia. Half got 40 milligrams of atorvastatin a day, the generic version of Lipitor. Half got a placebo.
Then the researcher followed participants for a median of 5.9 years. The trial was paid for by Australia’s National Health and Medical Research Council and the Heart Foundation of Australia, not a drug company.
The number that moved
Over roughly six years, 8.3% of the placebo group had a major cardiovascular event — a heart attack, a stroke, a procedure to open a blocked artery, or death from heart disease. In the statin group, 6.0% did.
That’s a 30% relative reduction, and it wasn’t a fluke: The confidence interval ran from 18% to 39%, and the odds of chance producing it were under one in a thousand.
In plain terms, the statin spared 2.3 people out of every 100 from a heart attack, stroke or similar event over six years.
For context, heart disease remains the leading cause of death in America, and the U.S. Centers for Disease Control and Prevention says only about one in six cardiovascular deaths happens before age 65. The other five are in this age group.
The number that didn’t
Here’s where STAREE gets interesting and honest. The researchers didn’t just count heart attacks. They set a second primary goal: disability-free survival, meaning you’re alive, you don’t have dementia and you haven’t developed a lasting physical disability.
That’s the outcome most people my age actually care about. Fewer heart attacks is good. Staying independent is the point.
On that measure, the statin did nothing detectable. Over the trial, 12.8% of the statin group died, developed dementia or became persistently disabled. In the placebo group it was 13.6%. The gap was too small to be sure it wasn’t chance.
Why would a drug prevent heart attacks without extending independent life? The likeliest answer is that at 75 and beyond, most of what ends independence isn’t cardiovascular. Cancer, falls, dementia and frailty don’t care about your LDL.
That doesn’t make the heart benefit fake. It makes it narrower than the marketing.
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The side effects
Muscle problems, liver-related issues and diabetes-related complications were all more common in the statin group. The trial didn’t report them as dramatic; serious adverse events were 2.7% in both groups, statin and placebo alike. But “more common” is real, and at this age a muscle problem can mean a fall.
The lead researcher, Monash University professor Sophia Zoungas, framed the result as a starting point, not a verdict. “We hope to see updated guidelines to help clinicians make use of these new findings,” she said in an announcement of the findings.
What this means for you
If you’re already on a statin and tolerating it, this trial gives you no reason to stop. If you’re over 70, healthy and not on one, it gives you a real reason to have the conversation, and a real reason not to accept a reflexive yes or no.
Three questions worth bringing:
1. What’s my actual 10-year risk? The benefit in STAREE was measured across everyone over 70. Your own odds depend on blood pressure, cholesterol, smoking history and family history. Ask for the number, not the adjective.
2. Would a calcium scan change the call? A coronary artery calcium scan is a cheap CT that shows plaque directly. It’s the tiebreaker many cardiologists use when the decision is a coin flip.
3. What am I trading? Ask about the muscle and diabetes risk specifically, in the context of your other medications.
Then decide whether a 2-in-100 reduction in heart events over six years is worth a daily pill to you. For many people it will be. For some it won’t. Both answers are defensible.
The bottom line
The cost side is easy. Generic atorvastatin runs under $10 a month at many pharmacies with a free discount card, according to GoodRx, and Medicare Part D covers it. Money isn’t the barrier here. Information was, and STAREE supplied some.
A second trial, PREVENTABLE, is testing the same drug in Americans 75 and older, with death, dementia and disability as its main outcome, but the results won’t be available for some time.
Until then, you’ve got the best evidence anyone has had: A statin will probably protect your heart after 70. Whether it protects the life you want to live is still an open question. Ask it out loud.
If you’d rather work on cholesterol without a prescription first, here are foods that can help lower it. And if you have diabetes, a separate study says timing matters more than you’d think.
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