For the first time, a major randomized trial was able to show that primary prevention statins did have a place for healthy older adults.
Statin therapy with daily atorvastatin 40 mg was clearly favored over placebo in people 70 and older when tallying the composite of death from cardiovascular causes, nonfatal myocardial infarction (MI) or stroke, or coronary revascularization over 6 years in the large STAREE trial (10.9 vs 15.5 events per 1,000 person-years, HR 0.70, 95% CI 0.61-0.82), reported Sophia Zoungas, MBBS, PhD, of Monash University in Melbourne, Australia, at the European Society of Cardiology (ESC) meeting held this year in Munich, Germany.
Zoungas highlighted the consistency of the benefit between those ages 70-74 and older, as well as subgroups defined by LDL cholesterol level, blood pressure, body mass index, and kidney function at baseline. The effects of statin therapy were also clear despite substantial crossovers, dose titrations, and adherence issues in STAREE, a pragmatic trial mimicking real-world practice.
"The effects were especially notable and are probably conservative given the substantial percentage of participants who discontinued the trial regimen, as well as the greater use of open-label statins in the placebo group than in the atorvastatin group," Zoungas and colleagues noted in their study manuscript, simultaneously published in the New England Journal of Medicine.
