THE NEW TRIAL ― In a double-blind trial (STAREE), 9971 community-dwelling adults ≥70 years old without cardiovascular disease, diabetes, or dementia were randomized to receive atorvastatin 40 mg or placebo once daily. At baseline, the mean LDL-C level was 127 mg/dL. After a median follow-up of 5.9 years, treatment with atorvastatin had reduced mean LDL-C by 48 mg/dL (vs 16 mg/dL with placebo). Almost half of the patients discontinued atorvastatin within 5 years.

The primary cardiovascular endpoint (a composite of death from cardiovascular causes, nonfatal myocardial infarction or stroke, or coronary revascularization) occurred significantly less often with atorvastatin than with placebo (10.9 vs 15.5 events/1000 patient-years; hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.61-0.82). The number needed to treat (NNT) to prevent one cardiovascular event was 37. The reduction in the primary cardiovascular endpoint was driven mainly by a decrease in nonfatal events; there was no significant difference between atorvastatin and placebo in the rate of cardiovascular death. There was also no significant difference between the two groups in the rate of disability-free survival (a composite of death from any cause, dementia, or persistent physical disability), the other primary endpoint.4

SAFETY ― Musculoskeletal, hepatobiliary, and diabetes-related adverse events occurred more often with atorvastatin than with placebo in the STAREE trial.4

CONCLUSION ― In relatively healthy older adults, starting a statin for primary prevention appears to reduce the risk of nonfatal cardiovascular events, but not the risk of cardiovascular death. Shared clinical decision-making is a reasonable approach when deciding whether to start statin therapy for primary prevention of atherosclerotic cardiovascular disease in such patients.

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