AHA 2026: Should older adults stop statins? New trial adds nuance

Clinical takeaway: In adults aged 70 years or older with multiple chronic conditions but no established cardiovascular disease, discontinuing statins appeared comparable to continuing therapy over 2 years for major cardiovascular events or death. However, clinicians should engage in shared decision-making, as longer follow-up suggested a modest increase in cardiovascular events after discontinuation.

Statins are widely used for primary prevention of cardiovascular disease. Discontinuation of statin therapy may be considered for adults with chronic conditions based on their risk of adverse effects or drug interactions. Yet evidence guiding whether to continue or stop treatment in older adults without cardiovascular disease has been limited.

The STREAM trial found that stopping statins in nearly 1,900 adults aged 70 years and older with at least two chronic conditions and no history of cardiovascular disease was noninferior to continuing therapy for the primary outcome of major cardiovascular events or death over 2 years. Participants who discontinued statins experienced an average of 96.5 event-free weeks compared with 98.5 weeks among those who continued treatment.

These results indicate that, on average, patients in the discontinuation group had a nonfatal myocardial infarction or stroke or died two weeks earlier over a 2-year period than those who continued statin therapy, and that one additional major cardiovascular event or death would occur over a period of 2 years for every 40 persons who discontinued statin therapy.

Notably, event rates were numerically higher in the discontinuation group. Approximately 10.7% of patients who stopped statins experienced a major cardiovascular event (nonfatal myocardial infarction, nonfatal ischemic stroke) or death from any cause over 2 years versus 8.2% of those who continued therapy. Over the full 4 year follow-up period, 12.7% in the discontinuation group and 9.2% in the continuation group experienced a primary-outcome event. No meaningful differences were observed in quality of life, pain, falls, sarcopenia risk, or medication adherence between groups.

The international, open-label, randomized STREAM trial enrolled 1,880 adults aged 70 years or older (mean age 77.5 years; 46.9% women; 32.1% with diabetes) from centers in Switzerland, France, and the Netherlands. Participants had at least two chronic conditions, were taking statins for primary prevention, and were randomized to either discontinue or continue treatment. The primary outcome was the first occurrence of nonfatal myocardial infarction, nonfatal ischemic stroke, or death from any cause.

“These findings suggest cautious statin discontinuation in primary prevention only after shared decision-making,” lead investigator Nicolas Rodondi said during the AHA late breaking session.

Future work will likely focus on identifying which older adults can safely deprescribe statins and which subgroups receive ongoing cardiovascular benefit from continued treatment.

Source: Rodondi N, et al. (2026 Nov 7) N Engl J Med. Discontinuing Statins in Older Adults without Cardiovascular Disease