Can older adults safely stop statins?

Clinical takeaway: For adults aged 75 years or older taking statins solely for primary prevention, stopping therapy did not increase all-cause mortality over 3 years compared with continuing treatment, supporting individualized deprescribing discussions based on patient preferences, comorbidities, and treatment goals.

Statins are widely prescribed for primary prevention, but evidence supporting continued use beyond age 75 has been limited because older adults have been underrepresented in major trials. At the same time, concerns about polypharmacy, adverse effects, and pill burden have prompted growing interest in deprescribing strategies for healthy older adults.

In the French SAGA/SITE trial, investigators randomized 1,160 adults aged 75 years or older with no history of atherosclerotic cardiovascular disease (ASCVD) who had been taking statins for at least 1 year for primary prevention. Participants were assigned either to continue statin therapy (n = 639) or discontinue treatment (n = 521) and were followed for 36 months. Median age was 80 years, nearly two-thirds were women, 30% had diabetes, and 77% had hypertension.

At 3 years, all-cause mortality was similar in both groups: 7.9% among those who continued statins and 7.2% among those who stopped. The trial met its predefined criterion for noninferiority, indicating that discontinuation was not associated with excess mortality. Rates of major ASCVD events were also comparable, occurring in 4.4% of the continuation group and 5.0% of the discontinuation group. Composite rates of death or major cardiovascular events were likewise similar (11.4% vs 12.0%).

Quality-of-life scores showed no meaningful differences between groups, and adverse events occurred at nearly identical rates. Notably, LCL cholesterol rose substantially after statin discontinuation, yet this increase was not accompanied by higher rates of cardiovascular events during follow-up.

“Our findings support individualised decision-making regarding statin discontinuation in older adults,” the authors wrote, emphasizing that decisions should be guided by shared clinician-patient discussions rather than routine continuation or routine deprescribing.

Source: Bonnet F, et al. (2026 Jul) Lancet Healthy Longev. Discontinuation of statins for primary prevention of atherosclerotic cardiovascular disease in adults aged 75 years or older (SAGA/SITE): a multicentre, open-label, pragmatic, non-inferiority randomised trial