ESC Congress 2026: Statins finally show primary prevention benefit after age 70

Clinical takeaway: Use these findings to support shared decision-making about atorvastatin for primary prevention in carefully selected, community-dwelling adults aged 70 years or older without cardiovascular disease, diabetes, or dementia, while explaining that treatment did not prolong disability-free survival and modestly increased some adverse events.

Whether to start statins in otherwise healthy older adults has remained controversial because this age group was underrepresented in prior statin trials. STAREE is the first large randomized study designed specifically to address the balance of benefits and risks of statin therapy in adults aged 70 years and older.

Presented at ESC Congress 2026 and published in the New England Journal of Medicine, the double-blind STAREE trial randomized 9,971 community-dwelling Australian adults aged 70 years or older without known cardiovascular disease, diabetes, or dementia to atorvastatin 40 mg daily or placebo. Participants were followed for a median of 5.9 years.

Major cardiovascular events occurred in 6.0% of patients receiving atorvastatin versus 8.3% receiving placebo, representing a 30% relative reduction. Investigators estimated that treating 37 patients for roughly six years would prevent one major cardiovascular event. Benefits were driven largely by fewer myocardial infarctions and coronary revascularizations, while stroke rates showed a smaller difference between groups.

The key secondary finding was neutral: atorvastatin did not significantly improve disability-free survival, defined as survival free of death, dementia, or persistent physical disability. Event rates were 12.8% with atorvastatin and 13.6% with placebo. Serious adverse events were uncommon and occurred at the same rate in both groups (2.7%), although muscle-, liver-, and diabetes-related adverse events were reported more often among statin-treated participants.

“The risk of heart attack and stroke is a concern for older people and knowing there is an effective measure for lowering that risk will be a huge reassurance to older people and their families,” said lead investigator Professor Sophia Zoungas, who added that the findings could help inform future guideline updates.

Source: Zoungas S, et al. (2026 Aug 29) N Engl J Med. Atorvastatin, Cardiovascular Events, and Disability-free Survival in Older Adults