Statins reduce MACE in older adults without CVD
ESC Congress 2026 – In the STAREE trial, atorvastatin reduced the risk of MACE by 30% compared with placebo in people aged ≥70 years with no history of CVD, but did not improve disability-free survival.
This summary is based on the presentation of Sophia Zoungas, MBBS, PhD (Melbourne, Australia) at the ESC Congress 2026 - STAREE: Statins for Reducing Events in the Elderly.
Introduction and methods
The efficacy of statins for reducing CV events is well established in patients at high CV risk or with established CVD. However, evidence supporting initiation of statin therapy for primary prevention in older adults is limited, particularly in persons aged >75 years. The STAREE (Statins in Reducing Events in the Elderly) trial evaluated whether atorvastatin reduces MACE and prolongs disability-free survival in community-dwelling older adults without clinical CVD.
STAREE was an investigator-initiated, double-blind, randomized, placebo-controlled trial conducted through general medical practices across Australia. The trial enrolled 9971 community-dwelling adults aged ≥70 years without a history of CVD, diabetes, dementia, disability, or hypercholesterolemia.
After a 30-day placebo run-in period, participants were randomized 1:1 to atorvastatin 40 mg once daily (n=4984) or placebo (n=4987). Mean age was 74.7 years and 51.9% were women. Mean (±SD) LDL-c at baseline was 127±28 mg/dL (3.27±0.72 mmol/L). Median follow-up was 5.9 years.
The two primary endpoints were:
- MACE defined as a composite of CV death, nonfatal MI or stroke, or coronary revascularization.
- Disability-free survival, defined as survival free from death from any cause, dementia, or persistent physical disability.
Main results
- At the end of follow-up, mean LDL-c had decreased by 47.6 mg/dL (1.23 mmol/L) in the atorvastatin group and by 16.2 mg/dL (0.42 mmol/L) in the placebo group, corresponding to a between-group difference of 31.4 mg/dL (0.81 mmol/L).
- MACE occurred in 297 participants (6.0%) receiving atorvastatin and 412 participants (8.3%) receiving placebo (HR: 0.70; 95%CI: 0.61–0.82; P<0.001).
- The reduction in MACE was consistent among participants aged 70–74 years and those aged ≥75 years.
- Disability-free survival occurred in 637 participants (12.6%) receiving atorvastatin and 676 participants (13.6%) receiving placebo (HR: 0.94; 95%CI: 0.84–1.05; P=0.25).
- Serious adverse events occurred in 2.7% of participants in both groups.
- Medically important adverse events were more common with atorvastatin than with placebo (8.8% vs. 6.7%), including musculoskeletal/connective-tissue, hepatobiliary, and diabetes-related adverse events.
Conclusion
In the STAREE trial, atorvastatin reduced the risk of MACE by 30% compared with placebo in community-dwelling adults aged ≥70 years without clinical CVD. However, atorvastatin did not improve disability-free survival compared with placebo.
- Our reporting is based on the information provided at the ESC Congress 2026 and publication in N Engl J Med.-