Statins Handed a Victory in Healthy Older People in STAREE

A groundbreaking randomized trial named STAREE has demonstrated the potential benefits of statin therapy for healthy older adults, aged 70 and above. The study, conducted by Sophia Zoungas and colleagues at Monash University in Melbourne, Australia, was presented at the European Society of Cardiology meeting in Munich, Germany.

In this large trial involving nearly 10,000 participants, daily atorvastatin 40 mg was found to be more effective than a placebo in reducing the composite of death from cardiovascular causes, nonfatal myocardial infarction or stroke, and coronary revascularization over a period of six years. The results showed a 10.9 events per 1,000 person-years rate with statins compared to 15.5 events per 1,000 person-years with placebo (HR 0.70, 95% CI 0.61-0.82).

The benefit of statin therapy was consistent across different age groups and subgroups defined by various health factors. Despite challenges such as crossovers, dose titrations, and adherence issues, the effects remained clear. The authors believe these results might be conservative given the substantial number of participants who discontinued the trial regimen and the greater use of open-label statins in the placebo group.

However, statin therapy did not reduce the risk of disability-free survival, combined death from any cause, dementia, or persistent physical disability. On the positive side, the largest effects were seen in reducing MIs and coronary revascularization events. Deaths from cardiovascular causes were too few to support any between-group difference.

Zoungas hopes that these findings will lead to updated treatment guidelines, helping clinicians make informed decisions regarding statin therapy for the oldest old. Despite the limited data available before STAREE, the moderate-intensity statin therapy was previously given a weak class IIb recommendation for the oldest old in the American lipid guidelines.

The trial also provided reassurance regarding the safety of statins in the elderly, with overall serious adverse events occurring at the same 2.7% rate between atorvastatin and placebo groups. There were minor excesses in certain medically important adverse events, such as musculoskeletal or connective tissue events, hepatobiliary events, and diabetes-related events.

Zoungas emphasized the importance of discussing the risks and benefits of statin therapy with treating physicians, taking into account the individual's ability to tolerate the medication. The STAREE trial included nearly 10,000 participants, with most remaining on statin therapy for at least three years. However, adherence to statin use fell short at 5 years, with 25 to 50% of patients discontinue the medication.

The researchers acknowledged that their results may not be entirely generalizable due to the predominantly white, English-speaking, and relatively healthy population studied. Other large statin studies, such as the U.S.-based PREVENTABLE trial and the European STREAM trial, are still pending.