Starting statins over 70 prevented about 2 heart events for every 100 healthy people over six years. But it did not clearly add healthy years. In the STAREE trial of 9,971 adults aged 74.7 on average, heart events struck 297 people on atorvastatin and 412 on a dummy pill (Trial). Time free of dementia or disability barely changed (Trial). So think of the statin as heart protection rather than a longevity pill.
What the STAREE Trial Tested
Older adults have long been a gap in statin research. The biggest combined analysis came from the Cholesterol Treatment Trialists’ (CTT) Collaboration in 2019. It gathered the raw patient records from 28 trials and 186,854 people. Only 14,483 of them were over 75 when they joined (Meta-analysis).
The CTT team found that statins cut major heart and stroke events at every age. They were also open about a weak spot. There was less direct evidence of benefit in people over 75 who did not already have blocked arteries (Meta-analysis).
In that healthy group, the results were small enough that chance could explain them (Meta-analysis). The authors said new trials were under way to fill the gap, and they named STAREE as one (Meta-analysis).
Why not just look at older people who happen to take statins? Studies that only watch people can mislead, especially in old age. Our piece on the cholesterol paradox shows how frailty can make low cholesterol look harmful. A coin-flip trial avoids that trap.
STAREE recruited through general practices across Australia (Trial). Everyone was 70 or older, with no past heart disease or stroke, and no diabetes or dementia. A coin flip decided who got atorvastatin 40 mg a day and who got a dummy pill that looked the same.
Neither the volunteers nor the researchers knew who had which. Just over half of them were women. The trial followed everyone for about six years.
The trial had two main yardsticks. The first was major heart and blood-vessel events, which we will call heart events for short. These covered deaths from heart or blood-vessel disease, heart attacks and strokes that people survived, and procedures to reopen blocked heart arteries (Report).
The second was disability-free survival, meaning staying alive without dementia and without a lasting disability. A disability meant losing the ability to do a basic task like bathing, dressing or walking. It only counted if it showed up at two check-ups six months apart (Study). This yardstick shows whether a pill adds good years of life.
Statins had been tested in older adults before. PROSPER, from 2002, gave pravastatin 40 mg or a dummy pill to 5,804 people aged 70 to 82 for about three years (Trial). It cut heart attacks and heart deaths, though not strokes. Its volunteers, however, either already had heart or blood-vessel disease or carried risk factors for it. So PROSPER could not answer the question for healthy people.
Fewer Heart Attacks, Fewer Procedures
The heart result was clear. Over about six years, 297 people on atorvastatin had a heart event, against 412 on the dummy pill (Trial). That is about 6 in every 100 versus about 8 in every 100. So about 2 in every 100 were spared a heart event. Put another way, the statin group had about 30% fewer events (Report).
Most of the gain came from heart events that people survived, the trial team noted. These were mainly heart attacks and procedures to reopen blocked heart arteries (Report). The trial tracked them as extra results, outside its two main yardsticks. A GP’s summary of the trial said both were almost halved on the statin (Review). Strokes did not clearly differ between the groups.
The drug lowered cholesterol, as statins do. LDL cholesterol, the kind that builds up in artery walls, fell about 38% on atorvastatin and 13% on the dummy pill (Review). It fell in the dummy-pill group partly because almost 1 in 5 of those people took a statin outside the trial. Nearly 1 in 10 people in the statin group did the same.
This mixing narrows the gap between the two groups. So the true effect of taking the pill may be a little larger than the headline result. The published results only compared the groups as the coin flip assigned them. Results for just the people who stayed on their trial pill were not reported (Review).
The result fits the wider evidence. In the 2019 CTT analysis, the benefit of statins shrank only slightly with age (Meta-analysis). That analysis lacked direct proof in healthy older people. STAREE now shows a similar heart benefit in healthy people over 70.
Why Healthy Years Held Steady
The second result is less encouraging. Death, dementia or lasting disability struck 637 people on the statin and 676 on the dummy pill (Trial). That gap is small enough that chance could explain it. In the authors’ words, the statin “did not result in longer disability-free survival”.
The authors offered one possible reason why fewer heart attacks did not mean more healthy years. About 80% of deaths in the trial came from causes other than heart and blood-vessel disease (Report). Deaths from heart and blood-vessel disease ran at the same rate in both groups (Report).
At this age, many illnesses compete to cause death and disability. Researchers call this competing risk. A statin mainly prevents problems in the heart and blood vessels. In the CTT analysis, statins had no effect on deaths from other causes, including cancer, at any age (Meta-analysis).
The heart events the statin did prevent were mostly ones people survived. They still matter, but they barely changed the overall count of death, dementia and disability.
Earlier trials suggest a statin probably does not protect the brain either. A 2016 Cochrane review combined two large trials with 26,340 people, all at raised risk of heart and blood-vessel disease. It concluded that statins given late in life to people like these do not prevent dementia or slow mental decline (Systematic review).
In the larger trial, 31 people developed dementia on a statin and 31 on the dummy pill. Only about 11,600 of the volunteers were 70 or older. So the match with STAREE is loose, but the result points the same way.
PROSPER found the same in people over 70. Pravastatin did not slow decline in any area of thinking over about three and a half years (Trial). The researchers wrote that using statins in older people to prevent mental decline “seems to be futile”.
Aspirin is a useful comparison. A trial called ASPREE tested daily low-dose aspirin in 19,114 healthy older adults (Trial). STAREE’s trial plan says recent trials have used its healthy-years yardstick, and it cites ASPREE (Study).
Aspirin failed that test outright. The trial stopped early, after nearly five years, when the data showed aspirin was unlikely to help. People on aspirin gained no extra time alive and free of dementia or disability. They also bled more: major bleeding hit 3.8% of the aspirin group against 2.8% on the dummy pill (Trial).
The statin also missed on healthy years, but the two results differ. Aspirin added harm and brought no clear gain. The statin brought a clear heart gain without extra serious harm (Trial). That is why a statin after 70 is still worth discussing.
Side Effects in Perspective
Serious side effects, the kind that can put someone in hospital, were equally rare: 2.7% of people in each group (Trial). Milder problems with muscles, the liver and blood sugar were more common on the statin.
Muscle and joint complaints showed up in 32.0% of people on atorvastatin and 29.4% on the dummy pill (Report). Liver and gallbladder problems hit 3.3% against 0.9%. Diabetes-related problems hit 4.0% against 2.7%. And 7.2% stopped the trial pill because of side effects, against 6.1% on the dummy pill (Review).
In blinded trials, where nobody knows who got the real pill, people report muscle aches either way. Across 19 such trials with 123,940 people, 27.1% on a statin reported muscle pain or weakness, against 26.6% on a dummy pill (Meta-analysis). The researchers concluded that more than 90% of muscle complaints on a statin were not caused by the drug. The small extra risk showed up mainly in the first year.
The SAMSON trial tested this directly. Sixty people who had quit statins over side effects signed up for a year of monthly bottles. Each month’s bottle held atorvastatin, a dummy pill, or nothing at all (Trial).
Taking any pill roughly doubled their symptom scores, whether it held a statin or not. About 90% of the symptoms that came with the statin also came with the dummy pill. Six months later, half of the 60 were back on a statin.
The diabetes signal is real but small. A 2024 CTT analysis of 23 blinded trials found that statins raise long-term blood sugar only slightly (Meta-analysis). In people without diabetes, the standard long-term sugar test rose by less than a tenth of a percentage point on average.
That nudge can tip some people over the diagnosis line. About 6 in 10 of the extra cases came from people whose starting blood sugar was already in the top quarter. Many of them were already close to diabetes.
Age may matter here. Across 13 trials with 91,140 people, the small extra diabetes risk was largest in trials whose volunteers were older on average (Meta-analysis). Overall, it came to about 1 extra case for every 255 people treated for 4 years. Still, any heart harm from the sugar rise is already counted in the trials’ heart benefit, the CTT authors note (Meta-analysis).
Who Benefits From Statins Over 70
Whether a statin makes sense after 70 depends on the person. Time is the first factor. A statin helps by preventing events years down the road, so it needs time to pay off.
A 2021 analysis measured that wait across 8 trials of 65,383 adults without heart disease. It took about 2.5 years of treatment to prevent 1 heart event for every 100 people treated (Meta-analysis). For people with less than 2.5 years to live, the authors suggested, the early harms may outweigh the benefits.
Those trials covered ages 50 to 75, though, so the timing for older people is less certain. STAREE itself ran for nearly six years, well past that window.
Heart risk is the second factor. In general, the higher someone’s heart risk, the more a statin has to prevent.
STAREE also hinted at differences between groups. A GP commentary on the trial noted that the benefit was less clear in women. The same went for people whose blood pressure, cholesterol and weight were already well controlled (Review). Results from small slices of a trial can easily be thrown off by chance. Treat them as questions worth raising with your doctor.
Health and frailty come third. STAREE’s volunteers were fairly healthy. The same commentary notes that most of them were white. It adds that the results may not apply to older adults who are frailer or have more health problems (Review).
A trial also cannot weigh your own situation, such as how many pills you already take or how you feel about side effects. Some people care most about avoiding a heart attack. Others care most about time free of dementia or disability, which the statin did not clearly change. Both are fair priorities, which is why this is a decision to make with your doctor.
If you already take a statin, do not stop it on your own. STAREE compared taking a statin with taking a dummy pill. It did not test what happens when someone quits. Talk to your doctor before changing anything.
More answers are on the way. PREVENTABLE is a US-led trial that plans to enroll 20,000 adults aged 75 and up. It tests the same 40 mg atorvastatin dose against a dummy pill (Study).
Volunteers must have no heart or blood-vessel disease, no disability and no dementia when they join. Its main yardstick is staying alive without new dementia or lasting disability. The trial registry still lists it as recruiting, with no results posted yet (Registry).
Frequently Asked Questions
Should I start taking statins over 70?
It depends on your heart risk, your health and what matters to you. In STAREE, atorvastatin prevented about 2 heart events in every 100 healthy people over six years. But it did not clearly add healthy years (Trial). The benefit takes a couple of years to build, so your expected lifespan matters too (Meta-analysis). Talk it through with your doctor.
Do statins prevent dementia in older adults?
The best evidence says probably not. A Cochrane review combined two large trials of people at raised heart risk. Statins started late in life did not prevent dementia or slow mental decline (Systematic review). STAREE also found no clear change in years free of dementia or disability (Trial).
I already take a statin at 75. Should I stop?
Do not stop on your own. Talk to your doctor before changing anything. STAREE tested starting a statin in healthy people. It did not test stopping one. Your doctor can weigh your heart history, other medicines and goals with you.
Are statins safe for people over 70?
In STAREE, serious side effects were equally rare on atorvastatin and the dummy pill, at 2.7% each (Trial). Mild muscle, liver and blood-sugar problems were somewhat more common on the statin (Report). Blinded trials suggest most muscle aches on a statin are not caused by the drug (Meta-analysis).
Key Takeaways
- Fewer heart events: Atorvastatin cut heart events in healthy over-70s from 412 people to 297, about 2 fewer in every 100 (Trial).
- No clear gain in healthy years: Death, dementia or lasting disability hit 637 people on the statin and 676 on the dummy pill. Chance could explain the gap (Trial).
- Equal serious side effects: They hit 2.7% of people in both groups (Trial). Mild muscle, liver and blood-sugar problems were somewhat more common on the statin (Report).
- Benefit takes time: About 2.5 years of treatment prevents 1 heart event per 100 people, in trials of adults aged 50 to 75 (Meta-analysis).
- A different result from aspirin: On a similar healthy-years test, aspirin gave no gain and more bleeding, 3.8% against 2.8% (Trial).
- Decide with your doctor: Weigh your heart risk, health and priorities together. Never stop a statin on your own.
Protecting the Heart After 70
STAREE gives healthy people over 70 a clearer answer in two parts. A daily statin can prevent heart attacks and the need for procedures to reopen heart arteries. But it did not clearly add years free of dementia or disability.
If this question is on your mind, bring it to your next appointment. Ask about your own heart risk, how long a benefit would take to show, and how the side effects compare. Then tell your doctor what you care about most. If you already take a statin, keep taking it until you have had that talk.
The first clear trial numbers on statins after 70 are finally in, and they are worth a careful look.
This article is for educational purposes and is not medical advice. Talk to a qualified clinician before changing your health regimen.
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