Atorvastatin, Cardiovascular Events, and Disability-free Survival in Older Adults
In healthy adults 70 years or older, atorvastatin lowered major cardiovascular events but did not extend disability-free survival.
*Double-blind randomized placebo-controlled trial; Level 2 (OCEBM).
Citation
Zoungas S, Wolfe R, Moran C, et al. Atorvastatin, Cardiovascular Events, and Disability-free Survival in Older Adults. New England Journal of Medicine. Published August 29, 2026. doi:10.1056/NEJMoa2607314
Background
Statins reduce cardiovascular events in many adults, but their value for first-time prevention in older adults has been uncertain. This trial tested whether starting atorvastatin helps older adults avoid cardiovascular events and preserve independent living.
Patients
9971 community-dwelling Australian adults aged 70 years or older. Exclusions included prior cardiovascular disease, diabetes, dementia, or other life-limiting illness.
Intervention
Atorvastatin 40 mg once daily.
Control
Matching placebo.
Outcome
Primary outcomes: major cardiovascular events; and death, dementia, or persistent physical disability. Cognitive screening used the Modified Mini-Mental State test (0–100 in person; 0–73 by telephone).
Follow-up Period
Median 5.9 years.
Results
| Outcome | Atorvastatin | Placebo | Effect |
|---|---|---|---|
| Major cardiovascular events (primary) | 10.9 per 1000 person-years | 15.5 per 1000 person-years | Hazard ratio 0.70 (95% confidence interval 0.61 to 0.82) |
| Cardiovascular death, heart attack, or stroke | 8.6 per 1000 person-years | 11.7 per 1000 person-years | Hazard ratio 0.73 (95% confidence interval 0.62 to 0.87) |
| Fatal or nonfatal heart attack | 2.9 per 1000 person-years | 5.0 per 1000 person-years | Hazard ratio 0.57 (95% confidence interval 0.43 to 0.75) |
| Coronary revascularization | 4.0 per 1000 person-years | 7.0 per 1000 person-years | Hazard ratio 0.57 (95% confidence interval 0.45 to 0.72) |
The number needed to treat was 37 to prevent one major cardiovascular event. Disability-free survival was not improved: hazard ratio 0.94 (95% confidence interval 0.84 to 1.05). Analyses were intention-to-treat. Composite cardiovascular benefit was mainly driven by fewer nonfatal heart attacks and revascularizations. Serious adverse events were similar, but muscle, liver, and diabetes-related events were more common with atorvastatin.
Limitations
Participants were mostly White, English-speaking, independent, and relatively healthy, limiting generalizability to frailer older adults. Treatment discontinuation and open-label statin use may have diluted effects. Cardiovascular benefits did not translate into longer survival, less dementia, or less disability.
Funding
Australian public/charitable funders; no industry involvement reported.
Clinical Application
Consider atorvastatin for selected healthy adults 70 or older after shared decision-making; do not promise preserved independence or dementia prevention.
Discussion
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In this double-blind randomized placebo-controlled trial, atorvastatin 40 mg reduced major cardiovascular events in adults ≥70 without CVD, diabetes, or dementia (HR 0.70; NNT 37) but not disability-free survival (HR 0.94). Should this change primary-prevention prescribing for older adults? In the STAREE trial, the primary cardiovascular outcome occurred at 10.9 events per 1000 person-years with atorvastatin versus 15.5 with placebo, with a hazard ratio of 0.70. Which interpretation is most appropriate?