What?
On Saturday, researchers shared the results of the STAREE trial at a cardiology congress in Munich, and the full paper appeared in the New England Journal of Medicine the same day. In this study, 9,971 adults aged 70 and older, who did not have heart disease, diabetes, or dementia at the start, received either 40 mg of atorvastatin or a placebo.
The trial set out to answer two main questions. First, it tracked heart attacks, strokes, cardiac deaths, and stent procedures. After about 5.9 years, 6.0% of people taking the drug had these events, compared to 8.3% on placebo. That 30% difference means 2.3 fewer people out of every 100 had these problems. Second, the study looked at whether the drug helped people live longer without dementia or physical disability. Here, those outcomes hit 12.8% of the drug group and 13.6% on placebo, a small difference that could have happened by chance.
So what?
Statins are among the most thoroughly studied drugs in medicine. Results from 27 randomized trials show they help prevent major vascular events, even for people at low risk. Even in that low-risk group, every 1 mmol/L drop in LDL cholesterol prevents about 11 events per 1,000 people over five years. The researchers concluded that the benefits are much greater than any known risks. If you already take a statin, there is no reason to stop based on this new study.
The real question is what benefit you personally might get. In Munich, that 2.3 in 100 came from adults with an average age of 74. In March, new US guidelines made 21.5 million more people eligible for statins. These people are younger and have a lower risk, with an average 3.1% risk over ten years. For them, the same 30% reduction means even fewer people benefit, but this is not always made clear. In Europe, the SCORE2 system is used, and the math works out the same.
The STAREE trial does not give information for people who are 50 years old. All participants were at least 70, and anyone with heart disease, diabetes, or dementia was excluded. So, you need to find out your own risk numbers.
Now what?
If you already take a statin, do not change your prescription until you talk with your doctor. Make sure to mention any symptoms or concerns at that visit.
Ask your doctor for your current risk estimate. In the US, learn about PREVENT and its 10-year and 30-year risk numbers. In Europe, ask which SCORE2 or SCORE2-OP estimate applies to you.
Review your ApoB and your one-time Lp(a) test result with your doctor. Try to keep ApoB below 80 mg/dL, or below 65 if you already have disease or a strong family history. Ask if a CAC score could change your risk category.
Ask your doctor this specific question: “With this dose, how many percentage points will my risk go down over the years I am likely to take it?”
At the same visit, ask about possible downsides. Serious side effects happened at the same rate in both groups, 2.7%. However, muscle, liver, and blood sugar problems were more common in people taking the drug.
You can find out your own risk number. Go and get it.
Stay healthy.
Andre