Discontinuing statin therapy in adults over 70 who have multiple chronic conditions but no known

Discontinuing statin therapy in adults over 70 who have multiple chronic conditions but no known cardiovascular disease proved statistically non-inferior to continuing the drugs on the STREAM study’s primary endpoint, researchers reported at the American Heart Association’s Scientific Sessions and in the New England Journal of Medicine — yet the same trial recorded more cardiovascular events among those who stopped, ad-hoc-news.de reported.

1,880 patients tracked across 24 centers in Switzerland, France and the Netherlands

The STREAM study, led by researchers at the University of California, enrolled 1,880 participants with a mean age of 77.5 years — 53% men and 47% women — each with at least two chronic conditions and no prior cardiovascular disease. At 24 centers, 938 people stopped taking statins while 942 continued; about 14% crossed over between groups. After two years, the mean event-free survival time was 96.5 weeks in the discontinuation group versus 98.5 weeks in the continuation group. The 2.0-week difference fell inside the pre-specified 5.2-week non-inferiority margin.

LDL cholesterol rebounds within a year, but quality-of-life measures hold steady

Stopping the drug had a clear biochemical cost: LDL cholesterol in the discontinuation group climbed to 176 mg/dL after 12 months, compared with 100 mg/dL among those who kept taking statins. Even so, the two groups showed no differences in quality of life, muscle pain, falls or sarcopenia.

One extra cardiovascular event per 40 patients over two years

At a median follow-up of 103 weeks, the groups diverged on hard outcomes. The combined endpoint of heart attack, ischemic stroke and death occurred in 12.7% of those who stopped statins versus 9.2% of those who continued — a hazard ratio of 1.38. That translated to 119 events in the discontinuation group against 87 in the continuation group, with death rates of 9.8% versus 8.0%. Over two years, that works out to roughly one additional cardiovascular event for every 40 people who stop. Serious adverse events affected 43% of the discontinuation group and 39.8% of the continuation group.

Study leader Rita Redberg of the University of California said no general recommendation to stop can be made from these data; instead, she called for shared decision-making between patients and physicians. She added that for most people in this age group without prior cardiovascular events, stopping is generally safe — but should never be done without consulting a doctor. Naveed Sattar of the University of Glasgow, who was not involved in the trial, described the absolute added risk as small but real, and said he would not advise relatives against stopping solely on the basis of these data.

British observational data point the same way over four years

A separate observational study published in The Lancet Healthy Longevity by Oxford researchers adds longer-term context. Using CPRD data from 1998 to 2021, the team compared 65,727 people aged 65 and older who stopped statins with 131,453 who continued — mean age 75.9, median follow-up 4.1 years. The analysis, which does not prove causation, found a 22% higher relative risk of hospital admission within one year (subdistribution hazard ratio 1.22, or 37.6 additional admissions per 1,000 people). In year five the sHR was 1.11, with crude rates of 199.7 versus 160.2 admissions per 1,000 person-years. Adverse events were nearly identical (73.1% versus 74.0%), and again no quality-of-life differences emerged.

Among the strongest and healthiest people, the adjusted hazard ratio was 1.30; for those with mild frailty, it was 1.22, and for those with moderate frailty, it was 1.16. No significant differences appeared in severe frailty (sHR 1.03) or dementia (sHR 1.05). Notably, for care home residents, stopping was associated with an sHR of 0.76 — 68.8 fewer admissions per 1,000 people. The scale of the question is large: more than 8 million adults in Britain take statins, including about 2.5 million over age 70.

The question still open for patients and their doctors

Neither study settles whether any individual over 70 should stop. The STREAM trial shows stopping is non-inferior on its primary endpoint and safe in day-to-day terms, but it also shows a measurable rise in heart attacks, strokes and deaths; the Oxford data suggest that risk persists over years and shifts with frailty and living situation. What remains unanswered is which patients, in which circumstances, gain more from stopping than they lose — a judgment the sources say belongs in a conversation with a physician, not in a blanket rule.

Cardiovascular risks and doctor guidance required

Is it safe to stop statins after age 70? In the STREAM trial, stopping was non-inferior to continuing on the primary endpoint and showed no differences in quality of life, muscle pain, falls or sarcopenia, but cardiovascular events rose from 9.2% to 12.7%. Study leader Rita Redberg said stopping is generally safe for most people in this group without prior cardiovascular events, but should never happen without a doctor’s involvement.

How much does cardiovascular risk rise after stopping? The STREAM study recorded a hazard ratio of 1.38 for heart attack, ischemic stroke or death — about one extra event per 40 people over two years. The Oxford observational study found a 22% higher relative risk of hospital admission within one year of stopping.

Does frailty change the picture? Yes, in the Oxford data. The elevated admission risk was highest among robust older adults (sHR 1.30) and faded with increasing frailty, showing no significant difference in severe frailty or dementia. Care home residents actually had fewer admissions after stopping (sHR 0.76).