A type of statin significantly reduces the risk of major cardiovascular events in elderly patients, demonstrating their continued importance despite the rising use of PCSK9 inhibitors in the past decade.

Atorvastatin, a generic medicine but one also sold under Pfizer’s famous brand name Lipitor, cut the risk of cardiovascular death, nonfatal myocardial infarction, and stroke or coronary revascularisation by 30% compared to placebo. Atorvastatin lowers LDL, also known as “bad”, cholesterol in the blood by blocking a key liver enzyme.

Data from the Australia-based study, called STAREE (NCT04536870), was presented in a hot line session at the European Society of Cardiology (ESC) Congress in Munich, Germany, with results also published in the New England Journal of Medicine.

Funded by Australia’s National Health and Medical Research Council (NHMRC) and the Heart Foundation of Australia, STAREE enrolled nearly 10,000 people aged 70 years and over with no history of clinical cardiovascular disease, diabetes or dementia.

Demonstrating that atorvastatin reduces the risk of major cardiovascular events in older patients is important because there is a lack of substantial risk-benefit evidence of statins in this population group. 

“An estimated 21,000 older Australians suffer from major cardiovascular events, like heart attack and stroke, each year,” noted the study’s lead researcher, professor Sophia Zoungas, from the Monash University School of Public Health and Preventive Medicine, Melbourne, Australia.

“The STAREE trial is the first large randomised controlled trial to examine whether statins can be used for primary prevention in older patients to help them live longer in good health,” she added.

The data is also timely because it affirms statins’ utility in the cardiology space amid the emergence of PCSK9 inhibitors. While more expensive, these more efficacious drugs help patients who cannot tolerate statins or need extra reduction. PCSK9 inhibitors, such as Amgen’s Repatha (evolocumab) are administered via injection, though MSD’s Lipfendra (enlicitide) became the first pill-based option in this class to win US Food and Drug Administration (FDA) approval in July 2026. Experts interviewed by Pharmaceutical Technology expect Lipfendra to have a significant impact in the cholesterol-lowering arena.

Indeed, the STAREE study did uncover a limitation of atorvastatin. Researchers found that the risk of death, dementia, or persistent physical disability did not differ between those taking atorvastatin or placebo. Muscle, liver and diabetes-related adverse events (AEs) were even more frequent in the atorvastatin group; though all serious AEs were uncommon.

Despite this, Zoungas still highlighted the importance of statins, which remain the most common and first-line treatment, for older people.

 “The risk of heart attack and stroke is a concern for older people and knowing there is an effective measure for lowering that risk will be a huge reassurance to older people and their families. We hope to see updated guidelines to help clinicians make use of these new findings,” she concluded.

Also presented at this year’s ESC was a study demonstrating that patients who do not take blood pressure-lowering medication as prescribed are deriving little-to-no therapeutic benefit in cardiovascular disease. This indicates that despite advancements in drug modalities, adherence remains integral in achieving full clinical outcomes.