Atorvastatin Prevents Cardiovascular Events in Older Adults without Prior Cardiovascular Disease

In a large randomized trial, atorvastatin 40 mg daily significantly reduced major cardiovascular events by 30% among community-dwelling adults aged 70 years or older without prior cardiovascular disease, diabetes, or dementia, but it did not significantly prolong disability-free survival over a median follow-up of 5.9 years. The double-blind, placebo-controlled trial conducted at general medical practices across Australia enrolled 9,971 participants, who were randomly assigned to atorvastatin (4,984 participants) or placebo (4,987 participants); their mean age was 74.7±4.5 years, and 51.9% were women. Major cardiovascular events—a composite of cardiovascular death, nonfatal myocardial infarction or stroke, or coronary revascularization—occurred in 297 participants in the atorvastatin group (10.9 events per 1,000 person-years) and 412 in the placebo group (15.5 per 1,000 person-years), corresponding to a hazard ratio of 0.70. In contrast, the composite outcome of death from any cause, dementia, or persistent physical disability occurred in 637 participants receiving atorvastatin and 676 receiving placebo, with no significant difference between groups (21.6 vs. 23.0 events per 1,000 person-years; HR, 0.94). Serious adverse events occurred in 2.7% of participants in both groups, although musculoskeletal, hepatobiliary, and diabetes-related adverse events were more common with atorvastatin. Overall, the findings show that statin therapy can meaningfully prevent major cardiovascular events in otherwise healthy older adults but does not appear to significantly extend survival free from death, dementia, or persistent physical disability. Source: https://www.nejm.org/