For every 40 people who stopped taking their statin, one more would have a major heart event or die within two years. That number comes from the lead researcher of the most careful trial yet on stopping statins in older adults. Most news headlines called stopping “safe.” The full results show more risk than that word suggests.
Millions of adults over 70 take a daily cholesterol pill to prevent a first heart attack or stroke. Whether they should keep taking it has never had a clear answer. Statins were mostly tested in middle-aged people. What they do in older people who live with multiple chronic conditions has been unclear. A new trial set out to find out.
The STREAM trial was presented on November 7, 2026, at the American Heart Association’s Scientific Sessions in Chicago. It was published the same day in the New England Journal of Medicine. It asked a question that older patients and their doctors care a lot about: is it safe to stop a statin you take to prevent a first heart attack or stroke? The answer depends on how far ahead you look.
What did the STREAM trial test?
The trial included 1,880 adults at 24 trial sites in Switzerland, the Netherlands, and France. It ran from November 2021 to April 2025. The average age was 77.5. Each person had at least two long-term health conditions but no known heart or artery disease. All had taken a statin for at least a year to prevent a first heart attack or stroke. Half were randomly picked to stop their statin. The other half kept taking it. Everyone knew which group they were in.
The trial focused on a group that past research had mostly left out. Statins were shown to work in middle-aged people, both before and after a first heart attack or stroke. But for adults 70 and older without heart disease, especially those with several health problems, the benefit was unclear. So doctors had to decide whether to keep or stop statins in these patients mostly on their own judgment, without solid data.
The main goal was to check results at two years. By then, people who stopped their statin did not have more major heart events or deaths than people who kept taking it, within the limits the trial had set in advance. That met the trial’s safety bar. But the two-year mark was not the whole story.
Was stopping statins actually safe?
In trials, “noninferior” has a specific meaning. It means the option being tested, here stopping the drug, was not worse than the other option by more than a set amount. It does not mean there was no difference. Over about two years (103 weeks), the main outcome happened in 12.7% of people who stopped and 9.2% of people who kept going.
Deaths from any cause were 9.8% in the group that stopped and 8.0% in the group that continued. By four years, people who stopped had about 1% more heart attacks, 1.4% more strokes caused by blocked blood flow, and 1.8% more deaths from any cause. That’s according to lead researcher Nicolas Rodondi, MD, of the University of Bern.
The researchers estimated that for every 40 people who stopped statins, there would be one more major heart event or death over two years. Millions of older adults take statins to prevent a first heart attack or stroke. Across that many people, this adds up to a large number of events that could be prevented.
Read More: Nearly 1 in 3 Older Adults With Dementia Are Still on Risky Drugs, Study Finds
By four years, the gap between the groups had grown. In June 2026, after STREAM ended, the trial’s safety board made a recommendation. It said people in the group that stopped should be told to talk with their doctor about restarting a statin.
At least one serious health problem happened in 43% of the group that stopped, compared with 39.8% of the group that kept going. This was not the trial’s main measure, but it is another difference between the groups.
What the Trial Did Not Find
Many older adults and their doctors think about stopping statins because they hope it will improve daily life. They hope for less muscle pain or fewer pills to take. In general, the trial found that stopping did not bring a clear benefit like that. The groups did not differ much in quality of life, pain, falls, or muscle loss, based on findings reported by HCP Live.
That goes against one of the most common reasons patients want to stop statins. Side effects and drug interactions are common in older patients and can make daily life harder. That’s why stopping sounds good in theory. But in this group, the hoped-for boost in quality of life did not show up.
Treatment Adherence: The 14% Who Didn’t Follow Their Assignment
During the trial, 131 people in the stop group and 112 in the continue group switched. Some told to stop started again, and some told to continue stopped. That’s about 14% of everyone in the trial. The researchers openly said this was a weakness. It blurs the difference between the groups. The real gap in heart outcomes between stopping and continuing may be somewhat bigger than the trial showed.
The researchers ran an extra analysis. It suggested the switching was unlikely to change the main conclusions. Still, it shows that patients make their own choices, and those choices have real effects. People recruited by family doctors seemed to do worse after stopping. They had 3.4 fewer weeks without a heart event, compared with 1.1 weeks for people recruited in hospitals. This suggests where people get their care may affect how they do after stopping.
Why This Population Is Scientifically Distinct
The researchers were careful to say that STREAM’s results don’t apply to all older adults. In older adults without heart disease, statins lower the number of heart attacks and strokes that aren’t fatal. But most studies have not found that they help people live longer when used to prevent a first event.
Who benefits most from statins in old age is not a simple question. A 2026 review in the Cleveland Clinic Journal of Medicine looked at older adults with memory problems, trouble with daily tasks, frailty, or other serious health risks. In these people, the long-term heart benefits of statins are unlikely to pay off. For them, the case for stopping may be stronger than STREAM shows.
Just months before STREAM, a trial called STAREE pointed the other way. It was presented at the European Society of Cardiology Congress in August 2026. The statin atorvastatin cut the risk of major heart events by 30% compared with a placebo, or dummy pill. The people in it were 70 and older with no known heart disease, diabetes, or dementia. Lead researcher Sophia Zoungas, MBBS, PhD, of Monash University in Melbourne said STAREE was the first large statin trial to show heart benefits for preventing a first event in people 70 and older.
In STAREE, the atorvastatin group had a much lower risk of heart events. Over 5.9 years, doctors would need to treat 37 people to prevent one event. Most of the benefit came from fewer non-fatal heart attacks and fewer procedures to reopen blocked arteries. The benefit held across age groups, including adults 75 and older.
Together, STAREE and STREAM agree: statins help prevent heart problems in older adults. But starting or stopping one should not be automatic. It should be based on the person.
How Statins Work, and Why Age Changes the Math
Statins lower LDL cholesterol. LDL stands for low-density lipoprotein. It’s the “bad” cholesterol most linked to plaque buildup and hardening of the arteries. Statins lower it in two ways. They block an enzyme called HMG-CoA reductase, which controls how much cholesterol the liver makes. They also make liver cells grab more LDL out of the blood.
Scientists know how statins work. The question in older adults is not whether statins lower LDL. It’s whether lowering LDL at age 77 prevents as many heart attacks and deaths as it does at age 55. Based on the 2026 research, it still helps. But the benefit is smaller and the tradeoffs are more complex.
Brain health is another factor. Rosuvastatin, a common statin, has been linked to about a 28% lower risk of dementia from any cause. That’s according to a 2025 systematic review covering more than 7 million patients. Dementia risk rises with age, so this possible benefit adds one more thing to weigh when deciding whether to stop.
Many older patients with several health problems take five or more pills a day. Wanting to take fewer pills makes sense. But the STREAM data suggest that dropping the statin comes with a cost to the heart.
What 2026 Guidelines Say About Statins in Older Adults
The 2026 ACC/AHA guidelines on cholesterol treat two cases differently. If an older adult is already on cholesterol-lowering drugs, it is usually fine to keep taking them. Starting a statin for the first time after 75 is a different matter. That choice should be made together by the patient and doctor. They should think about life expectancy, how many other drugs the person takes, and what matters most to the patient.
The full 2026 guideline was published in the Journal of the American College of Cardiology. It says trial data for adults over 75 are limited. But the data do support statins to prevent heart attacks and strokes in this group. The benefit may be smaller than in younger people, and there is no proof that statins help people over 75 live longer overall.
The 2025 National Lipid Association and American Geriatrics Society consensus also supports using a coronary artery calcium (CAC) score for adults aged 76 to 80. It recommends a statin when the score is 100 or more, and holding off when the score is 0. A CAC score uses a low-dose CT scan to measure calcium buildup in the heart’s arteries. It has become a useful way to see which older patients are most likely to benefit from staying on a statin.
The guidelines stress that patient and doctor should decide together, because no single rule fits everyone in this age group. Life expectancy, physical ability, how many pills someone takes, what they want, and their other health conditions all matter. Dr. Nicolas Rodondi noted when presenting STREAM that older adults and their family doctors often rank cholesterol drugs near the top of the list of pills to stop. That makes this a common and pressing question.
Key Takeaways
The STREAM trial does not support stopping statins in everyone over 70. It does support careful, one-on-one talks between patients and doctors. The goal is to decide if a statin still makes sense for each person, based on their health conditions and life expectancy.
At the AHA session, Dr. Rodondi said: “These findings suggest cautious statin discontinuation in primary prevention only after shared decision-making.” In plain terms, stopping a statin should be a careful choice made with your doctor. It should not happen just because of age, worry about side effects, or a wish to take fewer pills.
If you take a statin to prevent a first heart attack or stroke, STREAM found no proof that stopping will improve your quality of life, ease muscle symptoms, or lower your risk of falls. It did find that stopping is linked to more heart events and more deaths over time, and the gap grows the longer you look. That tradeoff needs to be weighed against each person’s risk, frailty, memory, and wishes, in a talk with their doctor.
If you already stopped a statin after age 70, know this: the STREAM safety board recommended that people who stopped talk with their doctor about restarting. If you’re having this talk for the first time, ask your doctor about a coronary artery calcium score. It can show whether staying on a statin is likely to protect your arteries.
Disclaimer: This information is not intended to be a substitute for professional medical advice, diagnosis, or treatment and is for information only. Always seek the advice of your physician or another qualified health provider with any questions about your medical condition and/or current medication. Do not disregard professional medical advice or delay seeking advice or treatment because of something you have read here.
AI Disclaimer: This article was created with the assistance of AI tools and reviewed by a human editor.