Adults over 70 without heart disease who stopped statins saw no significant rise in heart attacks over two years

Stopping statins did not significantly raise heart attack, stroke or death over about two years in 1,880 adults aged 70 and older who were taking the drugs to prevent a first cardiovascular event, according to results presented Nov. 7 at the American Heart Association’s Scientific Sessions. The average participant was 77, and all had at least two chronic conditions but no known heart disease. Rita Redberg, a professor of cardiology at the University of California, San Francisco, said discontinuation is generally safe for most people in this group.

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The trial also found small signals pointing the other way, and its authors stopped short of recommending that older patients drop the pills.

STREAM: 938 stopped, 942 continued, across three countries

The study, known as STREAM, ran from November 2021 to April 2026 at 24 clinical centers in Switzerland, France and the Netherlands, according to the American Heart Association’s release. Of the 1,880 participants, 53% were men and 47% women; 938 were assigned to stop statins and 942 to continue. People with a prior heart attack, stroke or other established cardiovascular disease were excluded. The published trial protocol shows the sponsor was Inselspital, Bern University Hospital, with Nicolas Rodondi of the University of Bern as corresponding author, and it defined the primary outcome as nonfatal heart attack, nonfatal ischemic stroke or death from any cause.

The full manuscript appeared the same day in the New England Journal of Medicine, and the trial is registered as NCT05178420 on ClinicalTrials.gov.

Eligibility required age 70 or older with no upper limit, at least two chronic conditions besides dyslipidemia lasting about six months or more, and statin use for at least 80% of the previous year. Exclusions included a prior heart attack, significant coronary disease, revascularization, ischemic stroke, probable familial hypercholesterolemia and expected death within three months, according to the protocol. Recruitment ran through hospitals and general practices in Switzerland, Bordeaux in France and Leiden in the Netherlands.

What two years of follow-up showed

Over two years, the release says, discontinuation did not significantly increase heart attack, stroke or death compared with continuing. Quality of life, muscle pain, falls and sarcopenia did not differ between the groups. The absolute difference was modest: about one additional cardiovascular event for every 40 people who stopped. Redberg said discontinuation is safe for most people in this age group without a previous cardiovascular event, then added a caution that a general recommendation to stop cannot be made for the whole population.

HCPLive’s report on the New England Journal paper adds detail that complicates a simple reading. Discontinuation met the pre-set non-inferiority test, with a difference in event-free survival of minus 2.0 weeks against a margin of 5.2 weeks. But the composite outcome occurred in 119 of 938 patients who stopped (12.7%) and 87 of 942 who continued (9.2%) over a median follow-up of 103 weeks, a hazard ratio of 1.38 with a confidence interval of 1.05 to 1.81. Heart attacks were 1.4% against 0.6%, ischemic strokes 1.9% against 0.8%, and deaths from any cause 8.2% against 6.9%.

Crossover, serious events and the limits of the data

About 14% of participants crossed over, with some in the stop group restarting statins and some in the continue group quitting them. Additional analyses that accounted for crossover did not change the results, the AHA release says. Serious adverse events were somewhat more common after discontinuation, at 43.0% against 39.8%, per HCPLive. The release also cautions that abstracts at the meeting are not peer reviewed at presentation, though here the full paper was published alongside.

The American College of Cardiology’s session coverage reports that presenter Nicolas Rodondi emphasized shared decision-making, given the rise in cardiovascular events after discontinuation, and that the trial’s data and safety monitoring board recommended that participants in the stop group discuss restarting statins with their care teams.

The protocol also shows how much room the designers allowed. It set a non-inferiority margin of a 5% absolute risk difference over 24 months, equal to about 5.2 weeks of lost event-free time, and planned for 1,800 participants randomized one to one. It assumed control-group event probabilities of 22% at 12 months and 34% at 24 months, drawn from preliminary data in an earlier trial called OPERAM. The 9.2% observed among patients who kept taking statins sits far below that assumption.

Because everyone enrolled was free of established cardiovascular disease by design, nothing here speaks to patients who have already had a heart attack or stroke.

Shared decisions rather than a blanket rule

The authors’ conclusion is a process rather than a rule. Patients over 70 who take a statin for primary prevention and have other chronic conditions are the ones this trial describes, and the decision to continue or stop, they argue, belongs in a conversation between patient and clinician. The trial cannot say what happens beyond its follow-up, in patients with prior heart disease, or in people without other chronic illness. The open question is how the gap between a modest absolute increase and a hazard ratio of 1.38 will be weighed in guidelines for older adults.

This article was produced with the assistance of AI and reviewed by Morning Overview editors prior to publication.

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