- Question
- Does atorvastatin for primary prevention reduce major cardiovascular events and extend disability-free survival in older adults without cardiovascular disease?
- Design
- Double-blind, randomized, placebo-controlled trial with 1:1 allocation, conducted in general medical practices across Australia. A total of 9971 participants were enrolled, with a median follow-up of 5.9 years.
- Population
- Community-dwelling adults aged 70 years or older with no history of cardiovascular disease, diabetes, or dementia. Mean age was 74.7 years and 51.9% were women.
- Intervention
- Atorvastatin 40 mg orally once daily (4984 participants).
- Control
- Identical placebo once daily (4987 participants).
- Primary outcome
- Two primary end points: (1) a composite of cardiovascular death, nonfatal myocardial infarction or stroke, or coronary revascularization; (2) a composite of death from any cause, dementia, or persistent physical disability (disability-free survival). They were analyzed with a hierarchical testing plan.
- Results
- The first end point occurred in 297 participants on atorvastatin (10.9 events per 1000 person-years) and 412 on placebo (15.5 per 1000 person-years): HR 0.70 (95% CI 0.61 to 0.82; P<0.001). The disability-free survival end point occurred in 637 participants (21.6 per 1000 person-years) on atorvastatin and 676 (23.0 per 1000 person-years) on placebo: HR 0.94 (95% CI 0.84 to 1.05; P=0.25).
- Safety
- Serious adverse events occurred in 131 participants (2.7%) on atorvastatin and 129 (2.7%) on placebo. Musculoskeletal, hepatobiliary, and diabetes-related adverse events were more common with atorvastatin.
- Conclusion
- Atorvastatin lowered the risk of major cardiovascular events versus placebo but did not lengthen disability-free survival in older adults without clinical cardiovascular disease.
- Why it matters
- It provides randomized evidence on statin use for primary prevention in older people, a group underrepresented in earlier trials. It shows a cardiovascular benefit without a gain in functional independence, supporting individualized treatment decisions.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026