Older adults may be able to stop statins safely, trial finds, but with a small added risk

For adults 70 and older who take statins but have never had a heart attack or stroke, stopping the drugs met a key safety test in a randomized trial. The same trial also found a modest rise in serious cardiovascular problems among people who quit, so the result supports stopping only with caveats.

The study, led by Dr. Nicolas Rodondi of the University of Bern in Switzerland, was published online Nov. 7 in the New England Journal of Medicine. Its release was timed to the American Heart Association's Scientific Sessions 2026, held Nov. 6 to 9 in Chicago.

The researchers enrolled 1,880 people aged 70 and older. Each had at least two chronic health conditions, and none had known cardiovascular disease. In other words, they were taking cholesterol-lowering drugs for primary prevention, to head off a first heart attack or stroke rather than a repeat one.

Participants were randomly assigned either to keep taking their statins and any other lipid-lowering medications or to stop them. The main question was whether stopping would shorten the time before a first cardiovascular event.

The trial was built as a noninferiority study. That design does not ask whether stopping is better. It asks whether stopping is not meaningfully worse than continuing, judged against a margin the investigators set in advance. By that standard, stopping passed. Over two years, the average stretch of event-free time in the discontinuation group was about two weeks shorter than in the group that kept taking the drugs. The statistical test for noninferiority was strongly significant, with a P value below 0.001.

The raw event counts tell a less reassuring story. Over a median follow-up of 103 weeks, 12.7% of people who stopped their statins had a nonfatal heart attack, a nonfatal ischemic stroke or died from any cause. Among those who continued, the figure was 9.2%.

That gap of about 3.5 percentage points is the part of the study worth dwelling on. A two-week difference in average event-free time sounds trivial. A higher share of people having a heart attack, a stroke or dying over roughly two years is harder to wave away, especially for a patient weighing the choice. Both numbers describe the same trial, and the gap between them shows how a technically successful noninferiority result can still leave room for concern.

Serious adverse events, a broader category, also ran slightly higher among those who stopped: 43.0% compared with 39.8% among those who stayed on treatment. The high rates in both groups reflect how sick this population was to begin with. The direction of the difference matters, though. One common argument for deprescribing in older adults is that fewer pills means fewer side effects and complications. This trial offers no sign that stopping statins reduced serious problems overall. The reported figures point slightly the other way.

The summary of the study does not say how much of the difference in the composite outcome came from deaths versus heart attacks or strokes. It also does not report why participants who kept their medication had fewer events. Those details will matter as doctors decide how to read the findings.

Co-author Dr. Rita F. Redberg of the University of California, San Francisco, acknowledged the tension in a statement. The small increase in cardiovascular events means "one cannot make a general recommendation about stopping statins in this patient population," she said.

Instead, she pointed to individual conversations. "There should be shared decision-making between the patient and the health care professional," Redberg said. She added that "in general, however, discontinuation is safe for most people who are in this age group" and without a previous cardiovascular event.

That framing is a careful balance, and it is probably the right one. The trial did not find that stopping is harmless, and it did not find that continuing is clearly essential. What it offers is a measured estimate of the trade-off, which patients and clinicians have long lacked for this age group.

Statins are among the most widely prescribed drugs in the world, and many people start them in middle age and simply keep going. The evidence for their benefit in preventing first heart attacks and strokes comes largely from trials of younger adults. People in their 70s and 80s, especially those managing several chronic illnesses, have been underrepresented. Doctors have often had to extrapolate when deciding whether an older patient should stay on a drug for decades.

The people in this trial, with at least two chronic conditions, are the patients most likely to be juggling many prescriptions. For them, the burden of daily pills, possible drug interactions and side effects are real considerations. A randomized trial that directly tests stopping, rather than starting, is a useful addition to that debate.

Still, the findings apply to a specific group: people 70 and older, with multiple chronic conditions and no known cardiovascular disease. They say nothing about people who have already had a heart attack or stroke, for whom statins play a different role. Follow-up was also relatively short, about two years, so the study cannot show what happens over five or 10 years after stopping.

The most defensible reading is narrower than the headline claim of safety. Stopping statins in this group did not lead to a large jump in harm over two years, but it did come with a measurable cost. Whether that cost is worth paying is a judgment that will vary from one patient to the next.