Millions of older adults take a statin “just in case,” to prevent a first heart attack or stroke. As people age and pick up more conditions and more pills, a common question is whether the statin can go. The STREAM trial, presented at the American Heart Association meeting and published in the New England Journal of Medicine, is the largest randomized study to answer it.
Who was studied
STREAM enrolled 1,880 adults aged 70 or older (average age 77.5) in Switzerland, the Netherlands and France. All had taken a statin for at least a year for primary prevention, meaning they had never had a heart attack or stroke, and all had at least two other chronic conditions. Half were told to stop their statin and half to continue (NEJM).
The headline result
Over two years, people who stopped their statin spent on average 96.5 weeks free of heart attack, stroke or death, compared with 98.5 weeks for those who kept taking it. That two-week gap fell within the limit researchers had set in advance, so stopping was declared “noninferior” (NEJM).
The fine print
The full picture is more cautious. Over the whole follow-up, a heart attack, stroke or death occurred in 12.7% of the stop group versus 9.2% of the continue group (ACC). Researchers estimated one extra event for every 40 people who stopped over two years (Healio).
By the end of follow-up, heart attacks occurred in 1.6% versus 0.6% and ischemic strokes in 2.2% versus 0.8% (TCTMD). After the trial, the safety board recommended that people in the stop group talk to their doctors about restarting.
Stopping also brought no clear quality-of-life benefit. Pain, falls and muscle loss were similar in both groups (MedPage Today), which weakens one of the main arguments for stopping.
What experts are saying
Lead author Dr. Nicolas Rodondi described stopping as “generally safe” but said it should happen only after shared decision-making (TCTMD). Co-author Dr. Rita Redberg noted that the small increase in events means “one cannot make a general recommendation about stopping statins” in this group (HCPLive).
Practical takeaways
- Never stop a statin on your own. Talk to your doctor first.
- If you tolerate your statin well, the evidence leans toward continuing.
- Stopping may make sense for some people, such as those with limited life expectancy, troublesome side effects or a heavy pill burden, but it should be a personal decision.