For adults over 70 taking statins for primary prevention with multiple chronic conditions, stopping the medication may be a reasonable choice, new international research shows. A trial presented at this week’s AHA 2026 conference found that halting statin therapy in this patient cohort was shown to be noninferior to continuing the medication regarding major cardiovascular events or all-cause mortality at the two-year mark.
The STREAM trial included over 1,880 individuals past the age of 70, with women making up nearly half of the participants, all of whom were using statins for primary prevention and suffered from at least two chronic health issues. Study investigators randomly assigned participants to either stop or continue their statin medication and evaluated noninferiority by analyzing the between-group difference in restricted mean event-free survival time at the two-year point. At two years, the results indicated the between-group difference in the restricted mean event-free survival time was −2.0 weeks.
STREAM Trial Outcomes for Older Adults
Over a median follow-up period of 103 weeks, 119 participants (12.7%) in the discontinuation group and 87 (9.2%) in the continuation group experienced a primary-outcome event. At least one serious adverse event was observed in 43% of those assigned to discontinuation compared with 39.8% of those assigned to continuation.
In presenting the findings, Nicolas Rodondi, MD, reinforced the need for shared decision-making around statin therapy given the increase in numbers of cardiovascular events following discontinuation. He noted that the data and safety monitoring board had also recommended advising participants assigned to the discontinuation group to discuss restarting statin therapy with their care team.
eZ-PAVE Trial Compares Cholesterol-Lowering Therapies
In a separate study, the eZ-PAVE trial originating from South Korea, researchers compared outcomes in a cohort of more than 3,000 patients with heart or blood vessel disease who were assigned to cholesterol lowering therapy with a statin by itself or with a statin plus ezetimibe. The results demonstrated that participants receiving combination therapy with a statin plus ezetimibe attained lower LDL cholesterol levels than those treated with statins alone over the course of three years; however, the rates of heart attack, stroke and other cardiovascular events were comparable between the two groups.
Findings on Combination Therapy and LDL Goals
In other results from the eZ-PAVE trial, participants assigned to combination therapy, along with a more stringent cholesterol goal of 55 mg/dL, reached an average LDL of 53 mg/dL in contrast to 62 mg/dL among those receiving only statins. For patients assigned to combination therapy and a standard LDL goal of >70 mg/dL, the average LDL was 63 mg/dL vs. 70 mg/dL.
“We expected that starting with combination therapy would lead to fewer heart attacks, strokes and other heart problems, but this was not the case,” said Byeong-Keuk Kim, MD, PhD. “A previous large study published … showed that adding ezetimibe to a statin reduced the rate of cardiovascular deaths, nonfatal heart attacks, unstable angina requiring rehospitalization, coronary revascularization or nonfatal stroke. However, that study was not primarily designed to adjust treatment to reach a target LDL cholesterol goal, and medication dose changes were limited.” Based on the findings, he suggested that “starting with a statin and adding ezetimibe as needed appears to be a reasonable strategy for people with long-term, stable heart or blood vessel disease whose cholesterol levels are checked regularly and medication doses are adjusted to reach their goals.”
