31st August 2026

Newsletter Monday

Hello Reader,

I can think of very few drugs that provoke opinions quite as strong as statins.

GLP-1 medications are probably giving them a run for their money at the moment, but plenty of people will never need to consider taking a GLP-1.

Statins, on the other hand, are something almost all of us will encounter eventually — either because we’re offered one ourselves, or because someone we know is.

So when the results of a large new statin trial were released last week, I was very interested.

The STAREE trial looked specifically at people aged 70 and over who did not already have cardiovascular disease, dementia or significant physical disability.

In other words, this wasn’t about treating people who had already had a heart attack or stroke. We already have good evidence for statins in that situation.

This was asking a much more interesting question:

If you’re in your seventies and basically well, does taking a statin help you stay well for longer?

Primary prevention trials like this aren’t new, but there were a couple of things I particularly liked about STAREE.

Firstly, 52% of the participants were women.

Hooray.

Women have historically not had a particularly fair seat at the medical research table, so seeing a trial in older adults in which women actually made up the majority deserves a small round of applause.

The researchers were also interested in more than simply whether people had a heart attack.

They looked at cardiovascular events, certainly, but they were also interested in disability, dementia and death.

And this matters.

Because preventing cardiovascular disease is important, but cardiovascular health is not the only thing that matters as we get older.

We don’t just want to know whether a tablet changes one particular disease risk.

We want to know whether it helps people live longer, healthier, independent lives.

So, what happened?

People taking atorvastatin had fewer cardiovascular events.

That won’t come as an enormous surprise.

Statins lower LDL cholesterol, and lowering LDL cholesterol reduces cardiovascular risk. This trial hasn’t suddenly rewritten everything we know about statins.

But — and this is the bit I think is important — that cardiovascular benefit didn’t translate into a clear improvement in the broader outcome of living free from dementia or persistent physical disability.

Nor was there a clear reduction in overall mortality.

And this is where the interpretation becomes rather more interesting than the headlines are likely to suggest.

If your priority is reducing your risk of a heart attack or stroke as much as possible, these results give you another reason to consider taking a statin in older age.

If, however, you’re a healthy 72-year-old who doesn’t particularly want to take another tablet and you’re wondering whether doing so is likely to make you live longer or remain independent for longer, the answer is much less compelling.

And this is also where the media coverage becomes entirely predictable.

Some headlines will take this trial and tell you it proves that statins save lives and everyone over 70 should be taking one.

Others will use exactly the same trial to tell you that statins don’t help people live longer and therefore there’s no point taking them.

Certain newspapers may manage both interpretations in the same week, particularly if it’s a slow news week.

The reality, annoyingly for anyone needing a dramatic headline, is more nuanced.

Both of those things can be true at the same time.

And I suspect that is where some of the inevitable arguments about this study will miss the point.

Medicine has a tendency to reduce health to individual numbers.

LDL.
Blood pressure.
HbA1c.
BMI / waist circumference

We measure them because they’re measurable, and because they matter.

But you are not an LDL cholesterol result.

The point of preventing disease isn’t simply to produce a nicer number on a blood test. It’s to help you remain healthy enough to continue doing the things you want to do.

That distinction becomes increasingly important as we get older.

There was another finding worth mentioning too.

As has been seen in previous statin research, there was a small increase in the development of diabetes in the statin group. We don't really know why this happens.

Again, that doesn’t mean statins are “bad”.

It means medicines have effects.

Some we want. Some we don’t.

And the decision about whether the balance is worthwhile depends partly upon the person taking them.

Which brings me to the deeply unfashionable conclusion to this newsletter:

You get to choose.

I know. Terribly disappointing.

No “STATINS SAVE EVERYONE.”

No “DOCTORS HAVE BEEN LYING TO YOU ABOUT CHOLESTEROL.”

Neither will perform particularly well on Facebook.

For somebody who is very concerned about cardiovascular disease and wants to reduce that risk as much as possible, STAREE provides useful reassurance that statins can still reduce cardiovascular events when started in otherwise healthy people over 70.

For somebody whose priorities are different, the absence of a clear benefit for survival, dementia or disability may reasonably influence their decision in the other direction.

That’s informed choice.

My job as a doctor isn’t to decide which outcome matters most to you.

It’s to explain what we know, what we don’t know, how big the likely benefits and harms are, and then help you make a decision you can live with.

STAREE hasn’t ended the statin debate.

I don’t think any trial ever will.

But it has given us better information with which to have the conversation.

And frankly, that’s much more useful.