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The STREAM trial found that stopping statins in adults 70+ with multiple chronic conditions but no established cardiovascular disease was noninferior to continuing them at 2 years — but longer follow-up told a more cautious story. Crucially, quitting statins didn't make patients feel any better either. Experts say the decision should be highly individualized and made through shared decision-making.
The STREAM trial, presented at the American Heart Association Scientific Sessions and simultaneously published in the New England Journal of Medicine, tackled a question many older patients ask their doctors: "Can I stop taking my statin?" Among nearly 1,900 adults aged 70+ with at least two chronic conditions but no established cardiovascular disease, stopping statins was noninferior to continuing them for the composite of heart attack, ischemic stroke, or death at 2 years.
But the nuance matters. At 4 years, those who stopped statins had higher rates of MI (1.6% vs. 0.6%), ischemic stroke (2.2% vs. 0.8%), and all-cause death (9.8% vs. 8%). And perhaps most surprisingly, stopping statins offered zero quality-of-life benefit — no improvement in pain, falls, or sarcopenia — undermining a key argument for deprescribing.
By the Numbers:
Why it matters: This trial gives clinicians real data to guide shared decision-making about statin deprescribing in older adults — a top patient request. The takeaway isn't "stop statins freely," but rather that carefully selected, very frail patients with limited life expectancy may have an acceptable risk profile for discontinuation, while healthier older adults likely benefit from staying on therapy.
