Statins

Last reviewed October 2026 · Based on 9 studies

Bottom line

In adults without heart disease, statins cut heart attacks and strokes; in the 2026 STAREE trial, atorvastatin cut major heart events by 30% in people over 70. That trial found no gain in disability-free survival, and muscle, liver and diabetes-related problems were more common on the statin. Whether to start one is a decision to make with a doctor.

What it helps with

Prevents heart attacks and strokes in people without heart disease — Benefit, evidence grade A (Strong). Systematic review of 22 randomised trials (90,624 people) with consistent relative benefit across groups.
Prevents heart events in healthy adults over 70 — Benefit, evidence grade B (Moderate). One large double-blind trial in this age group, supported by meta-analyses of all ages; older people without heart disease were thinly represented before it.
Helps older adults live longer free of dementia and disability — No effect, evidence grade B (Moderate). One large double-blind trial found no benefit, consistent with an observational analysis; a single trial.
Helps you live longer — Benefit, evidence grade B (Moderate). Systematic review of 22 trials, but the reduction is small and close to the limit of significance, and cardiovascular deaths alone did not fall significantly.
Causes muscle pain and weakness — Harm, evidence grade A (Strong). Individual-participant analysis of 19 large placebo-controlled trials; the excess is small and mostly limited to the first year.
Raises liver enzymes or causes liver problems — Mixed results, evidence grade B (Moderate). Trials disagree: one review found more liver dysfunction, another found no significant rise in raised liver enzymes; downgraded once for inconsistency.
Raises the risk of type 2 diabetes — Mixed results, evidence grade B (Moderate). Two reviews found no overall rise, but one high-intensity trial found more diabetes and STAREE reported more diabetes-related events; downgraded once for inconsistency.

What it is

Statins are medicines that lower LDL ('bad') cholesterol and are used to prevent heart attacks and strokes [1]. Atorvastatin is one of them. In primary prevention trials, people had no earlier heart attack or stroke [2]. This page covers the evidence for statins taken to prevent a first cardiovascular event, with a focus on older adults. It gives no advice on starting or stopping a medicine.

What the research says

Heart attacks and strokes. A systematic review for the US Preventive Services Task Force pooled 22 trials with 90,624 people without earlier cardiovascular events. Statins were linked to fewer deaths from any cause (risk ratio 0.92), fewer strokes (0.78), fewer heart attacks (0.67) and fewer combined cardiovascular events (0.72), which was about 1.3 fewer events per 100 people [2]. A pooled analysis of 28 trials with 186,854 people found significant reductions in major vascular events in every age group, with less direct evidence for people over 75 without existing heart disease [1].

After age 70. The 2026 STAREE trial gave atorvastatin 40 mg a day or a dummy pill to 9,971 adults aged 70 or older without cardiovascular disease, diabetes or dementia. After a median of 5.9 years, 297 people on atorvastatin and 412 on placebo had a major cardiovascular event (hazard ratio 0.70, 95% CI 0.61 to 0.82) [3].

Living longer without dementia or disability. In the same trial, death from any cause, dementia or persistent physical disability occurred in 637 people on atorvastatin and 676 on placebo (hazard ratio 0.94, 95% CI 0.84 to 1.05), so there was no gain in disability-free survival [3]. An observational analysis of healthy older adults in the ASPREE trial reached the same conclusion: statin use was linked to fewer cardiovascular events but not to better disability-free survival [4].

Muscle symptoms. An analysis of 19 large placebo-controlled trials (123,940 people) found a small excess of mostly mild muscle pain in the first year, and more than 90% of muscle reports on a statin were not due to the statin [5]. A 62-trial review found more self-reported muscle symptoms but not more clinically confirmed muscle disorders [6].

Liver and diabetes. The 62-trial review linked statins to more liver dysfunction (odds ratio 1.33), about 8 extra cases per 10,000 people treated for a year, but not to diabetes [6]. The USPSTF review found no significant rise in raised liver enzymes or in diabetes overall, although one trial of high-intensity statins found more diabetes [2]. In STAREE, musculoskeletal, hepatobiliary and diabetes-related adverse events were all more common with atorvastatin, although serious adverse events overall were equal at 2.7% in each group [3].

Doses used in studies

STAREE used atorvastatin 40 mg once a day [3]. In the muscle-symptom analysis, more intensive regimens meant 40 to 80 mg of atorvastatin or 20 to 40 mg of rosuvastatin a day, and they produced a higher rate of muscle symptoms than moderate-intensity regimens [5]. These are study doses, not recommendations.

Safety and interactions

Muscle: a small excess of mostly mild muscle pain, mainly in the first year [5].
Liver: more liver dysfunction in a 62-trial review (about 8 extra cases per 10,000 people treated for a year) [6]; the US review found no significant rise in raised liver enzymes [2].
Diabetes: no significant rise overall in two reviews, but one high-intensity trial found more [2]; STAREE reported more diabetes-related events [3].
Kidney and eyes: the 62-trial review linked statins to slightly more renal insufficiency and eye conditions [6].
Serious side effects overall: equal at 2.7% in each group in STAREE [3], and not significantly higher in the USPSTF review [2].
Upper limits, medicine interactions, pregnancy and breastfeeding: the studies read for this page did not report these, so this page does not cover them. Ask a doctor or pharmacist before combining a statin with other medicines or if pregnant or planning pregnancy.

Caveats and open questions

STAREE is one trial of generally healthy people aged 70 and older, testing one drug and dose [3]. Before it, data for people older than 75 without heart disease were sparse [2]. The large muscle-symptom analysis was of trials with an average participant age of 63, younger than STAREE's [5][3]. The STAREE abstract does not give counts for the extra muscle, liver and diabetes-related events [3]. Relative reductions describe groups of people, not what a particular person will gain.