STREAM: stopping statins was noninferior at two years in older adults without heart disease

The STREAM trial (Statins in Multimorbid Older Adults Without Cardiovascular Disease) was presented on 7 November 2026 at the American Heart Association Scientific Sessions and published the same day in the New England Journal of Medicine. Authors include Nicolas Rodondi and colleagues; Rita F. Redberg of the University of California, San Francisco, discussed the findings.

Design and main findings

The open-label, randomized, noninferiority trial with blinded outcome adjudication assigned 1,880 adults aged 70 or older (AHA: average age 77; 53% men and 47% women) who had at least two chronic conditions and no known cardiovascular disease to discontinue (938) or continue (942) statins taken for primary prevention. The study was conducted from November 2021 to April 2026 at 24 clinical centers in Switzerland, France and the Netherlands.

At about two years, discontinuation did not bring a significant increase in heart attack, stroke or death compared with continuation, the AHA reported. Citing the NEJM paper, HCPLive said two-year restricted mean event-free survival was 96.5 weeks with discontinuation and 98.5 weeks with continuation, a difference of −2.0 weeks (95% CI −3.7 to −0.3; P < .001 for noninferiority) within a prespecified margin of −5.2 weeks.

In follow-up lasting up to four years (HCPLive reported a median of 103 weeks), 12.7% of those who stopped statins had a heart attack, stroke or death, compared with 9.2% who continued (HCPLive: 119 of 938 versus 87 of 942; hazard ratio 1.38, 95% CI 1.05–1.81). Researchers estimated one additional major cardiovascular event or death over two years for every 40 people who stopped. There were no substantial differences in quality of life, muscle pain, falls or sarcopenia. About 14% of participants crossed over (HCPLive: 131 in the discontinuation group restarted and 112 in the continuation group stopped); additional analyses did not change the conclusions, investigators said.

Redberg said the small longer-term increase means there should not be a general recommendation to stop statins in this group, and that decisions should be shared with a clinician.

Limits — not personal medical advice

The trial was open-label and had no placebo. People with existing cardiovascular disease were excluded, so the results do not apply to secondary prevention. Crossover occurred in both arms. After the trial, the data and safety monitoring board recommended that participants who had stopped statins discuss restarting with their physician. This is not personal medical advice — talk to your doctor before starting or stopping a statin.