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Mark Greener reviews new ESC Congress findings on statins for primary cardiovascular prevention and dementia risk in older and diabetic patients, the cardiovascular toll of poor antihypertensive adherence, and Korean data linking chronic cough to a higher risk of pneumonia.
Ross Ferguson,
19 Oct 20265 Min
In Evidence reviews
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Atorvastatin as primary CVD prevention in older people
Atorvastatin reduced major cardiovascular events by 30% in older people without cardiovascular disease (CVD), diabetes or dementia, according to results from the STAREE trial presented during the ESC Congress and published in the New England Journal of Medicine. However, primary prevention with atorvastatin did not significantly prolong disability-free survival.
“The STAREE trial is the first large randomised controlled trial to examine whether statins can be used for primary prevention in older patients to help them live longer in good health,” notes lead researcher, Professor Sophia Zoungas, Monash University School of Public Health and Preventive Medicine, Melbourne.
STAREE enrolled 9,971 people from Australian general practice without cardiovascular disease, diabetes or dementia who were aged at least 70 years. The mean age was 74.7 years. Patients received atorvastatin 40 mg once daily or placebo.
During a median follow-up of 5.9 years, the risk of major cardiovascular events (cardiovascular death, nonfatal myocardial infarction, stroke or coronary revascularisation) was 30% lower with atorvastatin than placebo (6.0% and 8.3% respectively). The likelihood of death, dementia or persistent physical disability did not significantly differ between atorvastatin and placebo (12.8% and 13.6% respectively).
Musculoskeletal and connective-tissue (32.0% and 29.4% respectively), hepatobiliary (3.3% and 0.9% respectively) and diabetes-related (4.0% and 2.7% respectively) adverse events were more common with atorvastatin than placebo. Furthermore, 2.7% of people in both the atorvastatin and placebo groups experienced serious adverse events.
Patients who take fewer than 80% of their antihypertensives derive little or no cardiovascular benefit, according to a meta-analysis presented during the ESC congress.
The meta-analysis included 91,339 participants in nine trials that compared an ‘intervention group’, who received antihypertensives, with controls who received placebo or a less-intensive antihypertensive regimen. Overall, 88% of patients in the intervention group had higher adherence during the first year declining to 80% in year five compared with 87% and 77% respectively among controls.
The mean follow up was 4.7 years. In patients with higher adherence, systolic blood pressure fell by 5.2 mmHg in the intervention group compared with controls. In patients whose adherence was less than 80%, the reduction was 3.0 mmHg.
Higher adherence reduced the incidence of major cardiovascaulor disease by 11% compared with controls. No significant reductions emerged in patients with lower adherence.
Strategies that help improve adherence include simplifying regimens, single-pill combinations and longer-acting agents. “For years, we have neglected non-adherence to medication as a cause for uncontrolled hypertension,” says Professor Felix Mahfoud, Chairperson of the ESC Communication Committee. “Assessment of adherence should become a routine part of hypertension care so patients do not miss out on life-saving benefits. As healthcare providers, we are here to have open, non-judgemental conversations with our patients about any barriers they may have to taking medication, to help improve adherence.”
Statins protect against dementia
Starting statins within five years of type 2 diabetes (T2D) diagnosis reduces the risk of dementia, according to a study of Danish medical records presented during the European Society of Cardiology (ESC) Congress in Munich.
Researchers identified 132,585 T2D patients. During a median follow-up of 7.1 years, 2.7% developed dementia. Controls did not receive statins during the five years after T2D diagnosis.
Compared with controls, starting statins within a year of T2D diagnosis reduced all-cause dementia risk by 15%. Starting statins 1–5 years after T2D diagnosis reduced the likelihood of developing dementia by 10%. The benefits were similar in women and men.
“In individuals developing type 2 diabetes, statins were associated with a lower risk of dementia, most pronounced in those with early initiation,” says study author Dr Tummas Ternhamar, Copenhagen University Hospital. “Statins seem to be underused in patients with type 2 diabetes, despite their protective effects against cardiovascular disease. Our findings suggest another potentially important reason to ensure that patients with type 2 diabetes and high LDL-C receive timely statin treatment.”
Chronic cough increases pneumonia risk
Chronic cough independently increases the likelihood of pneumonia, according to a Korean study.
Researchers reviewed the medical records of 28,706 people with chronic cough and 356,711 controls. Participants’ mean ages were 58.9 and 50.7 years respectively. During the three-year follow up, pneumonia was more common in people with chronic cough than controls (18.87 and 11.32 per 1000 person-years respectively).
Adjusting for confounders, chronic cough, depending on the definition, increased the likelihood of pneumonia by 13–23%. The association between chronic cough and pneumonia was stronger among men (72% increase) than women (39%). Adults aged 40–49 and 50–59 years showed the highest age-related risk of pneumonia (37% and 23% increases respectively).
The authors note that many people with chronic cough show airway inflammation, which predisposes to respiratory infection. Upregulated cough reflexes “may perpetuate airway insults” and impair immune responses. Reduced mucociliary clearance may also increase the risk of pneumonia. Further research should clarify the mechanisms linking chronic cough and pneumonia. (BMJ Open Respir Res 2026;13:e003484)
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