STREAM Trial - Statins in Multimorbid Older Adults Without Cardiovascular Disease

Inclusion Criteria:

1. Written informed consent
2. ≥70 years of age
3. Multimorbid with ≥2 coexistent chronic conditions (defined by ICD-10 codes) with an estimated duration of 6 months or more based on clinical decision, besides dyslipidemia treated by statins
4. Intake of a statin for ≥80% of the time during the year before enrolment
5. Participation to a clinical trial with potential impact on the STREAM cardiovascular endpoints

Exclusion Criteria:

Cardiovascular secondary prevention setting based on previous large statin trials, defined as:

1. History of myocardial infarction type 1 (NSTEMI/STEMI), OR
2. History of unstable angina, defined as ACS symptomatic at rest, crescendo or new- onset angina (CCS 2 or 3) without ECG or cardiac biomarker changes (based on available documents), OR
3. Stable angina pectoris with a documented ischemia on a stress test or with a significant coronary disease defined as a coronary stenosis >50%, OR
4. History of percutaneous coronary intervention (balloon or stent) or coronary artery bypass graft, OR
5. History of Stroke, OR
6. History of Transient Ischemic Attack, defined as transient neurological deficit without diffusion restriction in MRI, OR
7. History of carotid revascularization (stent or bypass), OR
8. History of peripheral arterial disease requiring revascularization (stent or bypass; Fontaine IV)
9. Aortic disease that required a vascular repair or aortic aneurysm with a maximum diameter >5.5 cm (men) or >5.2 cm (women) based on available documents
10. Diagnosis of familial hypercholesterolemia based on Dutch lipid score ≥6 based on available documents (LDL cholesterol, family history, personal history)

Elevated risk of death within 3 months after baseline, defined as:

1. Hospitalized patients planned for palliative care within 24h of admission OR
2. Hospitalized patients with a Palliative Performance Scale (PPS) level <30% (based on situation at least 1 month before hospitalization), this corresponds to an estimated survival of 43% after 3 months; OR
3. Patients with an advanced metastatic cancer prognosis of ≤20% survival rate within 1 year after baseline (based on: https://cancersurvivalrates.com)