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Rethinking global statin guidelines for older adults in resource-diverse settings.

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Bibliographic Details
Title: Rethinking global statin guidelines for older adults in resource-diverse settings.
Authors: Chaabna K, Mamtani R, Cheema S
Source: Journal of global health [J Glob Health] 2025 Dec 05; Vol. 15, pp. 03047. Date of Electronic Publication: 2025 Dec 05.
Publication Type: Journal Article; Review
Language: English
Journal Info: Publisher: International Society of Global Health Country of Publication: Scotland NLM ID: 101578780 Publication Model: Electronic Cited Medium: Internet ISSN: 2047-2986 (Electronic) Linking ISSN: 20472978 NLM ISO Abbreviation: J Glob Health Subsets: MEDLINE
Imprint Name(s): Publication: <2019>-: Edinburgh : International Society of Global Health
Original Publication: Edinburgh : Edinburgh University Global Health Society, 2011-
MeSH Terms: Hydroxymethylglutaryl-CoA Reductase Inhibitors*/therapeutic use , Practice Guidelines as Topic* , Cardiovascular Diseases*/prevention & control , Global Health*, Humans ; Aged ; Developing Countries
Abstract: Statin guidelines for older adults are predominantly informed by evidence from high-income countries (HICs), making them less relevant in low- and middle-income countries (LMICs) with varying healthcare capacities. Identical patients may receive different recommendations depending on the geographic context, as seen in European Systematic Coronary Risk Evaluation 2 (SCORE2) and USA's Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) guidelines. LMICs often rely on the World Health Organization cardiovascular risk charts and implementation frameworks, such as the package of essential non-communicable disease interventions and HEARTS. While these frameworks are generally more feasible in resource-limited settings, they lack the clinical specificity of HIC-based guidelines. Emerging biological evidence challenges uniform cholesterol-lowering therapies in older adults. Polypharmacy, potential adverse effects, and the limited capacity for ongoing monitoring in many settings further complicate the net benefit of statin therapy in this population. These challenges underscore the need for context-sensitive, age-appropriate guidelines. We outline a context-sensitive approach to statin use in older adults and propose guiding principles to support more equitable, feasible, and clinically appropriate decision making. These include aligning treatment with functional status and prognosis, using fixed-dose combinations, and integrating statin use into broader primary care strategies through task-sharing and simplified protocols. To ensure meaningful cardiovascular disease prevention in ageing populations, global guidelines must evolve to reflect regional capacity, biological variation, and implementation.
(Copyright © 2025 by the Journal of Global Health. All rights reserved.)
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Substance Nomenclature: 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors)
Entry Date(s): Date Created: 20251204 Date Completed: 20251204 Latest Revision: 20251206
Update Code: 20251206
PubMed Central ID: PMC12677241
DOI: 10.7189/jogh.15.03047
PMID: 41343204
Database: MEDLINE
Description
Abstract:Statin guidelines for older adults are predominantly informed by evidence from high-income countries (HICs), making them less relevant in low- and middle-income countries (LMICs) with varying healthcare capacities. Identical patients may receive different recommendations depending on the geographic context, as seen in European Systematic Coronary Risk Evaluation 2 (SCORE2) and USA's Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) guidelines. LMICs often rely on the World Health Organization cardiovascular risk charts and implementation frameworks, such as the package of essential non-communicable disease interventions and HEARTS. While these frameworks are generally more feasible in resource-limited settings, they lack the clinical specificity of HIC-based guidelines. Emerging biological evidence challenges uniform cholesterol-lowering therapies in older adults. Polypharmacy, potential adverse effects, and the limited capacity for ongoing monitoring in many settings further complicate the net benefit of statin therapy in this population. These challenges underscore the need for context-sensitive, age-appropriate guidelines. We outline a context-sensitive approach to statin use in older adults and propose guiding principles to support more equitable, feasible, and clinically appropriate decision making. These include aligning treatment with functional status and prognosis, using fixed-dose combinations, and integrating statin use into broader primary care strategies through task-sharing and simplified protocols. To ensure meaningful cardiovascular disease prevention in ageing populations, global guidelines must evolve to reflect regional capacity, biological variation, and implementation.<br /> (Copyright © 2025 by the Journal of Global Health. All rights reserved.)
ISSN:2047-2986
DOI:10.7189/jogh.15.03047