From left: Dr. Ravinder Mamtani, Dr. Sohaila Cheema, and Dr. Karima Chaabna, members of the Institute for Population Health at WCM-Q.
Doha, Qatar: Population health experts at Weill Cornell Medicine-Qatar (WCM-Q) have published a perspective article, which outlines the need to rethink global statin guidelines for older adults in resource-diverse settings.
The paper highlights that guidelines for statin medications – used to control cholesterol levels – are largely based on evidence from high-income countries, where older adults, especially those ≥75 years, are underrepresented in clinical trials. In the context of increased global life expectancy, biological and regional variation in lipid profiles and CVD risk and regional differences in healthcare services, current uniform guidelines for statin use may not be appropriate and should be reviewed in order to improve appropriateness, feasibility, and equity of prevention strategies, the paper argues.
The situation is further complicated by major inconsistencies between US guidelines, which favor pharmacological prevention, and European guidelines, which place more emphasis on lifestyle and higher-risk thresholds to control cholesterol levels.
The paper, published in the Journal of Global Health, is authored by Dr. Karima Chaabna, manager of population health research; Dr. Sohaila Cheema, associate professor of clinical population health sciences assistant dean for the institute for population health; and Dr. Ravinder Mamtani, professor of population health sciences, professor of medicine (Centre for Global Health), and vice dean for population health and lifestyle medicine. All are members of WCM-Q’s Institute for Population Health, a specialist unit dedicated to advancing population health in Qatar and across the global through education, research and community engagement.
Dr. Mamtani, said: “Statins are widely prescribed and are proven to be effective at reducing the risk of heart attacks and strokes by reducing total and low-density lipoprotein (LDL) cholesterol levels. In the paper we emphasise, that a one-size-fits-all approach for prescribing statins is suboptimal on a global basis because it fails to account for biological and regional diversities, and healthcare resource limitations, particularly in low- and middle-income countries. We believe there is a need to review guidelines on statin use on a regional, context-specific basis in order to secure the best long-term outcomes for patients across the globe.”
The study highlights global disparities in statin guidelines, which mean that the same patient may qualify for statins under US guidelines but not under European ones, reflecting divergent thresholds and treatment philosophies. Meanwhile, many low- and middle-income countries struggle to apply either the US or the European guidelines due to limitations in data, infrastructure, and access. Additionally, regional differences are more pronounced in adults aged over 60 because of a lack of data, which stems from historic under-representation of older adults in clinical trials.
Biological diversity and cholesterol targets are also a factor, explained Dr. Cheema: “The data shows that many people living for 100 or more years may often have high cholesterol levels yet do not have higher rates of heart disease. Also, cholesterol levels considered as normal or even healthy may be labeled as high-risk in some populations. This applies to regions where genetics, diet and environmental factors can affect how the body processes fats and how the heart-disease risk develops,” she said.
