Doha – February 18, 2026: 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 (Center 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 emphasize, 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. ‘Furthermore, current guidelines are largely based on younger populations from high-income countries, which increases the risk of overdiagnosis and overtreatment of older adults with statins worldwide. Treatment guidelines for older adults need to be more nuanced and individualized to consider biological and regional variations.’
The paper describes how effective treatment with statins is impeded in low-income countries by health system constraints such as limited access to lipid testing, irregular statin supply, overburdened clinicians, and issues surrounding implementation of guidelines.
Dr
Chaabna said: ‘Our paper demonstrates that in order to reach equitable cardiovascular guidelines, statin recommendations must evolve to reflect biological diversity, local health system capacity, and the complexities of ageing. We call for collaborations between national governments and non-governmental organizations, such as the World Health Organization, to develop context-sensitive guidelines based on evidence that extends beyond high-income countries. There is also a need for more region-specific research on statin use. We believe these measures could lead to significantly enhanced outcomes for patients across the globe.’
The paper, titled ‘Rethinking global statin guidelines for older adults in resource-diverse settings’, can be read in full here: https://jogh.org/2025/jogh-15-03047