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

Area of Science:

• Cardiovascular Disease Prevention
• Global Health Equity
• Evidence-Based Medicine

Background:

• Current statin guidelines for older adults are primarily based on high-income country (HIC) data, limiting their applicability in low- and middle-income countries (LMICs).
• Discrepancies exist between HIC guidelines (e.g., SCORE2, PREVENT) and LMIC frameworks (e.g., WHO charts, HEARTS), impacting clinical recommendations.
• Challenges include varying healthcare capacities, polypharmacy concerns, potential adverse effects, and limited monitoring in LMICs.

Purpose of the Study:

• To highlight the limitations of current statin guidelines in LMICs.
• To propose a context-sensitive approach for statin use in older adults.
• To advocate for equitable and feasible cardiovascular disease prevention strategies globally.

Main Methods:

• Review of existing statin guidelines and implementation frameworks in HICs and LMICs.
• Analysis of emerging biological evidence regarding cholesterol-lowering therapies in older adults.
• Development of guiding principles for context-sensitive statin decision-making.

Main Results:

• Identical patients may receive different statin recommendations based on geographic context.
• Existing LMIC frameworks lack the clinical specificity of HIC guidelines.
• Emerging evidence questions uniform statin therapy for all older adults.

Conclusions:

• Statin guidelines must be adapted to regional capacities, biological variations, and implementation realities.
• A context-sensitive approach, considering functional status and prognosis, is essential.
• Integrating statin use into primary care with simplified protocols and task-sharing can improve feasibility and equity.