Statin guidelines lower treatment age to 30 as bad cholesterol remains linked to 27,000 deaths in Spain

According to the study 'Implications of the 2026 Dyslipidaemia Guidelines for Statin Therapy in Primary Prevention', published in JAMA, an estimated 87.5 million Americans aged between 30 and 79 now qualify for statins under the updated guidance, including 21.5 million who were not previously eligible.

The researchers said more than 93 per cent of adults aged 70 to 79 and 85 per cent of those aged 60 to 69 now qualify for statins for primary prevention, compared with 11 per cent of adults aged 30 to 39.

"The populations now eligible for statins are generally younger and at lower risk than those previously recommended for treatment," wrote the authors, led by Timothy Anderson, a general internal medicine researcher at the University of Pittsburgh.

They said the revised guidance substantially expands the US population for whom statin therapy is recommended for primary prevention, particularly among lower-risk adults.

Spain introduced similar changes last year. According to figures from the National Statistics Institute, diseases linked to LDL (or "bad" cholesterol), particularly ischaemic heart disease leading to heart attacks, caused almost 27,000 deaths in Spain during 2025, a figure similar to previous years.

This makes it the second leading cause of death from circulatory disease, according to the Spanish Society of Cardiology, whose Guidelines Committee also recently updated its criteria for treating dyslipidaemia, a condition involving abnormal levels of blood fats such as LDL cholesterol and triglycerides.

The revised recommendations assess both fatal and non-fatal cardiovascular events rather than only fatal ones, use non-HDL cholesterol instead of total cholesterol as a key marker, and widen the age ranges considered during risk assessment.

According to a paper published in the Spanish Journal of Cardiology, these additional risk factors may justify moving some patients into a higher cardiovascular risk category.

The US study was published just days before another JAMA paper, released on 29 July, found that elevated LDL cholesterol caused 3.6 million deaths across 204 countries and territories in 2023, accounting for six per cent of all deaths worldwide.

It also contributed to 90.7 million disability-adjusted life years among people aged 25 and over, a standard public health measure combining years lost through illness, disability and premature death, affecting both quality of life and healthy ageing.

The study found that the overall burden linked to elevated LDL cholesterol increased by 38.5 per cent between 1990 and 2023 because of population growth and ageing, with the greatest increases shifting towards countries with middle levels of socio-demographic development.

However, deaths attributed to high LDL cholesterol have fallen steadily over the past three decades. The Global Burden of Disease research group, which analysed more than 800 studies published between 1990 and 2023, estimated a 45 per cent reduction in mortality and a 40 per cent fall in disability linked to the condition.

The researchers said elevated LDL cholesterol remains a modifiable risk factor for cardiovascular disease, the leading cause of premature death worldwide, making accurate assessment essential for prevention and treatment strategies.

In Spain, separate cardiovascular risk criteria apply to adults aged 40 to 69 and those aged 70 to 89. The updated guidance also revises the thresholds for starting lipid-lowering treatment in people without established cardiovascular disease and recommends additional tests for patients at moderate risk or those close to treatment decision thresholds.

An accompanying editorial by researchers from the University of Washington, the George Institute for Global Health in Australia and the University of Abuja in Nigeria described the impact of elevated LDL cholesterol as "an important and possibly underestimated problem in many parts of the world", linking it to conditions including ischaemic heart disease and ischaemic stroke.