This significant initiative marks a milestone in addressing the unique
challenges & variations in dyslipidemia prevalence across the nation by
incorporating extensive Indian data.
New Delhi, July 4, 2024: In a landmark development, the Cardiological Society of
India (CSI) has unveiled the first-ever Indian guidelines for dyslipidemia management.
This significant initiative marks a milestone in addressing the unique challenges and
variations in dyslipidemia prevalence across the nation by incorporating extensive Indian
data.
Dyslipidemia, characterized by high Total Cholesterol, Elevated LDL-Cholesterol (bad
cholesterol), High Triglycerides, and Low HDL-Cholesterol (good cholesterol), is a critical
risk factor for cardiovascular diseases (CVD) such as Heart Attacks, Strokes, and
Peripheral Artery Disease. The prevalence of dyslipidemia in India is alarmingly high,
with significant interstate variations and particularly elevated rates in urban areas.
Speaking about the severity of Dyslipidemia, Dr. Pratap Chandra Rath, President of
Cardiological Society of India (CSI), stated, “Dyslipidemia is a silent killer, often
symptomless unlike hypertension and diabetes. He stressed the importance of proactive
management and early detection. New guidelines recommend non-fasting lipid
measurements for risk estimation and treatment, shifting from traditional fasting
measurements. Elevated LDL-C remains the primary target, but for patients with high
triglycerides (>150 mg/dL), non-HDL cholesterol is the focus.”
Dr. Durjati Prasad Sinha, Hony. General Secretary, CSI, highlighted, saying
“Non-fasting lipid measurements make testing more convenient and accessible,
encouraging more people to get tested and treated. The guidelines recommend the first
lipid profile at age 18, or earlier with a positive family history of premature heart
disease or familial hypercholesterolemia. The general population and low-risk individuals
should maintain LDL-C levels below 100 mg/dL and non-HDL-C levels below 130 mg/dL.
High-risk individuals, such as those with diabetes or hypertension, should aim for LDL-C
below 70 mg/dL and non-HDL below 100 mg/dL.”
“Aggressive targets are suggested for very high-risk patients, including those with a
history of heart attacks, angina, stroke, or chronic kidney disease. These patients
should aim for LDL-C levels below 55 mg/dL or non-HDL levels below 85 mg/dL.”
explained Dr. J. P. S. Sawhney, Chairman of the Department of Cardiology at
Sir Gangaram Hospital, New Delhi, & Chairman of the Lipid Guidelines.
“High LDL-C and non-HDL-C can be controlled with a combination of statins and oral
non-statin drugs. If goals are not achieved, injectable lipid-lowering drugs like PCSK9
inhibitors or Inclisiran are recommended,” noted Dr. S. Ramakrishnan, Professor of
Cardiology at AIIMS, New Delhi, & Co-Author of the Lipid Guidelines.
For patients with high triglycerides (>150 mg/dL), non-HDL cholesterol is the target.
Lifestyle changes, such as regular exercise, quitting alcohol and tobacco, and reducing
sugar and carbohydrate intake, are crucial. In patients with heart disease, stroke, or
diabetes, statins, non-statin drugs, and fish oil (EPA) are recommended. Triglycerides
levels above 500 mg/dL require the use of Fenofibrate, Saraglitazor, and Fish Oil.
“Genetic causes of dyslipidemia, such as familial hypercholesterolemia, are more
common in India than in other parts of the world. It is essential to identify and treat
these cases early through cascade screening of family members,” emphasized Dr.
Ashwani Mehta, Senior Consultant Cardiologist at Sir Ganga Ram Hospital,
New Delhi, & Co-Author of the Lipid Guidelines. Furthermore, the guidelines
recommend evaluating lipoprotein (a) levels at least once, as elevated levels (>50
mg/dL) are associated with cardiovascular disease. The prevalence of elevated
lipoprotein (a) is higher in India (25%) compared to the Western world (15-20%).
Standard Lipid Testing Panels & Targets for Various Risk Groups (all values in
mg/dl)
Lipid parameter* Desirable levels of various lipid fractions
Low Moderate risk High risk Very High Risk
LDL cholesterol <100 <100 <70 <55
Non-HDL
cholesterol
<130 <130 <100 <85
HDL cholesterol >40 M, >50 W >40 M, >50 W >40 M, >50 W >40 M, >50 W
Triglycerides <150 <150 <150 <150
Lipoprotein(a)* <50 <50 <50 <50
Calculate non-HDL if TGY >150mg/dL. Non-HDL =Total cholesterol-HDL-C
Low risk= no cardiovascular risk factor
Moderate risk = Any one of major CAD risk factors (Smoking/Tobacco, Hypertension, Diabetes,
Dyslipidemia, family history of young heart attack)
High Risk = Diabetes with 1 or more risk factor, Hypertension with 1 or more risk factor,
Chronic kidney disease, Familial hypercholesterolemia with no risk factor
Very High Risk = Clinical evidence of blockage in arteries (Angina, Stroke, Heart Attack), Diabetes
>20 years / Diabetes with complications, Familial hypercholesterolemia with blockage of arteries.
