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Cardiological Society of India Releases First Indian Guidelines for Dyslipidemia Management
In a significant move aimed at combating the rising prevalence of cardiovascular diseases (CVDs) in India, the Cardiological Society of India (CSI) has released the first-ever Indian guidelines for dyslipidemia management. These guidelines emphasize the need for stricter control of low-density lipoprotein cholesterol (LDL-C), commonly known as “bad” cholesterol, especially among individuals with diabetes and hypertension.
According to the CSI, while the general population or those at low risk should maintain LDL-C levels below 100 mg/dL, patients with diabetes or hypertension should aim for LDL-C levels below 70 mg/dL. Dyslipidemia, characterized by high total cholesterol, elevated LDL-C, high triglycerides, and low high-density lipoprotein cholesterol (HDL-C or “good” cholesterol), is a major risk factor for CVDs, which include heart attacks, strokes, and peripheral artery disease.
The guidelines highlight that individuals in the very high-risk category, such as those with a history of CVDs, should target even lower LDL-C levels, aiming for below 55 mg/dL. This stringent recommendation comes in response to the alarming increase in dyslipidemia and related CVDs in India, particularly among young adults.
In a shift from traditional practices, the new guidelines advocate for non-fasting lipid measurements for risk estimation and treatment, with increased LDL-C remaining the primary target. However, for patients with high triglycerides (more than 150 mg/dL), non-HDL cholesterol, which includes all types of bad cholesterol, becomes the focus.
Dr. J. P. S. Sawhney, Chairman of the Department of Cardiology at Sir Ganga Ram Hospital in New Delhi and Chairman of the Lipid Guidelines, explained, “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.”
For very high-risk patients, including those with a history of heart attacks, angina, stroke, or chronic kidney disease, the guidelines recommend even more aggressive targets. These patients should aim for LDL-C levels below 55 mg/dL or non-HDL levels below 85 mg/dL.
The guidelines also emphasize the importance of evaluating lipoprotein (a) levels at least once, as elevated levels (more than 50 mg/dL) are associated with cardiovascular disease. Notably, the prevalence of elevated lipoprotein (a) is higher in India (25%) compared to the Western world (15-20%).
In addition to these targets, the guidelines call for lifestyle changes, such as regular exercise, quitting alcohol and tobacco, and reducing sugar and carbohydrate intake. Medication strategies are also outlined, with high LDL-C and non-HDL-C being controllable with a combination of statins and oral non-statin drugs. If these goals are not achieved, injectable lipid-lowering drugs like PCSK9 inhibitors or Inclisiran are recommended.
Dr. S. Ramakrishnan, Professor of Cardiology at AIIMS, New Delhi, and Co-Author of the Lipid Guidelines, noted that for patients with heart disease, stroke, or diabetes, a combination of statins, non-statin drugs, and fish oil (EPA) is recommended. For triglyceride levels above 500 mg/dL, the use of Fenofibrate, Saroglitazar, and Fish Oil is advised.
The CSI’s guidelines represent a comprehensive approach to managing dyslipidemia and reducing the burden of cardiovascular diseases in India, aiming to improve the overall health and longevity of the population.
