Amid concerns around the alarming rise in cardiovascular events in the country, the Cardiological Society of India (CSI) has unveiled pioneering guidelines for dyslipidemia (high cholesterol) management. Cardiologists worldwide, including India, have been following the 2019 guidelines by the European Society of Cardiology. The first-ever guidelines for dyslipidemia management released by the CSI, a 22-member committee, are tailored according to Indians. The CSI guidelines are aimed at clinicians, individuals, and medical laboratories. The cut-off range for various lipid markers has been modified based on risk assessment for individuals.
What Is Dyslipidemia?
Dyslipidemia is a medical condition where there are abnormal levels of lipids in the bloodstream characterised by high total cholesterol, elevated LDL-cholesterol (low-density lipoprotein-cholesterol or bad cholesterol), high triglycerides, and low HDL-cholesterol (high-density lipoprotein-cholesterol or good cholesterol).
LDL cholesterol can build up clumps or plaques in the walls of the arteries which can cause a heart attack. HDL or good cholesterol helps remove LDL from the blood. Triglycerides are stored in fat cells. They come from the calories we eat but don’t burn right away. High LDL and triglyceride levels and low HDL levels put us at a higher risk for heart attack and stroke.
A study published in June 2023 in the journal ‘The Lancet Diabetes & Endocrinology’, and supported by the Indian Council of Medical Research (ICMR), showed that the national prevalence of dyslipidemia stands at an alarming 81.2 percent in India. A total of 1,13,043 people participated in the study, which was conducted between October 2008 and December 2020.
CSI Lipid Guidelines for Indians
- Non- Fasting Lipid Measurements
The new guidelines recommend non-fasting lipid measurements for risk estimation and treatment, shifting from the traditional fasting measurements.
- Dietary Contributors
Doctors said that dietary choices involving high sugar and carbohydrate levels are major contributors to blockages compared to modest fat consumption.
- Cholesterol Management
High LDL – cholesterol and HDL – cholesterol can be controlled with a combination of statins and oral non-statin drugs. If this doesn’t help, injectable lipid-lowering drugs like PCSK9 inhibitors or Inclisiran are recommended, said Dr S Ramakrishnan, Professor of Cardiology at AIIMS.
As per the guidelines, a person is at extremely high risk of heart disease if they have had recurrent vascular events (like peripheral artery disease and atherosclerosis) within 2 years.
- Diabetes and Genetics
Diabetes for over 20 years and genetic predisposition are high-risk factors for high levels of bad cholesterol in the body.
- Genetic Dyslipidemia
The experts mentioned that genetic dyslipidemia (a carrier of FH gene) affects over 5 million people in India and therefore, focus should be maintained on managing non-HDL cholesterol (a total of bad cholesterol present in LDL and triglycerides).
- Early Detection
Early detection of the FH gene in individuals can help with treatment to prevent premature heart disease.
- Lipoprotein (a)
Lipoprotein (a) levels should be evaluated 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 percent) compared to the Western world (15-20 percent).
- Triglycerides and non-HDL cholesterol
Individuals who have high triglycerides (more than 150 mg/dl), non-HDL cholesterol should immediately modify their lifestyle and be put on specific treatment.
- Right Age for Screening
The first lipid profile should be conducted at the age of 18 years, as per the doctors.
- LDL-cholesterol Level
Since it is a silent killer, high-risk individuals should maintain LDL-cholesterol (bad cholesterol) levels below 70 mg/dl.
- Lifestyle changes
Lifestyle changes, such as regular exercise, quitting alcohol and tobacco, and reducing sugar and carbohydrate intake, are crucial.
| 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 factors, Hypertension with 1 or more risk factor, Chronic kidney disease, Familial hypercholesterolemia with no risk factor Very High Risk = Clinical evidence of a blockage in arteries (Angina, Stroke, Heart Attack), Diabetes >20 years / Diabetes with complications, Familial hypercholesterolemia with blockage of arteries. | ||||
Standard lipid testing panels and targets for various risk groups (all values in mg/dl)
Leave a Comment