CSI releases first national guidelines for dyslipidemia management

New Delhi: The Cardiological Society of India (CSI) has announced India’s first-ever guidelines for dyslipidemia management. This effort aims to address the distinct challenges and regional variations in dyslipidemia prevalence by utilizing extensive Indian data.

Dyslipidemia, which involves high levels of Total Cholesterol, Elevated LDL-Cholesterol (bad cholesterol), High Triglycerides, and Low HDL-Cholesterol (good cholesterol), is a key risk factor for cardiovascular diseases (CVD) including heart attacks, strokes, and peripheral artery disease. In India, the prevalence of dyslipidemia is alarmingly high, with considerable variation between states and especially high rates in urban areas.

“Dyslipidemia is a silent killer, often symptomless unlike hypertension and diabetes,” stated Dr. Pratap Chandra Rath, President of the Cardiological Society of India. 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 of CSI, noted, “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 Ganga Ram Hospital, New Delhi, and 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,” added Dr. S. Ramakrishnan, Professor of Cardiology at AIIMS, New Delhi, and Co-Author of the Lipid Guidelines.

For patients with high triglycerides (above 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. Triglyceride levels above 500 mg/dL require the use of Fenofibrate, Saroglitazar, 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, and Co-Author of the Lipid Guidelines. The guidelines also recommend evaluating lipoprotein (a) levels at least once, as elevated levels (above 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%).