Dyslipidemia, characterized by high total cholesterol, high LDL cholesterol, high triglycerides, and low HDL (good cholesterol) cholesterol, is a critical risk factor for cardiovascular diseases (CVD), such as heart attacks, strokes, and peripheral artery disease.
People in the very high risk category, at extreme risk of CVD, should aim for LDL-C levels below 55 mg/dL, said the guidelines, which come at a time when the prevalence of dyslipidemia in India is increasing. is becoming alarmingly high and resulting CVDs are increasing. It is also increasing, especially among young adults.
The new guidelines also recommend non-fasting lipid measurements for risk estimation and treatment, moving away from traditional fasting measurements. Increasing LDL-C remains the primary goal, but for patients with high triglycerides (greater than 150 mg/dL), non-HDL cholesterol is the primary goal.
Non-HDL includes all types of bad cholesterol.
“The general population and low-risk individuals should keep 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,” according to the guidelines.
"Aggressive goals 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 levels of no -HDL below 85 mg/dL," explained Dr. J. P. S. Sawhney, chairman of the Department of Cardiology at Sir Ganga Ram Hospital in New Delhi and president of the Lipid Guidelines.
The guidelines state that the goal is non-HDL cholesterol for patients with high triglycerides (more than 150 mg/dL).
Additionally, the guidelines recommend evaluating lipoprotein (a) levels at least once, since high levels (more than 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).
He also called for lifestyle changes, such as regular exercise, giving up alcohol and tobacco, and reducing sugar and carbohydrate intake.
"High LDL and non-HDL levels can be controlled with a combination of statins and oral non-statin medications. If goals are not achieved, injectable lipid-lowering medications such as PCSK9 inhibitors or Inclisiran are recommended," said Dr. . S. Ramakrishnan, professor of cardiology at AIIMS, New Delhi and co-author of the lipid guidelines.
In patients with heart disease, stroke or diabetes, statins, non-statin medications and fish oil (EPA) are recommended. Triglyceride levels above 500 mg/dL require the use of fenofibrate, saraglitazor and fish oil, experts said.
People in the very high risk category, at extreme risk of CVD, should aim for LDL-C levels below 55 mg/dL, said the guidelines, which come at a time when the prevalence of dyslipidemia in India is increasing. is becoming alarmingly high and resulting CVDs are increasing. It is also increasing, especially among young adults.
The new guidelines also recommend non-fasting lipid measurements for risk estimation and treatment, moving away from traditional fasting measurements. Increasing LDL-C remains the primary goal, but for patients with high triglycerides (greater than 150 mg/dL), non-HDL cholesterol is the primary goal.
Non-HDL includes all types of bad cholesterol.
“The general population and low-risk individuals should keep 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,” according to the guidelines.
"Aggressive goals 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 levels of no -HDL below 85 mg/dL," explained Dr. J. P. S. Sawhney, chairman of the Department of Cardiology at Sir Ganga Ram Hospital in New Delhi and president of the Lipid Guidelines.
The guidelines state that the goal is non-HDL cholesterol for patients with high triglycerides (more than 150 mg/dL).
Additionally, the guidelines recommend evaluating lipoprotein (a) levels at least once, since high levels (more than 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).
He also called for lifestyle changes, such as regular exercise, giving up alcohol and tobacco, and reducing sugar and carbohydrate intake.
"High LDL and non-HDL levels can be controlled with a combination of statins and oral non-statin medications. If goals are not achieved, injectable lipid-lowering medications such as PCSK9 inhibitors or Inclisiran are recommended," said Dr. . S. Ramakrishnan, professor of cardiology at AIIMS, New Delhi and co-author of the lipid guidelines.
In patients with heart disease, stroke or diabetes, statins, non-statin medications and fish oil (EPA) are recommended. Triglyceride levels above 500 mg/dL require the use of fenofibrate, saraglitazor and fish oil, experts said.
