India issued its first set of guidelines aimed at managing dyslipidemia, or high cholesterol on Thursday. Cardiologists around the globe, including India have been referring to the 2019 guidelines by the European Society of Cardiology. However, now the Cardiological Society of India (CSI), a committee of experts, has unveiled new guidelines specific to the Indian population for managing high cholesterol. The recommendations come at a crucial time when there are rising concerns over the surge in heart attacks among young Indians.
What is Dyslipidemia or High Cholesterol?
Dyslipidemia or High Cholesterol is a medical condition, categorized by abnormal levels of one or more kinds of lipids (fats) in the bloodstream. People suffering from dyslipidemia usually have high levels of triglyceride or LDL, or they may have low levels of HDL. LDL is commonly called ‘bad’ cholesterol as it can build up as plaque in the walls of the arteries and cause heart attacks. HDL is known as ‘good’ cholesterol because it helps remove LDL from the bloodstream. When high cholesterol is left untreated, it raises the risk of heart-related diseases such as cardiac arrest and stroke.
Guidelines Based on Risk-level
According to the guidelines, the general population and low-risk individuals should maintain LDL-C levels below 100 mg/dL and non-HDL-C (total cholesterol minus good cholesterol) levels below 130 mg/dL. High-risk patients like those suffering from hypertension or diabetes should have LDL-C below 70 mg/dL and non-HDL-C below 100 mg/dL. Very high-risk patients like those with a medical history of heart attacks, angina, stroke, or chronic kidney disease should strictly follow the guidelines and aim for LDL-C levels below 55 mg/dL and non-HDL levels below 85 mg/dL.
People who have had recurrent vascular events (like peripheral artery disease and atherosclerosis) within two years are highly prone to heart disease. Furthermore, having diabetes for over 20 years and a genetic predisposition are also contributing risk factors.
Non-fasting Lipid Measurements
The new guidelines recommend non-fasting lipid measurements for risk estimation and treatment which is a shift from the traditional fasting measurements. Dr. Durjati Prasad Sinha, honorary general secretary at CSI pointed out that “Non-fasting lipid measurements make testing more convenient and accessible, encouraging more people to get tested and treated.”
The guidelines advise that the first lipid profile should be carried out at the age of 18, or younger if there is a family history of premature heart disease or hypercholesterolemia (high LDL). Dr Pratap Chandra Rath, President of CSI, called dyslipidemia “a silent killer” as it usually shows no symptoms.
Lifestyle Changes
The guidelines highlighted the importance of modifying lifestyle habits to manage dyslipidemia. Considering the Indian diet, it is recommended to reduce sugar and carbohydrate intake. The CSI also recommends exercising regularly and quitting alcohol and tobacco.
Prevalence in India
Dyslipidemia is alarmingly prevalent in India, with 81 per cent suffering from it according to a study published in The Lancet in June 2023 by the ICMR-INDIAB-17. This proportion was much higher compared to those suffering from hypertension (35 per cent) and diabetes (11.5 per cent). Furthermore, half of all heart attacks in India occur in people under 50. A combination of factors such as tobacco use, obesity, poor lifestyle and diet increase the risk of cardiac issues.
