High cholesterol is a ‘silent killer’: India adopts lipid guidelines for the first time

India has received its first set of guidelines to help people control their high cholesterol levels. Cardiologists across the world, including India, have been following the European Society of Cardiology’s 2019 guidelines. Now, the Cardiolgocial Society of India (CSI), a 22-member committee, has released the first-ever guidelines for the management of dyslipidemia (high cholesterol) in the country on July 4.

Dyslipidemia is a condition characterized by abnormal levels of lipids (fats) in the blood, such as high cholesterol or triglycerides. This imbalance can increase the risk of heart disease, stroke, and other health problems. It is often managed with diet, exercise, and medications.

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This condition is characterized by high levels of total cholesterol in the blood, including high levels of LDL cholesterol (bad cholesterol), high levels of triglycerides, and low levels of HDL cholesterol (good cholesterol).

Dyslipidemia, known as the “silent killer” because it has no symptoms, is a key marker of cardiovascular diseases such as heart attacks, strokes and peripheral artery disease.

HOW TO KNOW YOUR LIPID PROFILE?

Total cholesterol (lipid profile) is measured by a blood test. A healthcare professional takes a small sample of blood, usually from a vein in your arm.

The sample is then analyzed in a laboratory to determine the total amount of cholesterol, which includes low-density lipoprotein (LDL), high-density lipoprotein (HDL), and a portion of triglycerides.

According to the guidelines, the minimum cholesterol level should be less than 100 mg/DL (milligrams of sugar per deciliter).

Although high cholesterol levels are quite common throughout the country, much of this burden is seen in urban areas.

Doctors across the country unveiled the lipid guidelines after noting the high prevalence of cardiovascular diseases (CVD) and the fact that India has the highest number of premature deaths due to CVD in the world.

“We needed a set of guidelines for Indians as we are more susceptible to various diseases due to various factors including environmental, genetic and most importantly lifestyle. These CSI guidelines are meant for Indians to help us understand the importance of lipid profile in heart health,” said Dr JPS Sawhney, Chairman, Department of Cardiology, Sir Gangaram Hospital and Chairman, Lipid Guidelines.

According to the study conducted by CSI, low levels of HDL (good) cholesterol were observed in people living in almost all states of India except Rajasthan, Gujarat, Telangana and Manipur.

While LDL (bad) cholesterol level was highest in the northern region, Kerala and Goa.

GUIDELINES FOR CHOLESTEROL MAINTENANCE IN INDIA

The new guidelines recommend nonfasting lipid measurements for risk assessment and treatment, moving away from traditional fasting measurements.

Doctors said food choices involving high levels of sugar and carbohydrates contribute significantly to the blockages compared to modest fat consumption.

“High LDL and HDL cholesterol can be controlled with a combination of statins and non-statin oral drugs. If this is not enough, injectable lipid-lowering drugs like PCSK9 inhibitors or Inclisiran are recommended,” said Dr S Ramakrishnan, professor of cardiology at AIIMS.

According to the guidelines, a person is at extremely high risk for heart disease if they have had recurrent vascular events (such as peripheral artery disease and atherosclerosis) within two years.

Diabetes for more than 20 years and genetic predisposition are high risk factors for high levels of bad cholesterol in the body.

Experts mentioned that genetic dyslipidemia (carrying the FH gene) affects more than 5 million people in India and hence, the focus should be kept on managing non-HDL cholesterol (a total of bad cholesterol present in LDL and triglycerides).

“If we detect FH carriers and treat them early, we can prevent premature heart disease in society.

Hyperlipoproteinemia (a), which affects 25% of the Indian population, should be less than 50 mg/dl (milligrams of sugar per deciliter). However, there is no specific treatment for this condition.

People with high levels of triglycerides (over 150 mg/dL) and non-HDL cholesterol should immediately make lifestyle changes and receive specific treatment.

The first lipid profile should be done at age 18, doctors say.

Because it is a silent killer, people at high risk should maintain a lipid profile below 70 mg/dL of LDL cholesterol (bad cholesterol).