How to manage high cholesterol, a ‘silent killer’? India adopts guidelines for the first time – Firstpost

India has seen a rise in heart attacks among young people in recent years. Recently, a medical body in the country reported that Indians were suffering from cardiovascular diseases (CVD), which include strokes and heart attacks, “a decade earlier” than Westerners.

Dyslipidemia, or high cholesterol, is the major risk factor for cardiovascular disease. Amid growing concern over the surge in heart attacks, the Cardiological Society of India (CSI) has released the first-ever Indian-specific guidelines for the management of dyslipidemia.

Let’s take a closer look.

What is dyslipidemia?

Dyslipidemia, also known as hyperlipidemia or high cholesterol, means there are abnormal levels of lipids (fats) in your blood.

According to an article from the Cleveland Clinic, excess fat is bad because it can create blockages in the arteries, restricting blood flow throughout the body.

Low-density lipoprotein (LDL) or bad cholesterol is the “most dangerous type of cholesterol because it causes cholesterol deposits (plaques) to build up inside your blood vessels. This makes it harder for blood to flow, putting you at risk for stroke or heart attack,” the article reads.

If high cholesterol is left untreated, it can lead to coronary heart disease, carotid artery disease, sudden cardiac arrest, peripheral artery disease, and microvascular disease.

This disease can be treated with lifestyle changes, including exercise, healthy eating, and quitting smoking. Some patients may also need medication.

What do India’s guidelines say?

The CSI has issued guidelines partly based on the European guidelines but modified for Indians.

These recommendations follow a 2023 study published in the journal The Lancet Diabetes and Endocrinology who found the prevalence of dyslipidemia to be 81.2% in India.

The 22-member ISC said cholesterol levels should be below 100 mg/DL (milligrams of sugar per deciliter) for the general public and those at low risk. It also recommended keeping non-HDL cholesterol (total cholesterol, less good cholesterol) levels below 130 milligrams per deciliter, in line with the The imprint report.

For people at high risk, such as those with diabetes or high blood pressure, the guidelines set a goal of LDL-C (low-density lipoprotein cholesterol, or bad cholesterol) less than 70 milligrams per deciliter and non-HDL-C less than 100 mg/DL.

According to the guidelines, people at very high risk, such as those with a history of heart attack, angina, stroke or chronic kidney disease, should aim for LDL-C levels below 55 milligrams per deciliter and non-HDL-C levels below 85 milligrams per deciliter.

The new guidelines also mark a shift from traditional fasting measurements. The ISC has suggested nonfasting lipid measurements for risk assessment and treatment.

The CSI reportedly warned that people who have had recurrent vascular events, such as peripheral arterial disease and atherosclerosis, within two years are at high risk of heart disease.

“High LDL and HDL cholesterol can be controlled by 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 India today.

Guidelines state that the first lipid profile should be done at age 18 or younger for people with a family history of premature heart disease or hypercholesterolemia (high levels of bad cholesterol).

The CSI recommends immediate lifestyle changes and treatment for people with high triglyceride levels (over 150 mg/dL) and non-HDL cholesterol.

Doctors have emphasized that diet and lifestyle are the pillars of dyslipidemia management.

“Given the dietary habits in India, it is recommended to reduce the consumption of sugar and carbohydrates as these contribute more to blockages than moderate fat consumption. Regular exercise and yoga, which offer cardioprotective benefits and are culturally relevant, are also recommended,” the cardiologists said.

Why were these guidelines necessary?

Indians have a 20 to 50 percent higher mortality rate from coronary heart disease than other populations, Indian Express reported quoting Dr Milind Y Nadkar, president of the Association of Physicians of India (API).

It is in view of these alarming figures that these guidelines have been published.

Dr Pratap Chandra Rath, president of CSI, called dyslipidemia a “silent killer” as it usually has no symptoms, unlike hypertension and diabetes.

“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,” Dr JPS Sawhney, Chairman, Department of Cardiology, Sir Gangaram Hospital and Chairman, Lipid Guidelines, was quoted as saying by India today.

Talk to The imprintDr Sawhney said that about 50 per cent of Indians who suffer from heart attacks are under 50 years of age, and 15 to 20 per cent are under 40 years of age.

“These numbers are staggering and nearly 90% of these cases could be prevented if individuals knew their risk factors and worked to keep their lipid levels below the suggested cut-off range,” he added.

With contributions from agencies