India has just received its first set of guidelines to help manage high cholesterol levels. Until now, cardiologists in India, like their counterparts worldwide, have been relying on the 2019 guidelines issued by the European Society of Cardiology. However, on July 4, the Cardiological Society of India (CSI), through a 22-member committee, released the country's first-ever guidelines specifically for managing dyslipidemia (high cholesterol).
Dyslipidemia is a medical condition characterized by abnormal levels of lipids (fats) in the blood, such as high cholesterol or triglycerides. This imbalance can significantly increase the risk of heart disease, stroke, and other serious health problems. Managing this condition typically involves a combination of diet, exercise, and medication.
Dyslipidemia is identified by high total cholesterol levels in the blood, including elevated low-density lipoprotein (LDL) cholesterol, high triglycerides, and low high-density lipoprotein (HDL) cholesterol. Often referred to as the "silent killer" due to its lack of symptoms, dyslipidemia is a crucial marker for cardiovascular diseases like heart attacks, strokes, and peripheral artery disease.
 HOW TO KNOW YOUR LIPID PROFILE?
Total cholesterol, or lipid profile, is measured through a blood test. A healthcare provider draws a small blood sample, typically from a vein in your arm, which is then analyzed in a lab to determine the total cholesterol level, including LDL, HDL, and a portion of triglycerides.
According to the guidelines, cholesterol levels should ideally be below 100 mg/dL (milligrams per deciliter).
High cholesterol is prevalent across India, with a significant burden in urban areas. The new Lipid Guidelines were introduced in response to the high incidence of cardiovascular diseases (CVD) and the fact that India has the highest number of premature deaths due to CVD globally.
Dr. JPS Sawhney, Chairman of the Department of Cardiology at Sir Ganga Ram Hospital and Chairman of the Lipid Guidelines committee, stated, "We needed a set of guidelines tailored for Indians, who are more susceptible to various diseases due to environmental, genetic, and lifestyle factors. These CSI guidelines aim to highlight the importance of lipid profiles in heart health for the Indian population."
A CSI study revealed low levels of HDL cholesterol (good cholesterol) in people from nearly all Indian states, except Rajasthan, Gujarat, Telangana, and Manipur. Conversely, high LDL cholesterol (bad cholesterol) was most prevalent in the northern regions, Kerala, and Goa.
 GUIDELINES FOR MAINTAINING CHOLESTEROL IN INDIA
The new guidelines recommend non-fasting lipid measurements for risk estimation and treatment, a shift from traditional fasting measurements. Experts note that dietary choices high in sugar and carbohydrates are major contributors to cholesterol blockages, more so than modest fat consumption.
Dr S Ramakrishnan, Professor of Cardiology at AIIMS, explained, "High LDL and HDL cholesterol can be managed with a combination of statins and non-statin oral drugs. If these are ineffective, injectable lipid-lowering drugs like PCSK9 inhibitors or Inclisiran are recommended."
The guidelines also state that individuals are at extremely high risk of heart disease if they have had recurrent vascular events (like peripheral artery disease and atherosclerosis) within the past two years. Long-term diabetes (over 20 years) and genetic predisposition are also high-risk factors for elevated levels of bad cholesterol.
Experts highlighted that genetic dyslipidemia, affecting over 5 million people in India, necessitates a focus on managing non-HDL cholesterol, which includes the total of bad cholesterol present in LDL and triglycerides. Detecting carriers of the FH gene and treating them early can prevent premature heart disease in society.
The guidelines also recommend that elevated lipoprotein (a), which affects 25% of the Indian population, should be maintained at levels below 50 mg/dL. However, there is no specific treatment for this condition.
Individuals with high triglycerides (over 150 mg/dL) should immediately modify their lifestyle and commence specific treatment. Doctors advise that the first lipid profile should be conducted at the age of 18. High-risk individuals should aim to maintain an LDL cholesterol level below 70 mg/dL to mitigate the risks associated with this silent killer.
