India has received its first set of guidelines to help people control high cholesterol. Cardiologists worldwide, including India, have been following the 2019 guidelines by the European Society of Cardiology. Now, the Cardiolgocial Society of India (CSI), a 22-member committee, released the first-ever guidelines on July 4 for dyslipidemia (high cholesterol) management in the country.
Dyslipidemia is a medical condition where there are 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 medication.
This condition is characterised by the high total cholesterol in the blood including elevated LDL-cholesterol (bad cholesterol), high triglycerides, and low HDL-cholesterol (good cholesterol).
Dyslipidemia, known as the “silent killer” since it has no symptoms, is a key marker for cardiovascular diseases like heart attacks, strokes and peripheral artery disease.
HOW TO KNOW YOUR LIPID PROFILE?
Total cholesterol (lipid profile) is measured through a blood test. A healthcare provider draws a small sample of blood, usually from a vein in your arm.
The sample is then analysed in a lab to determine the total amount of cholesterol, which includes low-density lipoprotein (LDL), high-density lipoprotein (HDL), and a portion of triglycerides.
As per the guidelines, the minimum level of cholesterol should be less than 100 mg/DL (milligrams of sugar per decilitre).
While high cholesterol levels are quite prevalent across the country, a major part of this burden is seen in the urban areas.
Doctors across the country unveiled the Lipid Guidelines after witnessing the high prevalence of cardiovascular diseases (CVD) and how 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 because of various factors including environmental, genetic and especially lifestyle. These guidelines by the CSI are catered for Indians to help us understand how important lipid profile is when it comes to heart health,” said Dr JPS Sawhney, Chairman, Department of Cardiology, Sir Gangaram Hospital, and the Chairman of the Lipid Guidelines.
According to the study conducted by CSI, low levels of HDL-cholesterol (good cholesterol) were seen in people living in almost all states of India except Rajasthan, Gujarat, Telangana and Manipur.
Whereas high LDL-cholesterol (bad cholesterol) was the highest in the northern region, Kerala, and Goa.
GUIDELINES FOR MAINTAINING CHOLESTEROL IN INDIA
The new guidelines recommend non-fasting lipid measurements for risk estimation and treatment, shifting from the traditional fasting measurements.
Doctors said that dietary choices involving high sugar and carbohydrate levels are major contributors to blockages compared to modest fat consumption.
“High LDL-cholesterol and HDL-cholesterol can be controlled with a combination of statins and oral non-statin drugs. If this doesn’t help, injectable lipid-lowering drugs like PCSK9 inhibitors or Inclisiran are recommended,” said Dr S Ramakrishnan, Professor of Cardiology at AIIMS.
As per the guidelines, a person is at extremely high risk of heart disease if they have had recurrent vascular events (like peripheral artery disease and atherosclerosis) within 2 years.
Diabetes for over 20 years and genetic predisposition are high risk factors for high levels of bad cholesterol in the body.
The experts mentioned that genetic dyslipidemia (a carrier of FH gene) affects over 5 million people in India and therefore, focus should be maintained on managing non-HDL cholesterol (a total of bad cholesterol present in LDL and triglycerides).
“If we detect carrier of FH and treat them early we can prevent premature heart disease in society
Elevated lipoprotein (a), which affects 25% of India, should be less than 50mg/DL (milligrams of sugar per decilitre). However, there is no specific treatment for this.
Individuals who have high triglycerides (more than 150 mg/dl), non HDL-cholesterol should immediately modify their lifestyle and be put on specific treatment.
The first lipid profile should be conducted at the age of 18 years, as per the doctors.
Since it is a silent killer, high risk individuals should maintain a lipid profile of below 70 mg/dl LDL-cholesterol (bad cholesterol).
Rohit Malhotra is a medical expert and health journalist who offers evidence-based advice on fitness, nutrition, and mental well-being. His articles aim to help readers lead healthier lives.
