Dr. Dhirendra Singhania
Principal Consultant- Interventional Cardiology
Yashoda Super Speciality Hospitals
Kaushambi, Ghaziabad
It is a medical term where a patient has abnormal levels of lipids (fats) such as high cholesterol or triglycerides in his blood. This puts a person at an increased risk of getting heart disease, stroke, and peripheral artery disease. The typical characteristics include high total cholesterol in the blood including elevated LDL-cholesterol (bad cholesterol), high triglycerides, and low HDL-cholesterol (good cholesterol)
Indian Scenario
Coronary Artery Disease (CAD) is an inflammatory condition of the blood vessels of the heart and is one of the major causes of cardiovascular death worldwide. Studies have shown that Its prevalence is highly variable among different races. Indians who constitute a fifth of the global population have been noted to have the highest CAD rates thereby posing a major health challenge. The risk Indians of developing CAD is 11% for non-diabetic patients and 21.4% for diabetic patients.
According to reports published in different journals, managing cholesterol is quite a challenge. It has been found that a significant proportion of Indian population suffers from low levels of HDL-cholesterol (good cholesterol) and high LDL-cholesterol (bad cholesterol).
According to a data compiled by a healthcare organisation in India, 63 per cent had high LDL cholesterol in their blood. The test was conducted on 2,66 million people across 250 Indian cities and the age group was above 20.
Stress coupled with high sugar and carbohydrate intake (fast food) and sedentary lifestyle are some of the major contributors. This can be controlled by avoiding junk oily food, engaging in physical activities and regular intake of doctor prescribed medicines like statins (oral or injectable). Refined carbohydrates, sugar-sweetened beverages, and processed foods should be strongly restricted and replaced with healthy grains and fiber. Since, dyslipidemia is a silent killer, high risk individuals should maintain a lipid profile of below 70 mg/dl LDL-cholesterol (bad cholesterol).
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The fatty issue
High cholesterol and high triglycerides often show no symptoms, but plaque keeps on building up in the arteries leading to atherosclerotic plaque formation. A study published in The Lancet Diabetes & Endocrinology, revealed that the prevalence of dyslipidaemia in India is an alarming 81.2% which means a vast number of us are vulnerable to heart attacks and stroke. Hence, it becomes imminent for every individual to get a blood test (lipid profile test) regularly as it’s the simplest and easiest mode of self-monitoring of the health of your heart.
Testing for assessing risks
The first crucial step for a healthy heart is to keep a track of your lipid levels. Checking your lipid levels annually once you turn 18 is the key to preventing yourself from heart attack. Traditionally a lipid profile test was done with fasting but now the new guidelines (the first ever Indian guidelines) the lipid profile test should be done without fasting. Non-fasting lipid tests has many advantages like convenience and accessibility. With this new approach (non-fasting lipid test) will eventually encourage more individuals to undergo regular monitoring and avail quick treatment if the parameters of the tests are not under control.
New parameters:
At times, while your blood reports (pathological tests) show normal lipid profiles, your treating cardiologist still insists you to continue with certain medicines which you think is unnecessary. But the fact is that the new guidelines has been specially designed for Indian population as by genetic disposition they are prone to develop abnormal levels of lipids as they grow thus putting them at an increased the risk of developing heart disease, stroke, and peripheral artery disease.
The new guidelines are different and has brought about customisation for five sets of people. These categories are detailed below with recommendation. See at what risk category you or your near and dear ones fall into.
Low risk: General population with no risk factor can be classified as low risk. They are those individuals who have no known risk of having heart disease. Which means they don’t smoke, consume tobacco, or have any medical history including high blood pressure, diabetes, previous history of high lipids or a family history of heart attack or heart disease.
- Target: Maintaining LDL-C levels below 100 mg/dL and non-HDL-C levels below 130 mg/dL.
Moderate risk: This group comprises presence of any one of the standard risk factors like smoking/tobacco use, hypertension, diabetes or family history of coronary artery disease (CAD)
- Target: Target: Maintaining LDL-C levels below 100 mg/dL and non-HDL-C levels below 130 mg/dL.
High-risk: This group includes individuals with two or more risk factors with no manifest atherosclerotic cardiovascular diseases like coronary artery, cerebrovascular and peripheral vascular disease (ASCVD ), chronic kidney disease, suffering from diabetes for more than ten years, or hypercholesterolemia (HeFH - an inherited syndrome). Which means belonging to a family who have a history of having high levels of cholesterol which causes very high levels of cholesterol. ASCVD is caused by a buildup of cholesterol plaque in the arteries.
- Target: Maintaining LDL-C below 70 mg/dL and non-HDL below 100 mg/dL.
Very high-risk: This category has individuals with clinical evidence of atherosclerotic CAD, atherosclerotic disease in other vascular beds, with diabetes for more than 20 years, HeFH with ASCVD, or coronary imaging showing more than 50 % lesion in 2 coronary vessels.
- Target: Maintaining LDL-C below 55 mg/dL and non-HDL below 85 mg/dL.
Extremely high-risk: This group comprises those with recurrent vascular events and ASCVD with genetic dyslipidemias
- Target: Maintaining LDL-C below 55 mg/dL and non-HDL below 85 mg/dL.
Test for Lipoprotein
Lipoprotein (a), an important parameter in lipid testing has recently been included in the new Indian guidelines in lipid profile tests. Elevated levels of lipoprotein indicate an increased risk for heart disease and stroke. These particles, composed of proteins and lipids (fats) transport cholesterol through bloodstream to the cells. Elevated lipoprotein affects 25% of Indian population.
Managing Dyslipidaemia
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 now recommended by experts
The road ahead
Promoting education and awareness about CAD and the higher rates in this population can improve routine health maintenance. All individuals above the age of 18 should have their lipid profile evaluated. Such regular screening may be of particular benefit in identifying young adults with elevated LDL cholesterol. Discouraging cigarette smoking and adapting an exercise routine can promote better cardiovascular health. Indians should also consider their eating choices. Regular consumption of fresh fruit and green vegetables has shown to improve health of an individual. At the same time its important to reduce the intake of high fat dairy products.
Email :- dsinghania@hotmail.com
and contact Yashoda hospital, kaushambi , Room no :- 1026
(The above article has been written with inputs taken from Indian Heart Journal (76 (2024) S6-S19)
Note - This article is written by Brand Desk.