Raman Puri1, Vimal Mehta2, P Barton Duell3, Devaki Nair4, Jagdish Chander Mohan5, Jamal Yusuf2, Jamshed J Dalal6, Sundeep Mishra7, Ravi R Kasliwal8, Rajeev Agarwal9, Saibal Mukhopadhyay2, Harsh Wardhan10, Narendra Nath Khanna11, Akshaya Pradhan12, Rahul Mehrotra13, Amit Kumar14, Sonika Puri15, Arumugam Muruganathan16, Gururaj Balvantrao Sattur17, Madhur Yadav18, Harinder Pal Singh19, Rajesh Kumar Agarwal20, Rashmi Nanda21. 1. Indraprastha Apollo Hospitals, New Delhi, India. Electronic address: lipidaoi@gmail.com. 2. G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India. 3. Knight Cardiovascular Institute and Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, OR, USA. 4. Clinical Lead for Lipids and CVD Prevention, Royal Free NHS Foundation Trust Hospital, London, UK. 5. Fortis Hospital, New Delhi, India. 6. Kokilaben Dhirubhai Ambani Hospital, Director-Centre for Cardiac Sciences, Mumbai, Maharashtra, India. 7. AIIMS, New Delhi, India. 8. Division of Clinical and Preventive Cardiology, Medanta Hospital, Gurugram, Haryana, India. 9. Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India. 10. Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India. 11. Department of Cardiology, Indraprastha Apollo Hospitals, New Delhi, India. 12. Department of Cardiology King George's Medical University, Lucknow, Uttar Pradesh, India. 13. Max Superspeciality Hospital, Saket, New Delhi, India. 14. Mariampur Hospital, Kanpur, Uttar Pradesh, India. 15. Department of Nephrology/Transplant, Rutgers Robertwood Johnson University Hospital, New Brunswick, NJ, USA. 16. AG Hospital, Tirupur, Tamil Nadu, India. 17. Sattur Medical Care, Hubli, Karnataka, India. 18. Lady Harding Medical College, New Delhi, India. 19. Fortis Escorts Hospital, Amritsar, Punjab, India. 20. Department of Cardiology, Ruban Memorial Hospital, Patna, Bihar, India. 21. Cardiac Care Centre, South Extension, Part-2, New Delhi, India.
Abstract
BACKGROUND: Rates of atherosclerotic cardiovascular disease (ASCVD) are strikingly high in India compared to Western countries and are increasing. Moreover, ASCVD events occur at a younger age with only modest hypercholesterolemia, most commonly with low levels of high-density lipoprotein cholesterol. The course of ASCVD also appears to be more fulminant with higher mortality. OBJECTIVE: In light of these issues, the Lipid Association of India (LAI) endeavored to develop revised guidelines with more aggressive low-density lipoprotein cholesterol (LDL-C) goals in secondary prevention and for patients with familial hypercholesterolemia compared to guidelines in the United States and other countries. METHODS: Owing to the paucity of clinical outcomes data in India, it was necessary to place major emphasis on expert opinion as a complement to randomized placebo-controlled data generated mostly in non-Indian cohorts. To facilitate this process, the LAI conducted a series of 19 meetings among 162 lipid specialists in 13 cities throughout India over a period of 11 months before formulating this expert consensus statement. RESULTS: The LAI recommends an LDL-C goal <50 mg/dL in all patients in secondary prevention or very high-risk primary prevention but proposes an optional goal ≤30 mg/dL in category A extreme-risk patients (eg, coronary artery disease + familial hypercholesterolemia) and a recommended goal ≤30 mg/dL in category B extreme-risk patients [coronary artery disease + (1) diabetes and polyvascular disease/≥3 major ASCVD risk factors/end organ damage, or (2) recurrent acute coronary syndrome within 12 months despite LDL-C <50 mg/dL, or (3) homozygous familial hypercholesterolemia]. CONCLUSIONS: More aggressive LDL-C goals are needed for prevention of ASCVD in India, as described in this expert consensus statement. Use of statins and ezetimibe needs to increase in India in combination with improved control of other ASCVD risk factors. Proprotein convertase subtilisin kexin type 9 inhibitors can improve LDL-C goal achievement in patients with refractory hypercholesterolemia.
BACKGROUND: Rates of atherosclerotic cardiovascular disease (ASCVD) are strikingly high in India compared to Western countries and are increasing. Moreover, ASCVD events occur at a younger age with only modest hypercholesterolemia, most commonly with low levels of high-density lipoprotein cholesterol. The course of ASCVD also appears to be more fulminant with higher mortality. OBJECTIVE: In light of these issues, the Lipid Association of India (LAI) endeavored to develop revised guidelines with more aggressive low-density lipoprotein cholesterol (LDL-C) goals in secondary prevention and for patients with familial hypercholesterolemia compared to guidelines in the United States and other countries. METHODS: Owing to the paucity of clinical outcomes data in India, it was necessary to place major emphasis on expert opinion as a complement to randomized placebo-controlled data generated mostly in non-Indian cohorts. To facilitate this process, the LAI conducted a series of 19 meetings among 162 lipid specialists in 13 cities throughout India over a period of 11 months before formulating this expert consensus statement. RESULTS: The LAI recommends an LDL-C goal <50 mg/dL in all patients in secondary prevention or very high-risk primary prevention but proposes an optional goal ≤30 mg/dL in category A extreme-risk patients (eg, coronary artery disease + familial hypercholesterolemia) and a recommended goal ≤30 mg/dL in category B extreme-risk patients [coronary artery disease + (1) diabetes and polyvascular disease/≥3 major ASCVD risk factors/end organ damage, or (2) recurrent acute coronary syndrome within 12 months despite LDL-C <50 mg/dL, or (3) homozygous familial hypercholesterolemia]. CONCLUSIONS: More aggressive LDL-C goals are needed for prevention of ASCVD in India, as described in this expert consensus statement. Use of statins and ezetimibe needs to increase in India in combination with improved control of other ASCVD risk factors. Proprotein convertase subtilisin kexin type 9 inhibitors can improve LDL-C goal achievement in patients with refractory hypercholesterolemia.
Authors: A G Unnikrishnan; R K Sahay; Uday Phadke; S K Sharma; Parag Shah; Rishi Shukla; Vijay Viswanathan; S K Wangnoo; Santosh Singhal; Mathew John; Ajay Kumar; Mala Dharmalingam; Subodh Jain; Shehla Shaikh; Willem J Verberk Journal: PLoS One Date: 2022-03-31 Impact factor: 3.240