To measure cholesterol levels, a doctor often prescribes a Lipid panel test. Usually this test is conducted on an empty stomach and you need to fast for 10 to 12 hours before your lipid panel blood test. Now, you may not need to fast anymore.
In a landmark development, the Cardiological Society of India (CSI) has released the first-ever Indian guidelines for dyslipidemia management. Dyslipidemia refers to abnormal levels of lipids in the bloodstream, which poses a significant risk factor for cardiovascular (CV) diseases.
One of the major recommendations of these guidelines is that there is no need to take a lipid profile test on an empty stomach. Dr. Durjati Prasad Sinha, Hony. General Secretary, CSI explained taht non-fasting lipid measurements make testing more convenient and accessible, encouraging more people to get tested and treated.
“The guidelines recommend the first lipid profile at age 18, or earlier with a positive family history of premature heart disease or familial hypercholesterolemia. The general population and low-risk individuals should maintain LDL-C levels below 100 mg/dL and non-HDL-C levels below 130 mg/dL. High-risk individuals, such as those with diabetes or hypertension, should aim for LDL-C below 70 mg/dL,” Dr. Sinha said.
In a first, these guidelines specifically addresses the unique challenges and variations in dyslipidemia prevalence across India by incorporating extensive Indian data.
Dyslipidemia, characterised by high total cholesterol, elevated LDL-cholesterol (bad cholesterol), high triglycerides, and low HDL-cholesterol (good cholesterol), is also a critical risk factor for strokes, and peripheral artery disease. The prevalence of dyslipidemia in India is alarmingly high, with significant interstate variations and particularly elevated rates in urban areas, the doctors revealed during a press conference today.
The new guidelines recommend non-fasting lipid measurements for risk estimation and treatment, shifting from traditional fasting measurements. Elevated LDL-C remains the primary target, but for patients with high triglycerides (>150 mg/dL), non-HDL cholesterol is the focus, the experts pointed out.
“Aggressive targets are suggested for very high-risk patients, including those with a history of heart attacks, angina, stroke, or chronic kidney disease. These patients should aim for LDL-C levels below 55 mg/dL or non-HDL levels below 85 mg/dL. Lifestyle modifications are emphasized as a cornerstone of dyslipidemia management. Given the dietary habits in India, reducing sugar and carbohydrate intake is recommended, as these contribute more to blockages compared to modest fat consumption. Regular exercise and yoga, which offers cardioprotective benefits and is culturally relevant, are also recommended,” Dr. J. P. S. Sawhney, Chairman of the Department of Cardiology at Sir Gangaram Hospital, New Delhi, and Chairman of the Lipid Guidelines said while addressing the reporters.
Meanwhile, Dr. S. Ramakrishnan, Professor of Cardiology at AIIMS, New Delhi, and co-author of the Lipid Guidelines emphasised that high LDL-C and non-HDL-C can be controlled with a combination of statins and oral non-statin drugs.
“If goals are not achieved, injectable lipid-lowering drugs like PCSK9 inhibitors or Inclisiran are recommended,” he said.
According to the experts, for patients with high triglycerides (<150 mg/dL), non-HDL cholesterol is the target. Lifestyle changes, such as regular exercise, quitting alcohol and tobacco, and reducing sugar and carbohydrate intake, are crucial. In patients with heart disease, stroke, or diabetes, statins, non-statin drugs, and fish oil (EPA) are recommended. Triglycerides levels above 500 mg/dL require the use of Fenofibrate, Saraglitazor, and fish oil.
During the press conference, Dr. Ashwani Mehta, Senior Consultant Cardiologist at Sir Ganga Ram Hospital, New Delhi, and co-author of the Lipid Guidelines revealed that genetic causes of dyslipidemia, such as familial hypercholesterolemia, are more common in India than in other parts of the world.
“It is essential to identify and treat these cases early through cascade screening of family members. Furthermore, the guidelines recommend evaluating lipoprotein (a) levels at least once, as elevated levels (>50 mg/dL) are associated with cardiovascular disease. The prevalence of elevated lipoprotein (a) is higher in India (25%) compared to the Western world (15-20%),” Dr. Mehta revealed.
These guidelines will help the healthcare providers to better manage cholesterol and fight heart disease in India, ultimately promoting healthier lives for all.