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Cardio Diabetes Medicine 2017 311

International Lipid Guidelines :

What is Needed for Indians ?

Dr. S. N. Narasingan,
MD, FRCP [ Edin&Glasg] ,FACP,FICP,FCCP[USA]

Former Adjunct Professor The Tamil Nadu Dr. MGR Medical University
Managing Director, SNN Specialities Clinic, & SNN Diagnostic Centre, Chennai

Abstract : ] and newer updated guidelines from ACC/AHA are
There are number of guidelines and recommenda- highlighted in this chapter .
tions for managing cholesterol .American College
of Cardiology [ACC] / American Heart Association [ Introduction : Why do we need guidelines ?
AHA ] guidelines 2013 focussed on Atherosclerotic Many times we get conflicting data in guidelines.
Cardiovascular risk and not on lipid goals . Interna- What is reasonable to do for overall approach to make
tional Atherosclerosis Society [ IAS ] published global sense of the totality of data ? What we should aspire
recommendations in the same year for the manage- to do at a population level is to standardise care and
ment of dyslipidemia . National Lipid Association avoid inequalities. RCTs systematically test effects of
[NLA] guidelines were published in 2014 .Lipid Asso- an intervention on pre-specified outcomes in defined
ciation of India [ LAI ]has released Expert Consensus populations. Their use minimizes confounding . Their
Statement on Management of Dyslipidemia in Indi- ability to generalize results to real-world patients may
ans in 2016. European Guidelines on cardiovascular be limited due to exclusion criteria . Observational /
disease prevention in clinical practice was published Epidemiologic studies have world-wide in scope and
in 2016. .This chapter on Newer Lipid Guidelines : fo- may assess ASCVD risk across populations .Cohort
cuses on interpretation of these international guide- studies : evaluate mortality and morbidity within pop-
lines including recommendations of LAI which may ulations .Guidelines are published based on robust
be applicable for Indians. Many aspects of lipid man- evidence from RCTs , observational / epidemiological
agement targeting LDL- c and other lipoproteins are & cohort studies . Experimental data are taken into
discussed in detail .Indians have typical elevations account.
of triglyceride with low levels of HDL-c and almost Atherosclerosis is a preventable disorder. Of all the
normal LDL- c levels. Atherogenic dyslipidemia which lipoproteins, it is the LDL Cholesterol which plays a
is the characteristic feature of Metabolic syndrome central role not only in the initiation of atheroscle-
[MetS] and diabetes is characterised by an increase rosis but also in the progression of atherosclerosis
in triglyceride levels with low HDL –c and increase in ending in clinical cardiovascular events . Most robust
small dense LDL-c .In view of increasing prevalence evidence for the role played by LDL –C comes from
of obesity , MetS and diabetes, there is a need for RCT’s which had used statins. The evidence clearly
different approach in managing mixed dyslipidemia shows that by reducing LDL –c, we get substantial re-
.Randomised Control Trials [ RCTs] focussing on lipid duction in CV morbidity & mortality . Many secondary
lowering therapy have to be conducted for evidence prevention trials , primary prevention trials, and trials
and to develop guidelines for Indian patients . Patient conducted in high risk groups, clearly demonstrated
centric approach with evidence obtained from epi- the important role of LDL-C reduction and the po-
demiological / observational data on the prevalence tency of statins in reducing the atherosclerotic car-
and type of dyslipidemia were given importance in diovascular risk .
the recommendations of LAI which are highlighted
in this chapter. Recently published guidelines in 2017 NCEP ATP III Guidelines : Many guidelines were pub-
are AACE [ American Association of Clinical Endo- lished by various academic bodies across the globe
crinologists] ADA [ American Diabetes Association .After the publication of National Cholesterol Educa-

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