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Non HDL-c (Non-High-Density lipoprotein Cholesterol: Table : 2 Comparison of International Guidelines In-
cluding recommendations of LAI :
Non-HDL-C, which is equal to total cholesterol –
HDL-C and this includes all atherogenic lipoproteins .It ACC/AHA ESC/EAS NLA IAS LAI
is more accurate predictor of ASCVD risk, particularly Highlight the role of
in patients who have elevated TG (e.g. diabetes, obese Lifestyle     
persons, those with metabolic syndrome) and those
already on statin therapy. LAI recommends non- Highlight the need to
engage the patient
HDL-C as a co-primary target, as important as LDL-C, as a partner     
for lipid lowering therapy. Non-HDL-C level should be
kept within 30mg/dL of LDL-C levels. Statins remain Highlight the role
the first line agent for lipid lowering, regardless of of lipid modification     
whether LDL-C is the target for therapy or non-HDL-C. in the prevention of
CVD
Highlight the need
Relevance of HighTG Levels for risk assessment     
Elevated TG is associated with increased risk of In general use
ASCVD, independent of LDL-C levels. A combination an absolute risk     
of high TG and LDL-C imparts even greater risk. strategy
High TG is one of the components of atherogenic Risk categories
dyslipidemia.Keep TG<150 mg/dL, preferably easy to identify and     
<100mg/dL. In patients with elevated TG levels, rule agreed
out secondary causes of the same and intensify Good summary of
lifestyle modification, which can reduce TG by as RCT data     
much as 50%. Unless TG is very high (>500 mg/dL),
statin should be the first drug . Routine addition of a Table : 3 THE APPROACH : Comparison of International
fibrate or another non-statin drug must be avoided. Guidelines
Only when TG is not sufficiently lowered with above
measures, a non-statin drug should be added. ACC/AHA ESC/EAS NLA IAS LAI
Use doses seen in
trial scenarios     
High Density Lipoprotein Cholesterol
Emphasis on higher
Low HDL-C is an independent risk factor for ASCVD. intensity statins for     
It becomes even more relevant when LDL-C is not established ASCVD
elevated. Life style modification plays an important
role in raising HDL-C. Among pharmacological Highlight the role
of lipid modification
agents, statins remain mainstay in the treatment of in the prevention of     
low HDL-C also. Although several other agents have CVD
been tried specifically for raising HDL-C, none of them
has been shown to result in clinical benefit. Plus TARGETS    
% Reductions √  
Usage of statins for Lipid Management & Statin
Intolerance : The clinical benefit of statins depends THE BAD : Comparison of International
primarily on the extent of LDL-C reduction and not on
the type of statin used. The type of the statin and dose Guidelines
to be used should be based on the degree of LDL-C ACC/AHA and ESC/EAS guidelines seek to lower
reduction that is required to reach the target LDL-C LDL-C with statin therapy as their principal aim LAI
in a given patient. Atleast moderate- or high intensity also recommends the same . ACC/ AHA Guidelines
statin therapy is required to bring about a clinically : Treats risk alone with guidance only on treating AS-
meaningful reduction in LDL-C in most patients. CVD risk and discard the use of lipid targets It is
simply fire and forget approach .Do not recommend
The ACC/AHA 2013 guidelines on the treatment of additional lipid-lowering therapies among those with
blood cholesterol to reduce ASCVD risk : A comparison high residual risk despite achievement of 50% re-
with ESC/EAS guidelines for the management of duction in LDL-C . ESC/EAS Guidelines & LAI rec-
11
dyslipidaemias 2011 . Recommendations from LAI ommendations : Treats risk and more : Treats CVD
has been added apart from NLA & IAS for comparison
12 . Ref .Table 2 ,3,4 & 5 risk, create a greater understanding of the role of
LDL-C in CVD assessment (LDL-C monitoring) . In-

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