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The New Brave World of Dyslipidemia : 31
Ready to Target ASCVD After Statins

Goals for Lipid targets:
For several years LDL-C goals < 70 has been rec-
ommended for the very high risk group. The lipid
association of India has slashed down this goal to
<50 and the AACE guidelines 2017 to < 55 ml/dl
2
1
(Table 1 & 2). The goals for Non HDL-C are 30mg /
dL more than the LDL-C goal
Triglycerides
Triglycerides (TG) may be playing an important role in
Indian dyslipidemia but this has not been properly in-
vestigated in the Indian context.The Indian diabetolo-
gists should conduct a large RCT to find an evidence
based target and clarify its role. We have data that
low TG levels with loss function mutation APOC3
3
Figure 2: Evolution of lipid guidelines during last 29 and ANGPTL4 are associated with decreased cor-
4
years after ATP1 onary heart disease and so also increased TG levels
Amongst lipids, LDL-C and NonHDL-C are the prin- are associated with increase cardiovascular and all
cipal targets. ApoB is also a target but usually it is cause mortality. But we do not have any RCT which
not utilized because lack of facilities for estimating has shown benefit of lowering TG on top of stains.
it and an idea about its level is obtained from Non The ACCORD trial which tested efficacy of fibrates on
HDL-C. All trials of HDL-C elevation on top of statins top of statins in diabetic patients failed to show any
have been flop trials and there is no evidence based benefit. The diabetologists often use fibrates on ba-
target for it. In fact HDL-C is fallen angel. sis of subgroup analysis of the ACCORD trial and
5
meta-analysis of fibrate trials but the problem with

Table 1: Treatment goals for LDL-C and Non LDL-C as per Lipid association of India

Table 2: AACE Guidelines 2017

Cardio Diabetes Medicine