Page 648 - fbkCardioDiabetes_2017

624 Lifestyle & Noncommunicable Diseases: My ‘Formula of 80’
To Live Up To 80 Years Without A Lifestyle Disease

attributed to higher physical inactivity, low exercise normal, 25.0 - 29.9 for overweight and >30 kg/m
2
and diet that is lacking in polyunsaturated fatty acids for obesity.
(PUFAs).
11
BMI however is increasingly being recognised as a
A target LDL-C level less than 100 mg/dL is recom- poor indicator of body fat percentage, especially in
mended by all guidelines (except American College of the non-obese.
Cardiology/American Heart Association [ACC/AHA]) Waist circumference is a more sensitive measure
for the general population without CVD or high risk of abdominal obesity than BMI and thereby of obe-
of CVD. In high-risk patients with established CVD, sity-related health risks. Waist circumference has
diabetes, or lifetime risk of more than 45%, the rec- shown stronger associations with CVD and CVD risk
12
ommended LDL-C goal is less than 70 mg/dL.
factors.
A one standard deviation (1 mmol/L [38.5 mg/dL]) The consensus statement for diagnosis of obesity,
increase in LDL above the mean of 3.50 mmol/L (135 abdominal obesity and the metabolic syndrome for
mg/dL) is associated with an age adjusted relative Asian Indians has recommended cut-offs for waist
risk for coronary heart disease of 1.42 for men and circumference and also defined two action levels to
1.37 for women.
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control abdominal obesity.
The 2013 ACC/AHA guidelines on the management Any person with waist circumference above the cut-
of blood cholesterol focused on reducing the risk offs of 78 cm in men and 72 cm in women should
of atherosclerotic cardiovascular disease (ASCVD) avoid gaining weight and maintain physical activity to
rather than defining any target LDL-C levels. These avoid acquiring any of the cardiovascular risk factor.
guidelines did not recommend any specific LDL-C A waist circumference that is higher than 90 cm in
treatment goals, but identified four groups of pa- men and 80 cm in women should be investigated for
tients for whom statin treatment is recommended: obesity-related risk factors and their management.
Patients with established clinical ASCVD (coronary
heart disease [CHD], strokes, or peripheral arterial Blood sugar
disease of atherosclerotic origin); patients with pri-
mary elevation of LDL-C ≥190 mg/dL; patients aged Type 2 diabetes (T2DM) and metabolic syndrome

40 to 75 years with diabetes mellitus (type 1 or 2) and have reached epidemic proportions in India. With 69.1
with LDL-C levels between 70 and 189 mg/dL and million cases of diabetes in 2015, India is now second
patients without ASCVD or diabetes who are 40 to only to China, which has 110 million people with type

75 years of age and whose estimated 10-year ASCVD 2 diabetes. The ratio of undiagnosed to diagnosed
risk is ≥7.5%. diabetes is higher in rural compared with urban areas
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as was evident from the results of the phase I of the
Abdominal obesity ICMR- INdia DIABetes (INDIAB) Study.
The typical Asian Indian phenotype is the “thin-fat Around 77.2 million people in India reportedly have

Indian” i.e. Asian Indians have smaller muscle mass, prediabetes. The Indian Diabetes Prevention Pro-
but more body fat than their white or African counter- gramme-1 (IDPP-1) study in persons with IGT showed
parts or other Asian ethnic groups. The pattern of fat that the progression of IGT to diabetes is high in na-
deposition in abdomen, ectopic fat deposition (liver, tive Asian Indians; 18% per year.
pancreas) and also low lean mass are more import- The Asian Indian phenotype predisposes Indians
ant determinants of disease risk than body mass. to insulin resistance and type 2 diabetes because
15, Individuals with higher abdominal fat deposition of genetics and also lifestyle factors of unhealthy
are at higher risk of coronary artery disease (CAD), diet and physical inactivity. The DiabCare India 2011

type 2 diabetes and other cardiometabolic risk inde- study showed that type 2 diabetes also develops at
pendently of body mass index (BMI). a younger age in Indians and also at lower levels

BMI has been traditionally used to evaluate obesi- of BMI.
ty. Compared to the internationally recommended ASCVD is a common complication of type 2 diabetes.
cut-offs, the cut-offs of normal BMI are narrower Any increase in blood sugar levels above the normal
and lower in Asian Indians. The normal BMI cut-off is associated with an increased relative risk for myo-
2
ranges between 18.0-22.9 kg/m ; overweight is be- cardial infarction and stroke.
tween 23.0 and 24.9 kg/m and obesity is BMI >25
2
kg/m . While the corresponding currently WHO rec- In people without diabetes, the risk of CHD increas-
2
2
ommended cut-offs of BMI are: 18.5 - 24.9 kg/m for es 6% for every 1 mmol/L increase (18 mg/dL) in
GCDC 2017