CSI clinical practice guidelines for dyslipidemia management: Executive summary

Abstract

Dyslipidemias are the most important coronary artery disease (CAD) risk factor. Proper management of dyslipidemia is crucial to control the epidemic of premature CAD in India. Cardiological Society of India strived to develop consensus-based guidelines for better lipid management for CAD prevention and treatment. The executive summary provides a bird's eye-view of the 'CSI: Clinical Practice Guidelines for Dyslipidemia Management' published in this issue of the Indian Heart Journal. The summary is focused on the busy clinician and encourages evidence-based management of patients and high-risk individuals. The summary has serialized various aspects of lipid management including epidemiology and categorization of CAD risk. The focus is on management of specific dyslipidemias relevant to India-raised low density lipoprotein (LDL) cholesterol, non-high density lipoprotein cholesterol (non-HDL-C), apolipoproteins, triglycerides and lipoprotein(a). Drug therapies for lipid lowering (statins, non-statin drugs and other pharmaceutical agents) and lifestyle management (dietary interventions, physical activity and yoga) are summarized. Management of dyslipidemias in oft-neglected patient phenotypes-the elderly, young and children, and patients with comorbidities-stroke, peripheral arterial disease, kidney failure, posttransplant, HIV (Human immunodeficiency virus), Covid-19 and familial hypercholesterolemia is also presented. This consensus statement is based on major international guidelines (mainly European) and expert opinion of lipid management leaders from India with focus on the dictum: earlier the better, lower the better, longer the better and together the better. These consensus guidelines cannot replace the individual clinician judgement who remains the sole arbiter in management of the patient.

Keywords: Dyslipidemia; India; LDL cholesterol; Lipid management; Statins; Triglycerides.

Fig. 1

State level prevalence of various dyslipidemias in ICMR-INDIAB Study. All rights and permissions secured (Licence No. 5740641442671). Original figure from Anjana RM, Unnikrishnan R, Deepa M, et al.; ICMR-INDIAB Collaborative Study Group. Metabolic noncommunicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17). Lancet Diabetes Endocrinol. 2023 Jul;11(7):474-489. doi: 10.1016/S2213-8587(23)00119-5.

Fig. 2

Cardiovascular risk estimation and lipid management goals.

Fig. 3

Lipid management in the setting of acute coronary syndromes.

Fig. 4

Lipid management in chronic coronary syndromes.

Fig. 5

Statin associated muscle symptoms (SAMS) management.

Fig. 6

Management of hypertriglyceridemia.

Fig. 7

Familial hypercholesterolemia diagnosis and management.