Medical Dialogues
  • Dermatology
Login Register
This site is intended for healthcare professionals only
Login Register
  • MD Brand Connect
  • Vaccine Hub
  • MDTV
    • Breaking News
    • Medical News Today
    • Health News Today
    • Latest
    • Journal Club
    • Medico Legal Update
    • Latest Webinars
    • MD Shorts
    • Health Dialogues
  • Fact Check
  • Health Dialogues
Medical Dialogues
  • Medical News & Guidelines
      • Anesthesiology
      • Cardiology and CTVS
      • Critical Care
      • Dentistry
      • Dermatology
      • Diabetes and Endocrinology
      • ENT
      • Gastroenterology
      • Medicine
      • Nephrology
      • Neurology
      • Obstretics-Gynaecology
      • Oncology
      • Ophthalmology
      • Orthopaedics
      • Pediatrics-Neonatology
      • Psychiatry
      • Pulmonology
      • Radiology
      • Surgery
      • Urology
      • Laboratory Medicine
      • Diet
      • Nursing
      • Paramedical
      • Physiotherapy
  • Health news
      • Doctor News
      • Government Policies
      • Hospital & Diagnostics
      • International Health News
      • Medical Organization News
      • Medico Legal News
      • NBE News
      • NMC News
  • Fact Check
      • Bone Health Fact Check
      • Brain Health Fact Check
      • Cancer Related Fact Check
      • Child Care Fact Check
      • Dental and oral health fact check
      • Diabetes and metabolic health fact check
      • Diet and Nutrition Fact Check
      • Eye and ENT Care Fact Check
      • Fitness fact check
      • Gut health fact check
      • Heart health fact check
      • Kidney health fact check
      • Medical education fact check
      • Men's health fact check
      • Respiratory fact check
      • Skin and hair care fact check
      • Vaccine and Immunization fact check
      • Women's health fact check
  • AYUSH
    • Ayurveda
    • Homeopathy
    • Siddha
    • Unani
    • Yoga
  • State News
      • Andaman and Nicobar Islands
      • Andhra Pradesh
      • Arunachal Pradesh
      • Assam
      • Bihar
      • Chandigarh
      • Chattisgarh
      • Dadra and Nagar Haveli
      • Daman and Diu
      • Delhi
      • Goa
      • Gujarat
      • Haryana
      • Himachal Pradesh
      • Jammu & Kashmir
      • Jharkhand
      • Karnataka
      • Kerala
      • Ladakh
      • Lakshadweep
      • Madhya Pradesh
      • Maharashtra
      • Manipur
      • Meghalaya
      • Mizoram
      • Nagaland
      • Odisha
      • Puducherry
      • Punjab
      • Rajasthan
      • Sikkim
      • Tamil Nadu
      • Telangana
      • Tripura
      • Uttar Pradesh
      • Uttrakhand
      • West Bengal
  • Medical Education
      • Ayush Education News
      • Dentistry Education News
      • Medical Admission News
      • Medical Colleges News
      • Medical Courses News
      • Medical Universities News
      • Nursing education News
      • Paramedical Education News
      • Study Abroad
  • Industry
      • Health Investment News
      • Health Startup News
      • Medical Devices News
      • Pharma News
      • Pharmacy Education News
      • Industry Perspective
  • MDTV
      • Health Dialogues MDTV
      • Health News today MDTV
      • Latest Videos MDTV
      • Latest Webinars MDTV
      • MD shorts MDTV
      • Medical News Today MDTV
      • Medico Legal Update MDTV
      • Top Videos MDTV
      • Health Perspectives MDTV
      • Journal Club MDTV
      • Medical Dialogues Show
This site is intended for healthcare professionals only
LoginRegister
Medical Dialogues
LoginRegister
  • Home
  • Medical news & Guidelines
    • Anesthesiology
    • Cardiology and CTVS
    • Critical Care
    • Dentistry
    • Dermatology
    • Diabetes and Endocrinology
    • ENT
    • Gastroenterology
    • Medicine
    • Nephrology
    • Neurology
    • Obstretics-Gynaecology
    • Oncology
    • Ophthalmology
    • Orthopaedics
    • Pediatrics-Neonatology
    • Psychiatry
    • Pulmonology
    • Radiology
    • Surgery
    • Urology
    • Laboratory Medicine
    • Diet
    • Nursing
    • Paramedical
    • Physiotherapy
  • Health news
    • Doctor News
    • Government Policies
    • Hospital & Diagnostics
    • International Health News
    • Medical Organization News
    • Medico Legal News
    • NBE News
    • NMC News
  • Fact Check
    • Bone Health Fact Check
    • Brain Health Fact Check
    • Cancer Related Fact Check
    • Child Care Fact Check
    • Dental and oral health fact check
    • Diabetes and metabolic health fact check
    • Diet and Nutrition Fact Check
    • Eye and ENT Care Fact Check
    • Fitness fact check
    • Gut health fact check
    • Heart health fact check
    • Kidney health fact check
    • Medical education fact check
    • Men's health fact check
    • Respiratory fact check
    • Skin and hair care fact check
    • Vaccine and Immunization fact check
    • Women's health fact check
  • AYUSH
    • Ayurveda
      • Ayurveda Giuidelines
      • Ayurveda News
    • Homeopathy
      • Homeopathy Guidelines
      • Homeopathy News
    • Siddha
      • Siddha Guidelines
      • Siddha News
    • Unani
      • Unani Guidelines
      • Unani News
    • Yoga
      • Yoga Guidelines
      • Yoga News
  • State News
    • Andaman and Nicobar Islands
    • Andhra Pradesh
    • Arunachal Pradesh
    • Assam
    • Bihar
    • Chandigarh
    • Chattisgarh
    • Dadra and Nagar Haveli
    • Daman and Diu
    • Delhi
    • Goa
    • Gujarat
    • Haryana
    • Himachal Pradesh
    • Jammu & Kashmir
    • Jharkhand
    • Karnataka
    • Kerala
    • Ladakh
    • Lakshadweep
    • Madhya Pradesh
    • Maharashtra
    • Manipur
    • Meghalaya
    • Mizoram
    • Nagaland
    • Odisha
    • Puducherry
    • Punjab
    • Rajasthan
    • Sikkim
    • Tamil Nadu
    • Telangana
    • Tripura
    • Uttar Pradesh
    • Uttrakhand
    • West Bengal
  • Medical Education
    • Ayush Education News
    • Dentistry Education News
    • Medical Admission News
    • Medical Colleges News
    • Medical Courses News
    • Medical Universities News
    • Nursing education News
    • Paramedical Education News
    • Study Abroad
  • Industry
    • Health Investment News
    • Health Startup News
    • Medical Devices News
    • Pharma News
      • CDSCO (Central Drugs Standard Control Organisation) News
    • Pharmacy Education News
    • Industry Perspective
  • Home
  • Cardiology-CTVS
  • Cardiology & CTVS Guidelines
  • Lower LDL-C

Lower LDL-C <30 mg/dl in extreme risk category B: LAI dyslipedemia Guidelines Part III

Written By : Dr. Kamal Kant Kohli Published On 2021-02-05T11:45:34+05:30  |  Updated On 5 Feb 2021 3:12 PM IST
Lower LDL-C  <30 mg/dl in extreme risk category B: LAI dyslipedemia Guidelines Part III
  • facebook
  • twitter
  • linkedin
  • whatsapp
  • Telegram
  • Email

The burden of atherosclerotic cardiovascular disease (ASCVD) in India is alarmingly high and is a cause of concern. Indians are not only at high risk of developing ASCVD, they usually get the disease at an early age and have a more severe form of the disease with poor outcome as compared to the western populations.

The Lipid Association of India (LAI) made recommendations on the management of dyslipididemia based on the expert opinion, among lipid specialist throughout India. Subsequently, a total of 55 webinars held across the country over 3 months of period between May 2020 and July 2020 involving local physicians where the new Indian guidelines were presented, discussed, commented and recorded.

In order to decrease the risk of recurrent adverse CV events in patients with established ASCVD, the 2016 LAI part I guidelines recommended LDL-C goal of <50 mg/dl. However the risk of recurrent ASCVD events is determined by the presence of comorbidities, number of risk factors and by the extent of atherosclerosis. Therefore patients with multiple risk markers and comorbidities have increased risk and require even more aggressive risk factor control as well as LDL-C lowering.

Hence LAI has proposed a new group- Extreme risk. The justification for Extreme risk group has been discussed in detail in the consensus document. The patients in the Extreme risk group require aggressive management to decrease future ASCVD events. The Extreme Risk Group is further divided into category A and category B depending on the underlying risk conditions. An LDL-C target of less than 50 mg/dl is recommended in Extreme risk category A with an optional goal of ≤30 mg/dl. In Extreme risk category B the recommended LDL-C goal is ≤30 mg/dl.

Dr Raman Puri, Chairman Lipid Association of India told Medical dialogues "Indians are unique ethnographic population and unfortunately are afflicted with atherosclerotic cardiovascular disease (ASCVD) that is premature, severe and carries high mortality. Seized of this serious situation, Lipid Association of India (LAI) launched its mission of improving awareness and management of dyslipidemia - a major modifiable risk factor of ASCVD- amongst Indian medical community."

"Since its inception in 2012, LAI has published three Expert Consensus Statements in addition to other publications, in national and international journals.LAI has updated the previous recommendations and covered recent advances in the "LAI Expert Consensus Statement on Management of Dyslipidemia in Indians – Part III" in 2020.

Life style intervention has been dealt with the depth it deserves. Aggressive approach to LDL C lowering has been emphasised. The roles of triglycerides, non-HDL C, apo-B, Lp(a) and inflammation in ASCVD have been described. These recommendations are primarily from Indian experts, for Indian medical community and for Indian patients worldwide. These recommendations are not mandatory and are to be used by clinicians applying their experience and judgement, keeping patient's interest uppermost in mind, he said.

The state of the art LAI 2020 consensus statement sums up the latest data for the management of dyslipidemia in Indians. Following are the few recommendations mentioned in the LAI consensus document:

• The indications for fasting and non-fasting lipid profile have been clearly delineated in the LAI 2020 consensus document. In the recommendations, it is appropriately stated that all patients with hypertriglyceridemia should be evaluated for ASCVD risk and treated accordingly.

• The LAI panel also recommend to investigate and manage the secondary causes of hypertriglyceridemia. They noted that adequate glycemic control in diabetics will decrease triglyceride levels substantially.

• They also updated the ASCVD risk stratification risk algorithm by adding four new moderate non-conventional risk factors in place of metabolic syndrome.

• Increased lipoprotein (a) [Lp(a)] levels are highly prevalent but are neglected entity. Hence, LAI expert panel stated, "Universal screening of all subjects at age 18 years or earlier is recommended at least once in a lifetime as Lp(a) levels are genetically determined" to estimate the CV risk.

• In the section of C-reactive protein, the LAI panel of experts emphasizes that High Sensitivity C-Reactive Protein (hsCRP) has a minimal role in classifying high-risk individuals as they, in any case, need aggressive risk factor and dyslipidemia management. Normal or mildly elevated LDL-C levels may give a sense of complacency regarding the estimation and management of lipid risk. Therefore, LAI recommends apolipoprotein B (apo B) measurement in high-risk subjects, after LDL-C and non-HDL-C goals have been achieved. Discordant elevated apo B levels may identify individuals who have high residual cholesterol risk. This may warrant intensive statin therapy and the use of non-statin drugs.

The authors stated, "This document will provide guidance to the clinicians in their day to day practice and clinician should use their clinical judgment and should have detailed discussion of cost, risks and benefits with the patient, not to forget our focus on primary prevention of ASCVD and importance of therapeutic lifestyle intervention (tobacco, diet, exercise)".

For further information:

https://pubmed.ncbi.nlm.nih.gov/33350610/


Lipid Association of IndiaDyslipidemiapart IIIGuidelinesASCVDlow density lipoprotein cholesterol#LDL C
Article Source :  Journal of the Association of Physicians India
Dr. Kamal Kant Kohli
Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

Show Full Article
Next Story

Editorial

Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in Metastatic Breast Cancer - Dr Aditya Murali

Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in Metastatic Breast Cancer...

Aspirin in Primary Prevention- When to Consider?

Aspirin in Primary Prevention- When to Consider?

Featured image representing medico legal

What's the Role of Expert Opinion in Medical Negligence?

7- Point Discharge Protocol for AECOPD: Time to Inculcate in Practice

7- Point Discharge Protocol for AECOPD: Time to Inculcate in Practice

Aspirin Use in Women Aged 40-50 with Diabetes and Hypertension: Identifying the Ideal Candidates

Aspirin Use in Women Aged 40-50 with Diabetes and Hypertension: Identifying the Ideal Candidates

View All

Journal Club Today

Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in Metastatic Breast Cancer - Dr Aditya Murali

Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in Metastatic Breast Cancer...

View All

Health News Today

Health Bulletin 09/ May/ 2025

Health Bulletin 09/ May/ 2025

View All
© 2022 All Rights Reserved.
Powered By: Hocalwire
X
We use cookies for analytics, advertising and to improve our site. You agree to our use of cookies by continuing to use our site. To know more, see our Cookie Policy and Cookie Settings.Ok