You can now have your lipid profile tested without fasting — one of the major changes that the new guidelines for lipid management bring in, with the aim to prevent heart attacks.
Lipid profile has also been extended with the introduction of an additional parameter and different reference ranges for different risk categories. For the first time, India will have its own guidelines, partly moving away from the European standards.
The Cardiological Society of India (CSI) on Thursday released the first Indian guidelines for Dyslipidemia management which are crucial in the prevention of heart attack. Till now, India has followed the European guidelines. Dyslipidemia is the term used to describe abnormal lipid levels in the bloodstream.
The latest Indian guidelines recommend ‘non-fasting’ lipid measurements for risk estimation and treatment, shifting from traditional fasting measurements. Introducing some major changes, the new guidelines recommend that the main focus should be LDL-Cholesterol — also known as bad cholesterol — that contributes to plaque build-up in arteries but for patients with high triglycerides, non-HDL cholesterol should be the focus.
To simplify, non-HDL cholesterol is the difference between good cholesterol (or HDL) and total cholesterol. Non-HDL includes all types of bad cholesterol.
With several studies pointing out the increasing advent of heart diseases among the young population of India, the new guidelines recommend the first lipid profile test at the age of 18 years or earlier if there is a family history of premature heart disease.
These guidelines have been communicated to cardiologists across India and soon, they will become part of test reports at pathological labs as they bring changes in the pattern of reporting lipid profile.
The move holds importance as Dyslipidemia is known as a “silent killer” because rising cholesterol levels and triglycerides do not show symptoms but end up blocking arteries — leading to sudden heart attacks and strokes.
“Almost 80 per cent of people in India do not have normal lipid levels yet they don’t realise until they face an emergency,” Dr S Ramakrishnan, professor of cardiology at All India Institute of Medical Sciences (AIIMS), New Delhi, and co-author of lipid guidelines told News18.
“The idea behind drafting these guidelines is to prevent premature heart attacks and 50 per cent of them can be prevented, if these guidelines are adhered to.”
A study published in June 2023 in The Lancet Diabetes & Endocrinology, supported by the Indian Council of Medical Research (ICMR), revealed that the national prevalence of Dyslipidemia in India is an alarming 81.2 per cent.
New reporting format
New guidelines have uniquely designed lipid management in specific co-morbidities — giving a broader view for both patients and doctors to understand every patient better.
A patient with a history of heart disease believes that he is doing good as his bad cholesterol (LDL) is less than 100 because the reference range (as per the present guidelines inserted in his lipid test report) shows his results in the normal range. But that is incorrect, as per the latest recommendations. Hence, these guidelines have modified the cut-offs.
Dr JPS Sawhney, the lead author of the guidelines, explained that for a heart disease patient, LDL should be less than 55 because the patient falls in the category of a “very high-risk” individual.
This is how new guidelines are different and bring customisation for four sets of people – low risk, moderate risk, high risk and very high risk.
“We have been in discussion with the pathological and diagnostic labs across India for the change and uniformity in lipid profile’s reporting format. Around 2,500 labs are accredited by NABL making communication easy and for the rest, we are connecting through the associations,” Sawhney, who is chairman of cardiology at Sir Ganga Ram Hospital, Delhi, told News18.
Under the new format, ‘low risk’ means an individual who has no known risk of having heart disease whereas ‘moderate risk’ is the one who either smokes, consumes tobacco, has hypertension, diabetes, Dyslipidemia or a family history of young heart attack.
Those who fall in ‘high risk’ are people with diabetes with one or more risk factors, hypertension with one or more risk factors or chronic kidney disease or people with a family history of heart disease.
The ‘very high-risk’ category includes people with clinical evidence of blockages in arteries, diabetes for more than 20 years or diabetes with complications, and a family history of blockages in arteries.
Addition of one more parameter in lipid profiling
New guidelines add Lipoprotein (a) to the important lipid parameters while testing. Till now, LDL Cholesterol, Non-HDL Cholesterol, HDL Cholesterol and Triglycerides were the important parameters. However, testing of Lipoprotein (a) levels is now recommended.
An elevated level of Lipoprotein (a) can indicate an increased risk for heart disease and stroke. They are particles composed of proteins and fats (lipids) that transport cholesterol through your bloodstream to your cells.
“Elevated Lipoprotein (a) levels, over 50 mg/dl are linked with heart disease. It is documented that India has a higher prevalence of elevated lipoproteins of around 25 per cent against 15 per cent in the Western world,” Dr Ashwani Mehta, co-author of the guidelines, said, adding that one in every five Indians has elevated Lipoprotein levels.
Mehta, who is a senior consultant cardiologist at Sir Ganga Ram Hospital, said he has been treating several patients coming with heart attacks aged between 25 and 35. “In fact, there are several children as well who have a worrying lipid profile.”
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