Surge in Heart Attacks Among Young Indians: New Guidelines on Dyslipidemia Management

Surge in Heart Attacks Among Young Indians: New Guidelines on Dyslipidemia Management

Surge in Heart Attacks Among Young Indians: New Guidelines on Dyslipidemia Management

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 India has witnessed an alarming rise in heart attacks among its younger population in recent years. In response to this, the Cardiological Society of India (CSI) has issued the first-ever guidelines tailored for Indians to manage dyslipidemia, a primary risk factor behind cardiovascular diseases (CVD) including strokes and heart attacks.

Dyslipidemia, commonly known as high cholesterol, involves abnormal levels of lipids (fats) in the blood. According to the Cleveland Clinic, excess lipids can obstruct arteries, restricting blood flow. Low-density lipoprotein (LDL) or “bad cholesterol” is particularly dangerous as it causes plaque to collect inside blood vessels, increasing the risk of strokes and heart attacks. Untreated high cholesterol can lead to severe conditions such as coronary heart disease, carotid artery disease, and sudden cardiac arrest.

The CSI’s new guidelines, partly based on European recommendations but tailored for Indian needs, come at a crucial time. A 2023 study in The Lancet Diabetes & Endocrinology found dyslipidemia prevalence at a staggering 81.2% in India. The CSI recommends cholesterol levels be kept below 100 mg/DL for the general public and low-risk individuals, while those with diabetes or hypertension should aim for LDL-C levels below 70 mg/DL. For very high-risk individuals, such as those with a history of heart attacks or strokes, the target is even lower, with LDL-C levels below 55 mg/DL.

In a significant shift, the guidelines suggest non-fasting lipid measurements for risk estimation and treatment. Dr. S Ramakrishnan, Professor of Cardiology at AIIMS, emphasizes that high LDL-cholesterol can be controlled with a combination of statins and oral non-statin drugs, and if needed, injectable lipid-lowering drugs like PCSK9 inhibitors or Inclisiran are recommended.

The CSI has also highlighted the importance of lifestyle changes in managing dyslipidemia. For instance, due to dietary habits in India, reducing sugar and carbohydrate intake is advised as these contribute more to blockages than modest fat consumption. Regular exercise and yoga, which offer cardioprotective benefits and are culturally relevant, are also recommended.

The need for these guidelines is underscored by the high mortality rates from coronary artery disease among Indians. Dr. Milind Y Nadkar, President of the Association of Physicians of India (API), notes that Indians experience 20-50% higher deaths from this condition compared to other populations. Dr. Pratap Chandra Rath, President of CSI, describes dyslipidemia as a “silent killer” due to its lack of symptoms.

Dr. JPS Sawhney, Chairman of the Department of Cardiology at Sir Gangaram Hospital and head of the Lipid Guidelines, emphasizes the critical nature of these recommendations. He reveals that about 50% of Indians who suffer heart attacks are under 50 years old, with 15-20% under 40. “These numbers are astounding and nearly 90% of these cases can be prevented if individuals know their risk factors and work to keep their lipid levels below the suggested cut-off range,” he stated.