Cholesterol Management in Indians: Should We Treat the Targets or Treat the Risk?

Abstract

Clinical evidence on relationship between cholesterol and Cardiovascular Disease (CVD) has highlighted the importance of all lipid components in the pathogenesis of CVD, thereby generating the concepts of “target”. Low Density Lipoprotein Cholesterol (LDL-C) and Non High Density Lipoprotein Cholesterol (non HDL-C) have been identified as the main “targets” in the guidelines for lipid management. For the corresponding targets, different “target goals” have been defined in most guidelines according to the levels of risk, to guide the lipid management and to minimise CV events. In the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol guideline abandoned the target goal. This caused confusion among physicians. Recent trials like Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) have brought back into focus the concept of LDL hypothesis. Subsequent guidelines for dyslipidaemia management have retained the target goal based approach. In India, there is a high prevalence of dyslipidaemia and many patients do not achieve their lipid target goals. In this article, we have reviewed the evidence base used by different guidelines on lipid targets along with newer studies; in order to bring clarity to the dyslipidaemia management approach of Indian physicians.

Keywords

• cardiovascular disease
• clinical trials
• dyslipidaemia
• low density lipoprotein