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Guidelines

Recommendations from expert consensus statement for management of dyslipidemia in Indian population by Lipid Association of India published on March 2016 in JAPI (Journal of The Association of Physicians of India)

Lipid Association of India (LAI) recommends screening of all adults for atherosclerotic cardiovascular disease risk factors especially lipid panel at age 20 or college entry. This should be done earlier if there is a family history of premature heart disease, dyslipidemia, obesity, or other risk factors.

LAI recommends LDL-C as primary target and Non HDL‐C as co‐primary treatment target.

Non-HDL-C comprises the cholesterol carried by all potentially atherogenic particles, including LDL, intermediate density lipoproteins, very low-density lipoproteins (VLDL) and VLDL remnants, chylomicron remnants, and lipoprotein (a).

Elevated TG is associated with increased risk of ASCVD, independent of LDL-C levels. Keep TG <150 mg/dL, preferably <100mg/dL.

The level of HDL-C is an important risk indicator and used in risk factor counting.

LAI recommends at least one fasting lipid profile though non-fasting lipid levels can be used in screening and in general risk estimation as per most international guidelines.

Risk Stratification for ASCVD (Atherosclerotic cardiovascular disease) by Lipid Association of India 2016

Risk Category
Very High risk
  • Established ASCVD
  • Diabetes with 2 major risk factors or evidence of end organ damage
  • Familial Homozygous Hypercholesterolemia
High Risk
  • 3 major ASCVD risk factors
  • Diabetes with 1 major risk factor or no evidence of end organ damage
  • CKD stage 3B or 4
  • LDL >190 mg/dl
  • Extreme of a single risk factor
  • Coronary Artery Calcium - CAC >300 AU
  • Lipoprotein a > 50mg/dl
  • Non stenotic carotid plaque
Moderate Risk 2 major ASCVD risk factors
Low Risk 0-1 major ASCVD risk factors
Major ASCVD (Atherosclerotic cardiovascular disease) Risk Factors
  • Age ≥ 45 years in males and ≥ 55 years in females
  • Family history of premature ASCVD
  • Current Cigarette smoking or tobacco use
  • High blood pressure
  • Low HDL

Treatment goals and statin initiation thresholds according to ASCVD risk categories as per Lipid Association of India 2016

Risk Category Treatment Goal Consider Drug Therapy
  LDL-C (mg/dl) Non HDL-C (mg/dl) LDL-C (mg/dl) Non HDL-C (mg/dl)
Very High Risk < 50 < 80 >=50 >=80
High Risk < 70 < 100 >=70 >=100
Moderate Risk < 100 < 130 >=100 >=130
Low Risk < 100 < 130 >=130* >=160
* In low risk group, consider therapy after an initial adequate non-pharmacological intervention for 3 months