The Indian Heart Journal has published a pivotal editorial underscored with urgency for ‘Indian dyslipidaemia guidelines’ authored by prominent Cardiologists, Dr. Jitendra Pal Singh Sawhney from Sir Ganga Ram Hospital, and Dr. Rajeev Gupta of the Eternal Heart Care Centre & Research Institute. Published on January 12, 2024, the dire need for tailored dyslipidemia guidelines for the Indian population is underscored by increasing cardiovascular disease (CVD) burdens amid distinctive genetic and lifestyle profiles observed in the country.
DOI: 10.1016/j.ihj.2024.01.008
Article Reference Number: S0019-4832(24)00008-7
The Call for Personalized Guidelines
CVDs, primarily fueled by dyslipidemia – a disorder of lipid metabolism – have become one of the leading causes of morbidity and mortality in India. However, the application of global dyslipidemia guidelines often does not translate effectively when confronting the unique metabolic profiles of the Indian population, marked by higher levels of triglycerides, lower HDL cholesterol, and a pro-inflammatory state.
Dr. Sawhney instantly highlights, “India is battling an escalating epidemic of coronary artery disease where dyslipidemia plays a crucial role. Curbing this tide warrants the formulation of guidelines that encapsulate the epidemiological, genetic, and socio-economic tapestry of the Indian demographic.”
A Closer Look at the Indian Scenario
The preoccupation with dyslipidemia’s role is warranted given the staggering statistics. A study published by the Indian Council of Medical Research indicated a 34% increase in deaths due to CVDs between 1990 and 2016. Dyslipidemia lies at the heart of this upsurge, with prevalence rates spanning 10-30% of the urban and 5-15% of the rural populations.
Dr. Gupta reinforces this concern, presenting his case, “The average Indian diet is high in carbohydrates and trans-fats, akin to a ticking time bomb for cardiovascular health. Coupled with genetic predispositions such as ‘Lean Lipotoxicity’ and ‘Asian Indian Phenotype,’ we are faced with a daunting challenge.”
Dissection of the Editorial
Synthesis of Evidence and Practice
The editorial by Sawhney and Gupta revisits data from various studies, delving into metabolic peculiarities as a basis for crafting the dyslipidemia guidelines. They urge a synthesis between evidence-based research and clinical wisdom tailored to Indian lifestyle patterns and genetic characteristics.
Risk Assessment and Stratification
Integral to these guidelines is the elaborate risk assessment model. This model not only classifies individuals based on lipid profile deviations but also incorporates emerging risk indicators like Lipoprotein(a), High-Sensitivity C-Reactive Protein (hs-CRP), and ApoB/ApoA1 ratio, which the authors cite as being of elevated relevance in Indian cohorts.
A Lifespan Approach
Recognizing the early onset of cardiovascular risk factors, the editorial argues for the implementation of a lifespan approach. This includes early education on dietary habits, physical activity, and routine screening—a tactic intended to combat the insidious progression of dyslipidemia.
Implementing the Guidelines
The dissemination and implementation of these imminent guidelines extend beyond academia into the crux of healthcare policy. The authors advocate for multidisciplinary collaboration, engaging policymakers, healthcare providers, community leaders, and most significantly, patients.
Anticipated Impact
Enforcing Indian-specific dyslipidemia guidelines is anticipated to recalibrate the preventive strategy against CVDs, promoting a more robust, efficient, and culturally congruous healthcare framework. The authors project that embracing the personalized guidelines can diminish cases of premature mortality associated with CVDs and amplify the life quality of numerous Indians.
Next Milestones
The editorial underscores the necessary next steps, which involve comprehensive guideline drafting, systematic peer-review, and the establishment of a robust Indian Dyslipidaemia Registry to consolidate real-world data and outcomes.
Declarations
Sawhney and Gupta have declared that there are no known competing financial interests or personal relationships that might appear to have influenced the work reported in this article.
Conclusion
The clarion call by Dr. Sawhney and Dr. Gupta for India-centric dyslipidemia guidelines is a commendable stride forward in combating the ominous wave of cardiovascular diseases. It epitomizes a distinct urgency to adapt, innovate, and personalize in the realm of medical interventions—a resolution that may hold the key to safeguarding India’s cardiovascular health.
Further Reading
Exploring this topic further can provide insight into current research:
1. Gupta, R., & Sawhney, J. P. S. Indian dyslipidaemia guidelines: Need of the hour. Indian Heart Journal, S0019-4832(24)00008-7. DOI: 10.1016/j.ihj.2024.01.008
2. Gupta, M., Singh, N., & Verma, S. South Asians and Cardiovascular Risk: What Clinicians Should Know. Circulation, 2019; 139: e1-e8. DOI: 10.1161/CIRCULATIONAHA.118.046389
3. Enas, E. A., & Dharmarajan, T. S. (2024). Dyslipidaemia and Cardiovascular Disease in Asian Indians. American Journal of Cardiology.
4. Joshi, P., Islam, S., Pais, P., et al. (2007). Risk Factors for Early Myocardial Infarction in South Asians Compared With Individuals in Other Countries. JAMA, 297(3), 286-294.
5. Yusuf, S., Rangarajan, S., Teo, K., et al. (2014). Cardiovascular Risk and Events in 17 Low-, Middle-, and High-Income Countries. NEJM, 371(9), 818-827. DOI: 10.1056/NEJMoa1311890
Keywords
1. Indian Dyslipidaemia Guidelines
2. Cardiovascular Diseases in India
3. Indian Heart Journal Editorial
4. Dr. Jitendra Pal Singh Sawhney
5. Dr. Rajeev Gupta Cardiologist