Dyslipidemia is one of the most significant risk factors for coronary artery disease (CAD). Effective management of dyslipidemia is crucial to address the growing epidemic of premature CAD in India. The Cardiological Society of India (CSI) has developed consensus-based guidelines for improved lipid management aimed at preventing and treating CAD. These guidelines were published in the Indian Heart Journal.

      The guidelines provide a comprehensive framework for managing lipids, covering epidemiology and risk categorization for CAD. A significant focus is placed on managing specific dyslipidemias common in India, including elevated low-density lipoprotein (LDL) cholesterol, non-high-density lipoprotein cholesterol (non-HDL-C), apolipoproteins, triglycerides, and lipoprotein(a).

      The recommendations include both pharmaceutical and lifestyle interventions. Drug therapies such as statins, non-statin medications, and other pharmaceutical agents are detailed, alongside lifestyle management strategies, including dietary modifications, physical activity, and yoga. The guidelines also address the management of dyslipidemia in often-overlooked patient groups, such as the elderly, children and young adults, and individuals with comorbidities including stroke, peripheral arterial disease, kidney failure, post-transplant conditions, HIV, COVID-19, and familial hypercholesterolemia.

      The guidelines emphasize the accurate measurement of non-fasting lipid profiles, including total cholesterol, LDL cholesterol, HDL cholesterol, non-HDL cholesterol, and triglycerides, for risk assessment and treatment planning. Statins are highlighted as the cornerstone of dyslipidemia management, with specific mentions of rosuvastatin and atorvastatin. Additionally, newer lipid-lowering agents like ezetimibe, bempedoic acid, PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors, and inclisiran are recommended for use in combination with statins, offering a synergistic effect.

      The section on lifestyle management emphasizes the importance of food choices, preparation methods, and weight management. Therapeutic measures tailored to specific phenotypes are also discussed, with Apo B identified as a potentially superior biomarker for predicting coronary heart disease (CHD) and aiding in secondary prevention of atherosclerotic cardiovascular disease (ASCVD).

      The guidelines also address common barriers to statin therapy, such as cost, fear of actual or perceived side effects, and conflicting opinions about the risk-benefit ratio.

      Uniquely, the CSI guidelines offer insights into lipid management for specific comorbidities and patient phenotypes, catering to the unique needs of the Indian population.

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