Dyslipidemia Management in India: Challenges, Guidelines, and Innovations

Dyslipidemia management: Indian perspective

Jayaprasad V

Consultant – Cardiologist, Kauvery Hospital, Marathahalli

Background

Coronary Artery Disease in India

Cardiovascular diseases (CVDs) have now become the leading cause of mortality in India Compared to Europeans, Indians get CVD at least a decade earlier and in their most productive midlife years.

Incidence in young is 11-16 vs 2-5% in the west
Almost 30%–42% of all deaths in India are attributable to CVD
The age-standardized CVD mortality rate is estimated at 255–525 per 100,000 population in men and 225–299 per 100,000 population in women.

Ischemic Heart Disease

Dyslipidemia is always a major concern for CV event

Irrespective of Primary vs Secondary

CVD Primary Prevention Trials: STATINS are drug of choice

CVD Secondary Prevention Trials: STATINS are drug of choice

4S	Simvastatin 20 mg for 5.4 yrs (median)	35–70 yrs, prior angina or AMI, fasting total cholesterol 5.5–8.0 mmol/L	-35%	30% (15% to 42%) and 27% (20% to 34%)
LIPID	Pravastatin 40 mg for 6.1 yrs (mean)	31–75 yrs, prior AMI or unstable angina, fasting total cholesterol 4–7 mmol/L	-25%	22% (13% to 31%) and 29% (18% to 38%)
CARE	Pravastatin 40 mg for 5.0 yrs (median)	21–75 yrs, prior AMI, fasting LDL cholesterol 3.0–4.5 mmol/L	-28%	9% (-12% to 26%) and 25% (8% to 39%)
MIRACL	Atorvastatin 80 mg for 16 weeks (mean)	18 – 77 yrs, ACS, screening cholesterol <7.0 mmol	-52%	6% (-31% to 33%) and 10% (-16% to 31)
LIPS	Fluvastatin 80 mg for 3.9 yrs (median)	18–80 yrs, after the percutaneous intervention, screening cholesterol 3.5–7.0 mmol	-27%	-27% 31% (17% to -14%) and 19% (62% to - 24%)
PROSPER	Pravastatin 40 mg for 3.2 yrs (mean)	70–82 yrs, with vascular disease or at high risk, screening cholesterol 4.0–9.0 mmol/L	-34%	3% (17% to -14%) and 14% (-3% to 28%)
PROVE IT- TIMI 22	Atorvastatin 80 mg vs. Pravastatin 40 mg for 2.0 yrs (mean)	> 18 yrs, ACS, screening cholesterol £ 6.21 mmol/L or 5.18 mmol/L if on lipid lowering therapy	Atorva: -42% Prava: -10%	28% (-2% to +50%) and 13% (-8% to 32%)
TNT	Atorvastatin 80 mg vs. Atorvastatin 10 mg for 4.9 yrs (median)	35–75 yrs, stable CAD, LDL-c < 3.4 mmol/L	Atorva 80 mg: -21% Atorva 20 mg: no change	-1% (-19% to +15%) and 22% (7% to 34%)
IDEAL	Atorvastatin 80 mg vs. Simvastatin 20 mg for 4.8 yrs (median)	18–80 years, prior AMI	Atorva : -34% Simva : -17%	2% (-13% to 15%) and 17% (2% to 29%)