Background

Rates of atherosclerotic cardiovascular disease (ASCVD) are strikingly high in India compared to Western countries and are increasing. Moreover, ASCVD events occur at a younger age with only modest hypercholesterolemia, most commonly with low levels of high-density lipoprotein cholesterol. The course of ASCVD also appears to be more fulminant with higher mortality.

Objective

In light of these issues, the Lipid Association of India (LAI) endeavored to develop revised guidelines with more aggressive low-density lipoprotein cholesterol (LDL-C) goals in secondary prevention and for patients with familial hypercholesterolemia compared to guidelines in the United States and other countries.

Methods

Owing to the paucity of clinical outcomes data in India, it was necessary to place major emphasis on expert opinion as a complement to randomized placebo-controlled data generated mostly in non-Indian cohorts. To facilitate this process, the LAI conducted a series of 19 meetings among 162 lipid specialists in 13 cities throughout India over a period of 11 months before formulating this expert consensus statement.

Results

The LAI recommends an LDL-C goal <50 mg/dL in all patients in secondary prevention or very high-risk primary prevention but proposes an optional goal ≤30 mg/dL in category A extreme-risk patients (eg, coronary artery disease + familial hypercholesterolemia) and a recommended goal ≤30 mg/dL in category B extreme-risk patients [coronary artery disease + (1) diabetes and polyvascular disease/≥3 major ASCVD risk factors/end organ damage, or (2) recurrent acute coronary syndrome within 12 months despite LDL-C <50 mg/dL, or (3) homozygous familial hypercholesterolemia].

Conclusions

More aggressive LDL-C goals are needed for prevention of ASCVD in India, as described in this expert consensus statement. Use of statins and ezetimibe needs to increase in India in combination with improved control of other ASCVD risk factors. Proprotein convertase subtilisin kexin type 9 inhibitors can improve LDL-C goal achievement in patients with refractory hypercholesterolemia.

中文翻译：

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印度二级预防和家族性高胆固醇血症的拟议低密度脂蛋白胆固醇目标，重点是PCSK9抑制剂单克隆抗体：印度脂质协会的专家共识声明。

背景

与西方国家相比，印度的动脉粥样硬化性心血管疾病（ASCVD）发病率非常高，并且还在增加。此外，ASCVD事件发生在年轻时，只有中等程度的高胆固醇血症，最常见的是低密度的高密度脂蛋白胆固醇。ASCVD的病程似乎也更加成功，死亡率更高。

目的

鉴于这些问题，与美国和美国的指南相比，印度脂质协会（LAI）致力于制定修订后的指南，在二级预防和家族性高胆固醇血症患者中，制定更具攻击性的低密度脂蛋白胆固醇（LDL-C）目标。其他国家。

方法

由于印度缺乏临床结果数据，因此有必要将重点放在专家意见上，以补充大多数在非印度人群中产生的随机安慰剂对照数据。为了促进这一过程，LAI在制定此专家共识声明之前的11个月中，在印度13个城市的162名脂质专家中进行了19次会议。

结果

LAI建议所有二级预防或高危一级预防中的患者的LDL-C目标<50 mg / dL，但对A类高危患者（例如冠状动脉疾病+家族性高胆固醇血症），B类极端危险患者的建议目标≤30 mg / dL [冠状动脉疾病+（1）糖尿病和多血管疾病/≥3种主要的ASCVD危险因素/终末器官损害，或（2）复发性急性冠脉疾病LDL-C <50 mg / dL，或（3）纯合子家族性高胆固醇血症，仍可在12个月内患上X综合征。

结论

如本专家共识声明所述，在印度预防ASCVD需要更积极的LDL-C目标。印度需要增加他汀类药物和依泽替米贝的使用，同时还要加强对其他ASCVD危险因素的控制。前蛋白转化酶枯草杆菌蛋白酶kexin 9型抑制剂可改善难治性高胆固醇血症患者的LDL-C目标达成情况。