Cardiovascular Disease Epidemic in India and Triglyceride-Associated Residual Atherosclerotic Cardiovascular Disease Risk

Abstract

Cardiovascular disease (CVD) is the leading global cause of mortality, with a significant rise in low- and middle-income countries. India faces a substantial burden of CVD, with alarming prevalence rates and an increase in associated deaths over the years. Despite a comparable cardiovascular death rate to Western populations, Indians developed atherosclerotic cardiovascular disease (ASCVD) a decade earlier. Lifestyle factors, genetic predisposition, and various risk factors contribute to this high prevalence. The management of ASCVD risk in India lifestyle measures, addressing risk factors such as sedentary lifestyle, unhealthy diet, obesity, metabolic syndrome, smoking, dyslipidemia, prediabetes, diabetes, and hypertension. Specifically, focusing on lipid management guidelines, low-density lipoprotein cholesterol (LDL-C) lowering is considered a crucial global need for additional interventions. This expert paper highlights the role of hypertriglyceridemia, its association with ASCVD, and the importance of managing triglyceride levels. Non-high-density lipoprotein cholesterol (nonHDL-C) and apolipoprotein B (Apo B) are highlighted as valuable indicators for assessing residual risk beyond LDL-C levels. The Lipid Association of India proposes non-HDL-C as a coprimary target, emphasizing the need for a comprehensive lipid management strategy, particularly in high-risk populations.