Highlights
- •74 million adults in India had diabetes in 2021 (1 in 12), more than half undiagnosed.
- •Diabetes in India is associated with earlier age of onset compared to Western groups.
- •More than 90% of Indian patients with diabetes are estimated to have dyslipidemia.
- •Indian patients with diabetes have an aggressive course of atherosclerosis.
- •Aggressive treatment of diabetic dyslipidemia is needed to prevent ASCVD events.
Abstract
In 2021 an estimated 74 million individuals had diabetes in India, almost all type
2 diabetes. More than half of patients with diabetes are estimated to be undiagnosed
and more 90% have dyslipidemia that is associated with accelerated development of
atherosclerotic cardiovascular disease (ASCVD). Patients of Indian descent with diabetes
have multiple features that distinguish them from patients with diabetes in Western
populations. These include characteristics such as earlier age of onset, higher frequency
of features of the metabolic syndrome, more prevalent risk factors for ASCVD, and
more aggressive course of ASCVD complications. In light of the unique features of
diabetes and diabetic dyslipidemia in individuals of Indian descent, the Lipid Association
of India developed this expert consensus statement to provide guidance for management
of diabetic dyslipidemia in this very high risk population. The recommendations contained
herein are the outgrowth of a series of 165 webinars conducted by the Lipid Association
of India across the country from May 2020 to July 2021, involving 155 experts in endocrinology
and cardiology and an additional 2880 physicians.
Keywords
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References
- IDF diabetes atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045.Diabetes Res Clin Pract. 2022; 183109119
- Epidemiology of type 2 diabetes in India.Indian J Ophthalmol. 2021; 69: 2932-2938
- The increasing burden of diabetes and variations among the states of India: the global burden of disease study 1990–2016.Lancet Glob Health. 2018; 6: e1352-e1362
- Incidence of diabetes and prediabetes and predictors of progression among Asian Indians: 10-year follow-up of the Chennai urban rural epidemiology study (CURES).Diabetes Care. 2015; 38: 1441-1448
- Prevalence of diabetes and prediabetes in 15 states of India: results from the ICMR-INDIAB population-based cross-sectional study.Lancet Diabetes Endocrinol. 2017; 5: 585-596
- Cardiovascular disease and risk management: standards of medical care in diabetes-2022.Diabetes Care. 2022; 45: S144-S174
- AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood cholesterol: executive summary: a report of the american college of cardiology/American heart association task force on clinical practice guidelines.J Am Coll Cardiol 2019. 2018; 73: 3168-3209
- ESC national cardiac societies. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk.Atherosclerosis. 2019; 290 (Erratum in: Atherosclerosis. 2020;292:160-162. Erratum in: Atherosclerosis 2020;294:80-82): 140-205
- The changing landscape of lipid-lowering therapy after the new ESC/EAS guidelines for the management of dyslipidaemias: launching the era of triple hypolipidaemic therapy in very high risk patients.Atherosclerosis. 2020; 292: 231-233
- 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD.Eur Heart J. 2020; 41: 255-323
- NLA expert panel. National lipid association recommendations for patient-centered management of dyslipidemia: part 2.J Clin Lipidol. 2015 Nov-Dec; 9: S1-122.e1
- American association of clinical endocrinologists and American College of Endocrinology guidelines for management of dyslipidemia and prevention of cardiovascular disease.Endocr Pract. 2017; 23: 1-87
- Changing definitions of metabolic syndrome.Indian J Endocrinol Metab. 2012; 16: 7-12
- Lipid association of India expert consensus statement on management of dyslipidemia in Indians 2016: part 1.J Assoc Physicians India. 2016; 64: 7-52
- Lipid Association of India (LAI) expert consensus statement on management of dyslipidaemia in Indians 2017: part 2.Clin Lipidol. 2017; 12: 56-109https://doi.org/10.1080/17584299.2017.1383700
- Lipid Association of India expert consensus statement on management of dyslipidemia in Indians 2020: part III.J Assoc Phys India. 2020; 68: 8-58
- Proposed low-density lipoprotein cholesterol goals for secondary prevention and familial hypercholesterolemia in India with focus on PCSK9 inhibitor monoclonal antibodies: expert consensus statement from Lipid Association of India.J Clin Lipidol. 2020; 14: e1-e13
- Management of dyslipidaemia for the prevention of stroke: clinical practice recommendations from the Lipid Association of India.Curr Vasc Pharmacol. 2022; 20: 134-155
- Evidence for intensive LDL-C lowering for acute coronary syndrome: recommendations from the Lipid Association of India.J Clin Lipidol. 2022; 16: 261-271
- Chronic complications in newly diagnosed patients with type 2 diabetes mellitus in India.Indian J Endocrinol Metab. 2014; 18: 355-360
- Age- and sex-specific prevalence of diabetes and impaired glucose regulation in 11 Asian cohorts.Diabetes Care. 2003; 26: 1770-1780
- Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: phase I results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study.Diabetologia. 2011; 54: 3022-3027
- Correlates of prediabetes and type II diabetes in US South Asians: findings from the Mediators of Atherosclerosis in South Asians living in America (MASALA) study.Ann Epidemiol. 2015; 25: 77-83
- Metabolic syndrome in South Asians.Indian J Endocrinol Metab. 2012; 16: 44-55
- The metabolic syndrome and dyslipidemia among Asian Indians: a population with high rates of diabetes and premature coronary artery disease.J Cardiometab Syndr. 2007; 2 (Fall): 267-275
- Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults.Circulation. 2004; 110: 1245-1250
- Diabetes in South Asians: is the phenotype different?.Diabetes. 2014; 63: 53-55
- Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians.Lancet. 1991; 337: 382-386
- Subcutaneous abdominal adipose tissue is associated with the metabolic syndrome in Asian Indians independent of intraabdominal and total body fat.Heart. 2010; 96: 579-583
- Relation of serial changes in childhood bodymass index to impaired glucose tolerance in young adulthood.N Engl J Med. 2004; 350: 865-875
- Serum cholesterol, diet and coronary heart-disease in Africans and Asians in Uganda.Lancet. 1959; 2: 534-537
- Ethnic differences in mortality from ischemic heart disease and cerebrovascular disease in England and Wales.BMJ. 1991; 302: 560-564
- Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the study of health assessment and risk in ethnic groups (SHARE).Lancet. 2000; 356: 279-284
- Emerging epidemic of cardiovascular disease in developing countries.Circulation. 1998; 97: 596-601
- Meta-analysis of coronary heart disease prevalence in India.Indian Heart J. 1996; 48: 241-245
- Cardiovascular disease in India: a 360 degree overview.Med J Armed Forces India. 2020; 76: 1-3
- Presence of coronary artery disease in diabetic and non-diabetic South Asian immigrants.Indian Heart J. 2018; 70: 50-55
- Cardiovascular risk factors, micro and macrovascular complications at diagnosis in patients with young onset type 2 diabetes in India: CINDI 2.Indian J Endocrinol Metab. 2016; 20: 114-118
- Do known risk factors explain the higher coronary heart disease mortality in South Asian compared with European men? Prospective follow-up of the Southall and Brent studies, UK.Diabetologia. 2006; 49: 2580-2588
- Prevalence and pattern of diabetic dyslipidemia in Indian type 2 diabetic patients.Diabetes Metab Syndr. 2010; 4: 10-12
- An epidemiological study of obesity in adults in the urban population of Delhi.J Assoc Phys India. 1994; 42: 212-215
- The association of dyslipidemia and obesity with glycated hemoglobin.Clin Diabetes Endocrinol. 2015; 1 (23): 6
- Increased prevalence of smaller and denser LDL particles in Asian Indians.Arterioscler Thromb Vasc Biol. 1999; 19: 2749-2755
- Coronary heart disease and its risk factors in first-generation immigrant Asian Indians to the United States of America.Indian Heart J. 1996; 48: 343-353
- US trends in premature heart disease mortality over the past 50 years: where do we go from here?.Trends Cardiovasc Med. 2020; 30: 364-374
- Heart protection study collaborative group. MRC/BHF heart protection study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial.Lancet. 2003; 361: 2005-2016
- Reduced coronary events in simvastatin-treated patients with coronary heart disease and diabetes or impaired fasting glucose levels: subgroup analyses in the Scandinavian simvastatin survival study.Arch Intern Med. 1999; 159: 2661-2667
- Effect of lowering LDL cholesterol substantially below currently recommended levels in patients with coronary heart disease and diabetes: the Treating to New Targets (TNT) study.Diabetes Care. 2006; 29: 1220-1226
- IMPROVE-IT (improved reduction of outcomes: vytorin efficacy international trial) investigators. Benefit of adding ezetimibe to statin therapy on cardiovascular outcomes and safety in patients with versus without diabetes mellitus: results from IMPROVE-IT (Improved reduction of outcomes: vytorin efficacy international trial).Circulation. 2018; 137: 1571-1582
- Impact of triglyceride levels beyond low-density lipoprotein cholesterol after acute coronary syndrome in the PROVE IT-TIMI 22 trial.J Am Coll Cardiol. 2008; 51: 724-730
- Association of LDL cholesterol, non-HDL cholesterol, and apolipoprotein B levels with risk of cardiovascular events among patients treated with statins: a meta-analysis.JAMA. 2012; 307: 1302-1309
- Fourier steering committee and Investigators. Evolocumab and clinical outcomes in patients with cardiovascular disease.N Engl J Med. 2017; 376: 1713-1722
- Dapagliflozin decreases small dense low-density lipoprotein-cholesterol and increases high-density lipoprotein 2-cholesterol in patients with type 2 diabetes: comparison with sitagliptin.Cardiovasc Diabetol. 2017; 16: 8
- Mechanism of increased LDL (Low-Density Lipoprotein) and decreased triglycerides with SGLT2 (Sodium-Glucose Cotransporter 2) inhibition.Arterioscler Thromb Vasc Biol. 2018; 38: 2207-2216
- GLP-1 receptor agonists and cardiovascular disease: a meta-analysis of recent cardiac outcome trials.Cardiovasc Drugs Ther. 2018; 32: 65-72
- Effect of glucagon-like peptide-1 receptor agonists on lipid profiles among type 2 diabetes: a systematic review and network meta-analysis.Clin Ther. 2015; 37: 225-241.e8
- Odyssey outcomes committees and Investigators. Alirocumab and cardiovascular outcomes after acute coronary syndrome.N Engl J Med. 2018; 379: 2097-2107
- PCSK9 inhibitor therapy: a systematic review and meta-analysis of metabolic and cardiovascular outcomes in patients with diabetes.Diabetes Obes Metab. 2019; 21: 903-908
- Cardiovascular risk factor targets and cardiovascular disease event risk in diabetes: a pooling project of the atherosclerosis risk in communities study, multi-ethnic study of atherosclerosis, and Jackson heart study.Diabetes Care. 2016; 39: 668-676
- Control of cardiovascular risk factors among US adults with type 2 diabetes with and without cardiovascular disease.Am J Cardiol. 2019; 124: 522-527
- ESC scientific document group. 2016 ESC/EAS guidelines for the management of dyslipidaemias.Eur Heart J. 2016; 37: 2999-3058
- Fighting the atherosclerotic cardiovascular disease epidemic: declaring war on lipids by lipid association of India.J Assoc Phys India. 2020 Nov; 68: 6-7
- Gould investigators. Use of lipid-lowering therapies over 2 years in GOULD, a registry of patients with atherosclerotic cardiovascular disease in the US.JAMA Cardiol. 2021; 6: 1-9
- Very low levels of atherogenic lipoproteins and the risk for cardiovascular events: a meta-analysis of statin trials.J Am Coll Cardiol. 2014; 64: 485-494
- Long-term safety and efficacy of achieving very low levels of low-density lipoprotein cholesterol: a prespecified analysis of the IMPROVE-IT Trial.JAMA Cardiol. 2017; 2: 547-555
- Open-label study of long-term evaluation against LDL cholesterol (OSLER) Investigators. Efficacy and safety of evolocumab in reducing lipids and cardiovascular events.N Engl J Med. 2015; 372: 1500-1509
- Odyssey long term investigators. Efficacy and safety of alirocumab in reducing lipids and cardiovascular events.N Engl J Med. 2015; 372: 1489-1499
- Efficacy and safety of further lowering of low-density lipoprotein cholesterol in patients starting with very low levels: A meta-analysis.JAMA Cardiol. 2018; 3: 823-828
- Clinical efficacy and safety of evolocumab in high-risk patients receiving a statin: secondary analysis of patients with low LDL cholesterol levels and in those already receiving a maximal-potency statin in a randomized clinical trial.JAMA Cardiol. 2017; 2: 1385-1391
- Fourier investigators. Clinical efficacy and safety of achieving very low LDL-cholesterol concentrations with the PCSK9 inhibitor evolocumab: a prespecified secondary analysis of the FOURIER trial.Lancet. 2017; 390: 1962-1971
- Very low achieved low-density lipoprotein cholesterol level with alirocumab treatment after acute coronary syndrome: odyssey outcomes.Eur Heart J. 2019; 40: P1226
- Effect of alirocumab on mortality after acute coronary syndromes.Circulation. 2019; 140: 103-112
- Mustard oil and cardiovascular health: why the controversy?.J Clin Lipidol. 2022; 16: 13-22
- Prevention of atherosclerotic cardiovascular disease in South Asians in the US: a clinical perspective from the national lipid association.J Clin Lipidol. 2021; 15: 402-422
- American heart association nutrition committee of the council on lifestyle and cardiometabolic health; council on epidemiology and prevention; council on cardiovascular disease in the young; council on cardiovascular and stroke nursing; and council on clinical cardiology. Omega-3 polyunsaturated fatty acid (fish oil) supplementation and the prevention of clinical cardiovascular disease: a science advisory from the American heart association.Circulation. 2017; 135: e867-e884
- Obesity-related non-communicable diseases: south Asians vs white Caucasians.Int J Obes (Lond). 2011; 35: 167-187
- Reduce-IT investigators. Rationale and design of REDUCE-IT: reduction of cardiovascular events with icosapent ethyl-intervention trial.Clin Cardiol. 2017; 40: 138-148
- Serum triglycerides as a risk factor for cardiovascular diseases in type 2 diabetes mellitus: a systematic review and meta-analysis of prospective studies.Cardiovasc Diabetol. 2019; 18: 48
- Triglycerides and residual atherosclerotic risk.J Am Coll Cardiol. 2021; 77: 3031-3041
- Fibrates and future PPAR alpha agonists in the treatment of cardiovascular disease.Nat Clin Pract Cardiovasc Med. 2008; 5: 542-553
- Legacy effect of fibrate add-on therapy in diabetic patients with dyslipidemia: a secondary analysis of the Accordion study.Cardiovasc Diabetol. 2020; 19: 28
- Nonfasting lipids, lipoproteins, and apolipoproteins in individuals with and without diabetes: 58434 individuals from the Copenhagen general population study.Clin Chem. 2011; 57: 482-489
- Assessment and clinical relevance of non-fasting and postprandial triglycerides: an expert panel statement.Curr Vasc Pharmacol. 2011; 9: 258-270
- Diagnostic value of postprandial triglyceride testing in healthy subjects: a meta-analysis.Curr Vasc Pharmacol. 2011; 9: 271-280
Article info
Publication history
Published online: November 22, 2022
Accepted:
November 9,
2022
Received:
August 12,
2022
Identification
Copyright
© 2022 National Lipid Association. Published by Elsevier Inc. All rights reserved.
