apfcbAPFCB eNewscoAPFCB News Volume 3, Issue 1MultidisciplinaryEnglishJan-Jun, 2024NNY20240517ArticlesCardiovascular Disease Epidemic in India and Triglyceride-Associated Residual Atherosclerotic Cardiovascular Disease RiskEnglishY7382PratishthaMehra1EnglishNVimalMehta1EnglishYJamalYusuf1EnglishYSafal1EnglishYPradeep KumarDabla2EnglishY10.62772/APFCB-News.2024.1.1Cardiovascular 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.Englishhttps://apfcb.org/APFCB_News/abstract?id=1References16191. Amini M, Zayeri F, Salehi M. Trend analysis of cardiovascular disease mortality, incidence, and mortality-to-incidence ratio: results from global burden of disease study 2017. BMC Public Health 2021;21:401.2. Krishnan MN. Coronary heart disease and risk factors in India- on the brink of an epidemic? Indian Heart J 2012;64(4):364-7.3. Huffman MD, Prabhakaran D, Osmond C, et al. Incidence of cardiovascular risk factors in an Indian urban cohort results from the New Delhi birth cohort. J Am Coll Cardiol2011;57:1765-74.4. The changing patterns of cardiovascular diseases and their risk factors in the states of India: the global burden of disease study 1990and;ndash;2016. Lancet Glob Health 2018;6:e1339-e1351.5. Kalra A, Jose AP, Prabhakaran P. The burgeoning cardiovascular disease epidemic in Indians- perspectives on contextual factors and potential solutions. Lancet Reg Health Southeast Asia 2023:12:100156.6. Mehta V, Iyengar SS, Yusuf J, Mukhopadhyay S, Sattur GB, Puri R. Fighting the atherosclerotic cardiovascular disease epidemic: Declaring war on lipids by Lipid Association of India. J Assoc Physicians India 2020;68(11[Special]):6-7.7. Ardeshna DR, Bob-Manuel T, Nanda A, Sharma A, Skelton WP 4th, Skelton M, Khouzam RN. Asian-Indians: a review of coronary artery disease in this understudied cohort in the United States. Ann Transl Med 2018;6(1):12.8. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): casecontrol study. Lancet 2004;364:937-52.9. IDF Diabetes Atlas. 10th edition, 2021. https://diabetesatlas.org/data/en/country/93/in.html10. Geldsetzer P, Manne-Goehler J, Theilmann M, et al. Diabetes and hypertension in India: a nationally representative study of 1.3 million adults. JAMA Intern Med 2018;178:363- 72.11. Joshi SR, Anjana RM, Deepa M, et al. Prevalence of dyslipidemia in urban and rural India: the ICMRand;ndash;INDIAB Study. PLoS One 2014;9(5):e96808.12. Lloyd-Jones DM, Morris PB, Ballantyne CM, et al. 2022 ACC Expert Consensus Decision Pathway on the role of nonstatin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk: A report of the American College of Cardiology solution set oversight committee. J Am Coll Cardiol 2022;80(14):1366-1418.13. Mach F, Baigent C, Catapano AL, Koskinas KC, et al; ESC Scientific Document Group. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020;41(1):111-188.14. Puri R, Mehta V, Duell PB, et al. 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(2):e1-e13.15. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 20,536 high-risk individuals: a randomized placebo-controlled trial. Lancet 2002;360(9326):7-22.16. Puri R, Mehta V, Iyengar SS, et al. Triglycerides and atherosclerotic cardiovascular disease. J Assoc Physicians India. 2020 Nov;68(11[Special]):35-41.17. Sacks FM, Tonkin AM, Shepherd J, et al. Effect of pravastatin on coronary disease events in subgroups defined by coronary risk factors: the Prospective Pravastatin Pooling Project. Circulation 2000;102(16):1893-900.18. Bhatt DL, Steg PG, Miller M, et al. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med 2019;380:11-22.19. Budoff MJ, Bhatt DL, Kinninger A, et al. Effect of icosapent ethyl on the progression of coronary atherosclerosis in patients with elevated triglycerides on statin therapy: final results of the EVAPORATE trial. Eur Heart J 2020;41(40):3925-32.20. Nicholls SJ, Lincoff AM, Garcia M, et al. Effect of high-dose omega-3 fatty acids vs corn oil on major adverse cardiovascular events in patients at high cardiovascular risk: The STRENGTH randomized clinical trial. JAMA 2020;324(22):2268-80.21. Oscarsson J, Hurt-Camejo E. Omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid and their mechanisms of action on apolipoprotein B-containing lipoproteins in humans: a review. Lipids Health Dis 2017;16:149.22. Das Pradhan A, Glynn RJ, Fruchart JC, et al. Triglyceride lowering with fenofibrate to reduce cardiovascular risk. N Engl J Med 2022;387:1923-34.23. Puri R, Mehta V, Iyengar SS, et al. Non-HDL cholesterol and atherosclerotic cardiovascular disease. J Assoc Physicians India 2020;68(11[Special]):54-58.24. Robinson JG, Wang S, Jacobson TA. Meta-analysis of comparison of the effectiveness of lowering apolipoprotein B versus low-density lipoprotein cholesterol and non-highdensity lipoprotein cholesterol for cardiovascular risk reduction in randomized trials. Am J Cardiol2012;110:1468-76.