Management of triglycerides, non-high density lipoprotein cholesterol and high density lipoprotein cholesterol

Area of Science:

• Cardiology
• Metabolic Disorders
• Public Health

Background:

• Dyslipidemia, including high total cholesterol/LDL-C and low HDL-C, is a significant risk factor for atherosclerotic cardiovascular disease (ASCVD).
• Asian Indians exhibit a higher prevalence of atherogenic dyslipidemia, characterized by elevated triglycerides (TG), low HDL-C, and increased small dense LDL (sdLDL).
• Hypertriglyceridemia is linked to obesity, metabolic syndrome, and diabetes mellitus, necessitating management to reduce ASCVD and pancreatitis risks.

Purpose of the Study:

• To summarize the characteristics of dyslipidemia, particularly atherogenic dyslipidemia in Asian Indians.
• To outline the management goals and strategies for hypertriglyceridemia.
• To discuss the role of non-HDL-C and HDL-C in ASCVD risk assessment and management.

Main Methods:

• Literature review and synthesis of current understanding regarding dyslipidemia and cardiovascular risk.
• Analysis of the prevalence and characteristics of dyslipidemia in the Asian Indian population.
• Evaluation of therapeutic targets and guidelines for managing dyslipidemia.

Main Results:

• Atherogenic dyslipidemia is prevalent in Asian Indians, presenting challenges in ASCVD risk reduction.
• Management of hypertriglyceridemia involves lifestyle modifications and pharmacotherapy, with specific targets for severe vs. mild/moderate cases.
• Non-HDL-C is a valuable metric for ASCVD risk assessment, especially in patients with mild to moderate hypertriglyceridemia, and is included in some international guidelines.
• Low HDL-C is common in Indians, but therapeutic strategies to increase HDL-C have not demonstrated cardiovascular benefits, making it not a current drug-based treatment target.

Conclusions:

• Atherogenic dyslipidemia, characterized by high TG and low HDL-C, is a critical concern for ASCVD risk in Asian Indians.
• Non-HDL-C measurement offers a superior risk assessment tool compared to LDL-C in certain dyslipidemic populations.
• Current evidence does not support HDL-C as a therapeutic target for cardiovascular risk reduction.