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Should India have separate guidelines for preventing heart diseases?

Here's what the President of Public Health Foundation Dr. Srinath Reddy had to say about preventing heart diseases in India.

Written by Editorial Team |Updated : June 29, 2015 9:21 AM IST

Heart diseaseAfter the release of new cholesterol guidelines by the American Heart Association (AHA) and the American College of Cardiology (ACC), which asserted that health care providers should prescribe statins (cholesterol lowering drugs) to healthy patients if their 10-year cardiovascular risk is found to be 7.5% or greater, a lot has been thought about whether these guidelines are relevant to India.

Primarily addressing this issue, Mumbai's Asian Heart Institute (AHI), the world renowned cardiac care hospital, held a press conference on Saturday February 15, where keynote speaker Dr K Srinath Reddy, President of the Public Health Foundation of India (PHFI) and the World Heart Federation highlighted the Indian angle for cholesterol guidelines.

Here are the key points presented at the conference:

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Why does India need guidelines for preventing heart diseases at all?

According to statistics presented at the conference, heart diseases will account for 35.9% deaths in India by the year 2030. 'There is an increasing incidence and prevalence of heart diseases in India, and guidelines will surely help to reduce this increasing burden if physicians adhere to them. In fact, it has been found that with every 10% increase in adherence to guidelines, the mortality rate decreases by 10%,' suggested Dr Reddy. Read more about is it necessary to take statins for preventing heart diseases?

Read more about causes, symptoms, diagnosis and treatment of heart disease.

Why can't India follow the American guidelines?

Highlighting the main limitations of AHA guidelines, Dr Reddy mentioned 'The AHA guidelines are somewhat useful for us but not entirely relevant because they don't take into consideration low HDL levels (levels of good cholesterol), high levels of triglycerides and life-time risk factor, which are major concern among Indians.'

'Moreover, there are a lot of differences between diet and lifestyle pattern of Americans and Indians. Indians have more body fat that lean fat unlike Americans may look obese but have lesser body fat. Our diet mainly consists of refined carbohydrates, which is the main reason why high LDL levels are common in Indians, whereas Americans eat more meat. Indians also don't exercise much that adds to increased insulin resistance and diabetes.'

What should be considered when Indian guidelines are to be made?

  • 'Small dense LDL (bad cholesterol) is biggest factor that adds to the risk of heart diseases. But in India, most laboratories do not have the measurement tools for LDL, so there's no point of taking it into consideration. Instead the ratio of triglycerides to HDL (good cholesterol) that captures risk of high LDL should be considered. A ratio higher than 3.8 may indicate higher LDL.' Here's our mega-guide on cholesterol.
  • 'Low dose statin therapy should be considered for Indians rather than high dose. Since statins have been shown to raise blood sugar levels and increase the risk of developing diabetes, its effect among Indians, who are already prone to diabetes, should be identified.'
  • 'Prevention in India should be based on educating people as well as physicians. Indians have common risk factors as other population but within that abdominal obesity, diabetes, unhealthy diet, low exercise is more common. Physicians should be able to identify risk factors (age, weight, physical activity etc) and suggest laboratory tests to patients so as to confirm whether they are risk.'
  • Dr Reddy also emphasised the need for stronger policy measures in India. 'If the taxes on tobacco and junk foods are increased and healthy foods are subsidised then people will automatically turn to healthier options.' Read more about the secret to countering a high cholesterol diet.

Till then what should be done?

Dr Reddy suggests, 'Right now India doesn't have long-term data to have definitive guidelines. Until then, we should follow the British guidelines or New Zealand heart foundation guidelines as our best bet because they take into consideration multiple risk factors including low HDL levels and long-term risk of patients, making it more relevant to Indians.'

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