1. According to the evidence, people with Atherosclerotic Cardiovascular Disease (ASCVD) are a Heterogeneous Population, with some having a higher risk than others. In these patients, further reducing Low-density Lipoprotein Cholesterol (LDL-C) can reduce future Cardiovascular (CV) events. As a result, Lipid Association of India (LAI) experts felt there was a need for an extreme risk group.
2. Statin therapy is remarkably safe; typically, treating 10,000 patients for 5 years with a standard statin regimen is expected to prevent 1,000 major Vascular events (secondary prevention) and 500 major Vascular events (primary prevention).
3. LAI recommendations-2020
a. Elevated Apolipoprotein B (apoB) is a moderate Nonconventional risk factor (a level >110 mg/dL of apoB corresponds to an LDL-C >130 mg/dL).
b. ApoB measurement is recommended in high-risk subjects after LDL-C, and Non-high-density Lipoprotein Cholesterol (non-HDL-C) goals have been achieved. Discordant elevated apoB levels may identify individuals who have high residual cholesterol risk. This may warrant intensive statin therapy and the use of nonstatin drugs.
c. The ASCVD risk assessment classifies hsCRP 2 mg/L or more as a moderate Nonconventional risk factor.
d. hsCRP may help identify patients with high risk for subsequent adverse cardiac events, which may require more aggressive management of risk factors in the post-ACS (acute coronary syndrome) scenario. Readings of hsCRP taken at least 4 weeks after an ACS should be taken into consideration for this.
Dr. Raman Puri is an experienced Interventional Cardiologist with 39+ years in the field. He is a Fellow in Cardiology, National Cardiovascular Centre, Osaka, Japan, and also a Clinical Fellow in Interventional Cardiology Hospital Charles, Nicolas, France. He has written several publications in reputed international as well as national medical journals.
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