Browsing by Author "Rajeev Agarwala"

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Does Adopting Western Low-density Lipoprotein Cholesterol Targets Expose Indians to a Higher Risk of Cardiovascular Events? Expert Opinion From the Lipid Association of India
(Journal of Association of Physicians of India, 2024) Raman Puri; Vimal Mehta; Manish Bansal; P. Barton Duell; S.S. Iyengar; Sadanand Shetty; Ian Graham; J.C. Mohan; Upendra Kaul; Dayasagar Rao; Rajeev Agarwala; Gurpreet Singh Wander; Prakash Hazra; Soumitra Kumar; S.K. Wangnoo; Abdul Hamid Zargar; Banshi Saboo; Jamal Yusuf; Vinod M. Vijan; Prem Aggarwal; Sarat Chandra; Ravi R. Kasliwal; P.C. Manoria; M.U. Rabbani; Milan C. Chag; D. Prabhakar; Aziz Khan; Neil Bordoloi; Saravanan Palanippan; Kunal Mahajan; Akshay Pradhan; Dharmender Jain; A. Murugnathan; Pradeep Kumar Dabla; Nagaraj Desai; Mangesh H. Tiwaskar; Devaki R. Nair; Charanjeet Singh; Jayant Panda; Vitull Gupta; Prashant Sahoo; Nathan D. Wong
Adverse cardiovascular (CV) events have declined in Western countries due at least in part to aggressive risk factor control, including dyslipidemia management. The American and European (Western) dyslipidemia treatment guidelines have contributed significantly to the reduction in atherosclerotic cardiovascular disease (ASCVD) incidence in the respective populations. However, their direct extrapolation to Indian patients does not seem appropriate for the reasons described below. In the US, mean low-density lipoprotein cholesterol (LDL-C) levels have markedly declined over the last 2 decades, correlating with a proportional reduction in CV events. Conversely, poor risk factor control and dyslipidemia management have led to increased CV and coronary artery disease (CAD) mortality rates in India. The population-attributable risk of dyslipidemia is about 50% for myocardial infarction, signifying its major role in CV events. In addition, the pattern of dyslipidemia in Indians differs considerably from that in Western populations, requiring unique strategies for lipid management in Indians and modified treatment targets. The Lipid Association of India (LAI) recognized the need for tailored LDL-C targets for Indians and recommended lower targets compared to Western guidelines. For individuals with established ASCVD or diabetes with additional risk factors, an LDL-C target of <50 mg/dL was recommended, with an optional target of ≤30 mg/dL for individuals at extremely high risk. There are several reasons that necessitate these lower targets. In Indian subjects, CAD develops 10 years earlier than in Western populations and is more malignant. Additionally, Indians experience higher CAD mortality despite having lower basal LDL-C levels, requiring greater LDL-C reduction to achieve a comparable CV event reduction. The Indian Council for Medical Research—India Diabetes study described a high prevalence of dyslipidemia among Indians, characterized by relatively lower LDL-C levels, higher triglyceride levels, and lower high-density lipoprotein cholesterol (HDL-C) levels compared to Western populations. About 30% of Indians have hypertriglyceridemia, aggravating ASCVD risk and complicating dyslipidemia management. The levels of atherogenic triglyceride-rich lipoproteins, including remnant lipoproteins, are increased in hypertriglyceridemia and are predictive of CV events. Hypertriglyceridemia is also associated with higher levels of small, dense LDL particles, which are more atherogenic, and higher levels of apolipoprotein B (Apo B), reflecting a higher burden of circulating atherogenic lipoprotein particles. A high prevalence of low HDL-C, which is often dysfunctional, and elevated lipoprotein(a) [Lp(a)] levels further contribute to the heightened atherogenicity and premature CAD in Indians. Considering the unique characteristics of atherogenic dyslipidemia in Indians, lower LDL-C, non-HDL-C, and Apo B goals compared to Western guidelines are required for effective control of ASCVD risk in Indians. South Asian ancestry is identified as a risk enhancer in the American lipid management guidelines, highlighting the elevated ASCVD risk of Indian and other South Asian individuals, suggesting a need for more aggressive LDL-C lowering in such individuals. Hence, the LDL-C goals recommended by the Western guidelines may be excessively high for Indians and could result in significant residual ASCVD risk attributable to inadequate LDL-C lowering. Further, the results of Mendelian randomization studies have shown that lowering LDL-C by 5–10 mg/dL reduces CV risk by 8–18%. The lower LDL-C targets proposed by LAI can yield these incremental benefits. In conclusion, Western LDL-C targets may not be suitable for Indian subjects, given the earlier presentation of ASCVD at lower LDL-C levels. They may result in greater CV events that could otherwise be prevented with lower LDL-C targets. The atherogenic dyslipidemia in Indian individuals necessitates more aggressive LDL-C and non-HDL-C lowering, as recommended by the LAI, in order to stem the epidemic of ASCVD in India. © The Author(s).
National Consensus Statement on Role of Bisoprolol across Cardiovascular Continuum: Special Focus on Women
(Journal of Association of Physicians of India, 2025) Hriday Kumar Chopra; Kamal Kumar Sethi; Tiny Nair; Chandrashekhar Kashinath Ponde; Saumitra Ray; Sarita Rao; Shanmunga Sundaram; Dinesh K. Khullar; Navin C. Nanda; Jatinder Pal Singh Sawhney; Sarita M. Bajaj; Yatin Mehta; Arvind Kumar Pancholia; Pradeep Jain; Ashok Kumar Omar; Aditya K. Kapoor; Rishi Rishi Sethi; Atul Damodar Abhyankar; Vinod Kumar Sharma; Anil Dhall; Ajay Kumar Sinha; Shishu Shankar Mishra; Satya Narayan Rautray; Gyarsi Lal Sharma; Ashwani Mehta; Rajeev Agarwala; Rajeev Kumar Rajput; Ajay Umakant Mahajan; Sanjay C. Porwal; Ramesh K. Hotchandani; Vishal Rastogi; Rajeev Passey; Mohan Bhargava; Justin Paul Gnanaraj; Dorairaj Prabhakaran; Vivudh Pratap Singh; Vinod Mittal; Vitull Kumar Gupta; Anil Kumar Bhalla; Virender Kumar Katyal; Ishwarappa Balekundri Vijaylakshami; Asha Moorthy; Poonam Malhotra; Vanita Arora; Mona Bhatia; Prabhavathy Bhat; Shibba Takkar Chhabra; Sugandhi Gopal; Tripti Deb; Preeti Gupta; Hemlata Tewari; Anupam Goel; Rekha Mishra; Lovelina Singh; Zakia Khan; Geeta S. Sheth; Chandra Mukhi; Inder Pal Singh Kalra; Yogender Kumar Arora; Uttara Das; Kavita Tyagi; Satya Nand Pathak; Samir Kubba; Saurabh Bagga; Asha Mahilmaran; Ameet Sattur; Rohit Tandon; Dharmender Jain; Hetan C. Shah; Cecily Mary Majella; Ravi Prakash; Manish Aggarwal; Ruchi Verma; Sumit Sethi; Alka Gujral; Kanika Sood; Sonia Rawat; Varsha Kaul; Surinder S. Arora; Manjiti Arora; Veena Bhat; Anil Kumar Bali; Sanjay Sood; Shakuntala Dawesar; Bhushan K. Dawesar; Nilakshi Deka; Makarand Paithankar; Rajiv Handa; Nitish Parmar; Sheikh U. Nabi; Naveen K. Garg; Sandeep Sharma; Vivek Tandon; Manoj Pabrai; Samshad Alam; Manju Tyagi; Manisha Sahay; Manju Hotchandani; Anupama Kathpalia; Ish Kathpalia
Cardiovascular diseases (CVDs) represent a significant health concern worldwide, with women facing distinct challenges in the prevention, diagnosis, and management of these conditions. In India, hypertension is a prevalent cardiovascular (CV) risk factor, affecting nearly one-third of adults, and women experience a disproportionately high burden across all age-groups. The CV continuum, which spans from risk factors to CV events and ultimately to heart failure (HF), demonstrates how the progression of CVD impacts women at each stage differently due to gender-specific mechanisms like hormonal influences, pregnancy complications and the effects of menopause. This manuscript aims to present a set of consensus statements developed by an expert panel in India, focusing on the role of bisoprolol across the CV continuum with special attention to women. The consensus was formed based on a thorough review of clinical experiences, existing clinical data and alignment with both global and regional clinical guidelines. The manuscript highlights the gender-specific CV risks faced by women, their higher mortality rates following acute cardiac events, delayed diagnoses and less aggressive treatments. It also discusses bisoprolol as an effective therapy for managing hypertension, HF and other CV conditions in women. Bisoprolol's benefits include consistent blood pressure (BP) control, improved outcomes in HF and reduced CV risks, particularly in postmenopausal women and those with comorbidities. The manuscript underscores the need for gender-tailored approaches to the CV continuum, from prevention through to management, to address these challenges and improve outcomes for women. © The Author(s).