Lipid Association of India: LAI Expert Consensus Statement-2020

• 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.

• 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).

• LAI recommendations-2020

• 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).

• 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.

• The ASCVD risk assessment classifies hsCRP 2 mg/L or more as a moderate Nonconventional risk factor.

• 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.