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Puri R, Bansal M, Mehta V, Duell PB, Wong ND, Iyengar SS, Kalra D, Nair DR, Nanda NC, Narula J, Deedwania P, Yusuf J, Dalal JJ, Shetty S, Vijan VM, Agarwala R, Kumar S, Vijay K, Khan A, Wander GS, Manoria PC, Wangnoo SK, Mohan V, Joshi SR, Singh B, Kerkar P, Rajput R, Prabhakar D, Zargar AH, Saboo B, Kasliwal RR, Ray S, Bansal S, Rabbani MU, Chhabra ST, Chandra S, Bardoloi N, Kavalipati N, Sathyamurthy I, Mahajan K, Pradhan A, Khanna NN, Khadgawat R, Gupta P, Chag MC, Gupta A, Murugnathan A, Narasingan SN, Upadhyaya S, Mittal V, Melinkeri RP, Yadav M, Mubarak MR, Pareek KK, Dabla PK, Nanda R, Mohan JC. Lipid Association of India 2023 update on cardiovascular risk assessment and lipid management in Indian patients: Consensus statement IV. J Clin Lipidol 2024; 18:e351-e373. [PMID: 38485619 DOI: 10.1016/j.jacl.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE In 2016, the Lipid Association of India (LAI) developed a cardiovascular risk assessment algorithm and defined low-density lipoprotein cholesterol (LDL-C) goals for prevention of atherosclerotic cardiovascular disease (ASCVD) in Indians. The recent refinements in the role of various risk factors and subclinical atherosclerosis in prediction of ASCVD risk necessitated updating the risk algorithm and treatment goals. METHODS The LAI core committee held twenty-one meetings and webinars from June 2022 to July 2023 with experts across India and critically reviewed the latest evidence regarding the strategies for ASCVD risk prediction and the benefits and modalities for intensive lipid lowering. Based on the expert consensus and extensive review of published data, consensus statement IV was commissioned. RESULTS The young age of onset and a more aggressive nature of ASCVD in Indians necessitates emphasis on lifetime ASCVD risk instead of the conventional 10-year risk. It also demands early institution of aggressive preventive measures to protect the young population prior to development of ASCVD events. Wide availability and low cost of statins in India enable implementation of effective LDL-C-lowering therapy in individuals at high risk of ASCVD. Subjects with any evidence of subclinical atherosclerosis are likely to benefit the most from early aggressive interventions. CONCLUSIONS This document presents the updated risk stratification and treatment algorithm and describes the rationale for each modification. The intent of these updated recommendations is to modernize management of dyslipidemia in Indian patients with the goal of reducing the epidemic of ASCVD among Indians in Asia and worldwide.
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Affiliation(s)
- Raman Puri
- Chair, FNLA, Sr. Consultant Cardiologist, Cardiac Care Centre, New Delhi, India (Dr Puri).
| | - Manish Bansal
- Co-Chair, Senior Director, Department of Cardiology, Medanta- The Medicity, Gurugram, Haryana, India (Dr Bansal)
| | - Vimal Mehta
- Co-Chair, Director-Professor, Department of Cardiology, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India (Dr Mehta)
| | - P Barton Duell
- Co-Chair, FNLA, Professor of Medicine, Knight Cardiovascular Institute and Division of Endocrinology Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, OR, USA (Dr Duell)
| | - Nathan D Wong
- FNLA, Professor & Director Heart Disease Prevention program division of Cardiology, University of California, Irvine School of Medicine, USA (Dr Wong)
| | - S S Iyengar
- Sr. Consultant and Head, Department of Cardiology, Manipal Hospital, Bangalore, Karnataka, India (Dr Iyengar)
| | - Dinesh Kalra
- FNLA, Professor of Medicine, University of Louisville School of Medicine, USA (Dr Kalra)
| | - Devaki R Nair
- Sr. Consultant Department of Lipidology and Chemical pathologist, Royal Free Hospital, London, UK (Dr Nair)
| | - Navin C Nanda
- Professor of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, KY, USA (Dr Nanda)
| | - Jagat Narula
- Executive Vice President and Chief Academic Officer, UT Health, Houston, TX USA (Dr Narula)
| | - P Deedwania
- Professor of Medicine, University of California San Francisco, San Francisco, CA, USA (Dr Deedwania)
| | - Jamal Yusuf
- Director-Professor and Head, Department of Cardiology, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India (Dr Yusuf)
| | - Jamshed J Dalal
- Sr. Consultant Cardiologist, Kokilaben Dhirubhai Ambani Hospital, Director-Centre for Cardiac Sciences, Mumbai, Maharashtra, India (Dr Dalal)
| | - Sadanand Shetty
- Head, Department of Cardiology, K. J. Somaiya Super Specialty Institute, Sion (East), Mumbai, Maharashtra, India (Dr Shetty)
| | - Vinod M Vijan
- Director, Vijan Hospital & Research Centre, Nashik, Uniqare Hospital, PCMC, Pune, India (Dr Vijan)
| | - Rajeev Agarwala
- Sr. Consultant Cardiologist, Jaswant Rai Specialty Hospital, Meerut, Uttar Pradesh, India (Dr Agarwala)
| | - Soumitra Kumar
- Professor and Head, Department of Cardiology, Vivekananda Institute of Medical Sciences, Kolkata, India (Dr Kumar)
| | - Kris Vijay
- FNLA, Professor of Medicine, Arizona Heart Foundation, University of Arizona, Phoenix, USA (Dr Vijay)
| | - Aziz Khan
- Sr. Consultant cardiologist, Crescent Hospital and Heart Centre, Nagpur, Maharashtra, India (Dr Khan)
| | - Gurpreet Singh Wander
- Professor of Cardiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India (Dr Wander)
| | - P C Manoria
- Director, Manoria Heart and critical Care Hospital, Bhopal, Madhya Pradesh, India (Dr Manoria)
| | - S K Wangnoo
- Sr. Consultant Endocrinology & Diabetologist, Indraprastha Apollo Hospitals, New Delhi, India (Dr Wangnoo)
| | - Viswanathan Mohan
- Director Madras Diabetic Research foundation and Chairman & chief Diabetology, Dr Mohan Diabetes Specialties Centre, Chennai, India (Dr Mohan)
| | - Shashank R Joshi
- Sr. Consultant Endocrinologist, Lilavati Hospital, Mumbai, Maharashtra, India (Dr Joshi)
| | - Balbir Singh
- Chairman - Cardiac Sciences, Max Hospital Saket, New Delhi, India (Dr Singh)
| | - Prafulla Kerkar
- Sr. Consultant Cardiologist, Asian Heart Institute and Research Centre, Mumbai, India (Dr Kerkar)
| | - Rajesh Rajput
- Professor & Head, Department of Endocrinology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India (Dr Rajput)
| | - D Prabhakar
- Sr. Consultant, Department of Cardiology, Apollo Hospitals, Chennai, Tamil Nadu, India (Dr Prabhakar)
| | - Abdul Hamid Zargar
- Medical Director, Centre for Diabetes and Endocrine Care, National Highway, Gulshan Nagar, Srinagar, J&K, India (Dr Zargar)
| | - Banshi Saboo
- Chairman-Diacare- Diabetes Care, and Hormone Clinic, Ahmedabad, India (Dr Saboo)
| | - Ravi R Kasliwal
- Chairman, Division of Clinical & Preventive Cardiology, Medanta- The Medicity, Gurugram, Haryana, India (Dr Kasliwal)
| | - Saumitra Ray
- Director of Intervention Cardiology, AMRI (S), Kolkata, India (Dr Ray)
| | - Sandeep Bansal
- Professor and Head, Dept. of Cardiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India (Dr Bansal)
| | - M U Rabbani
- Professor Dept. of Cardiology, J. N. Medical College, AMU, Aligarh, India (Dr Rabbani)
| | - Shibba Takkar Chhabra
- Professor Dept. of Cardiology, Dayanand Medical College and Hospital, Ludhiana, India (Dr Chhabra)
| | - Sarat Chandra
- Chief Cardiologist, TX Group of Hospitals, Banjara Hills, Hyderabad, India (Dr Chandra)
| | - Neil Bardoloi
- Managing Director and HOD, Cardiology, Excel Care Hospital, Guwahati, Assam, India (Dr Bardoloi)
| | - Narasaraju Kavalipati
- Director of Cardiology and Sr Interventional Cardiologist, Apollo Hospitals, Hyderabad, India (Dr Kavalipati)
| | - Immaneni Sathyamurthy
- Sr. Consultant Cardiologist, Apollo Hospital, Chennai, Tamil Nadu, India (Dr Sathyamurthy)
| | - Kunal Mahajan
- Director Dept. of Cardiology, Himachal Heart Institute, Mandi, Himachal Pradesh, India (Dr Mahajan)
| | - Akshya Pradhan
- Sr. Consultant, Department of Cardiology King George's Medical University, Lucknow, Uttar Pradesh, India (Dr Pradhan)
| | - N N Khanna
- Sr. Consultant, Department of Cardiology, Indraprastha Apollo Hospitals, New Delhi, India (Dr Khanna)
| | - Rajesh Khadgawat
- Professor, Department of Endocrinology and Metabolism, All India Institute of Medical Sciences (AIIMS), New Delhi, India (Dr Khadgawat)
| | - Preeti Gupta
- Associate Professor Dept. of Cardiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India (Dr Gupta)
| | - Milan C Chag
- Sr. Consultant Cardiologist, Marengo CIMS Hospital, Ahmadabad, Gujarat, India (Dr Chag)
| | - Ashu Gupta
- Sr Consultant Cardiologist, Holy Heart Advanced Cardiac Care and Research Centre, Rohtak, Haryana, India (Dr Gupta)
| | - A Murugnathan
- Sr. Consultant Internal Medicine, AG Hospital, Tirupur, Tamil Nadu, India (Dr Murugnathan)
| | - S N Narasingan
- Former Adjunct Professor of Medicine, The Tamil Nadu Dr MGR Medical University & Managing Director, SNN Specialties Clinic, Chennai, India (Dr Narasingan)
| | - Sundeep Upadhyaya
- Sr. Consultant, Department of Rheumatology, Indraprastha Apollo Hospitals, New Delhi, India (Dr Upadhyaya)
| | - Vinod Mittal
- Sr. Consultant Diabetologist and Head, Centre for Diabetes & Metabolic disease Delhi Heart & Lung Institute, Delhi, India (Dr Mittal)
| | - Rashida Patanwala Melinkeri
- Sr. Consultant, Department of Internal Medicine, KEM Hospital and Sahyadri Hospitals, Pune, Maharashtra, India (Dr Melinkeri)
| | - Madhur Yadav
- Director- Professor of Medicine, Lady Harding Medical College, New Delhi, India (Dr Yadav)
| | - M Raseed Mubarak
- Sr. Consultant Cardiologist, Lanka Hospital, Colombo, Sri Lanka (Dr Mubarak)
| | - K K Pareek
- Head, Department of Medicine, S. N. Pareek Hospital, Dadabari, Kota, Rajasthan, India (Dr Pareek)
| | - Pradeep Kumar Dabla
- Professor of Biochemistry, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India (Dr Dabla)
| | - Rashmi Nanda
- Managing Director, Ashakiran Family Wellness Clinic, Indrapuram, U.P, India (Dr Nanda)
| | - J C Mohan
- Sr. Consultant Cardiologist, Institute of Heart and Vascular Diseases, Jaipur Golden Hospital, New Delhi, India (Dr Mohan)
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Rastogi S, Verma N, Raghuwanshi G, Kumar Verma D, Atam V. Chronomedicine Insights: Evaluating the Impact of Time-Restricted Meal Intake on Lipid Profile Parameters Among Individuals With Type 2 Diabetes in Northern India. Cureus 2024; 16:e56902. [PMID: 38659523 PMCID: PMC11042785 DOI: 10.7759/cureus.56902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Time-restricted meal intake (TRM) has shown potential benefits such as enhanced insulin sensitivity, lowered blood sugar levels, and possible weight loss in individuals with type 2 diabetes mellitus (T2DM). Our study aimed to investigate the impact of TRM on lipid profile parameters such as total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) in fasting conditions in T2DM patients. METHODS In total, 400 patients from the endocrinology department at King George's Medical University (KGMU), Lucknow were enrolled in this study, adhering to the guidelines of the American Diabetes Association (ADA). Male and female patients with recently diagnosed T2DM (in the past five years), aged between 25 to 60 years, on oral anti-diabetic therapy excluding insulin, expressing willingness to provide written consent and to adhere to TRM were included in the TRM group. It was a longitudinal study as diabetic dyslipidemia is primarily caused by insulin resistance and nutritional reasons and we wanted to assess the effect of TRM on lipid profile in T2DM patients. Patients were enrolled via simple random sampling using the random number table method (computerized). The TRM group had an early dinner at 7 pm whereas the control group was of non-TRM/late-night eaters. TRM group was given comprehensive guidance including strategies to manage hunger, permissible beverage options (water and prescribed medication) during the fasting period, and daily maintenance of a diary documenting their timing, type, and quantity of food intake which they were requested to bring fortnightly. Emphasis was placed on recording even minor dietary items consumed throughout the day. The TRM group consumed food ad libitum during a 12-hour eating window from breakfast at 7 am to dinner at 7 pm. Data distribution was non-parametric. Mann-Whitney U test compared TRM and control group using mean values at baseline and follow-ups. Analysis used GraphPad Prism 9.2.0 software (GraphPad Inc., La Jolla, CA). A p-value less than 0.05 (p < 0.05) was considered statistically significant. RESULTS A total of 127 patients were lost to follow-up, resulting in 273 patients who completed the study. The mean value of TC in the TRM and non-TRM groups using the Mann-Whitney U test registered a highly significant p-value <0.0001 at 18 months, with a decrease of 14.17% from baseline in the TRM group and a decrease of 1.53% from baseline in the non-TRM group. The TRM group had a decrease of 24.75% in TG from a baseline value of 145.4±41.9, whereas the non-TRM group showed a decrease of 2.2% from a baseline value of 154.7±37.30 (p-value <0.0001). The TRM group showed an increase of 9.25% in HDL from a baseline value of 50.14±8.58; the non-TRM group showed an increase of 0.82% from a baseline value of 48.62±9.31 (p-value <0.0001). TRM group showed a decrease of 8.62% in LDL from a baseline value of 68.20±16.2 while the non-TRM group showed an increase of 1.54% from a baseline value of 65.38±19.3 (p-value <0.0002). The TRM group showed a decrease of 13.97% in VLDL from a baseline value of 32.20±18.7; the non-TRM group showed an increase of 4% from a baseline value of 30.16±24.2 (p-value <0.0001). CONCLUSION Our study's promising results underscore the potential of TRM as an effective strategy for managing dyslipidemia in individuals with T2DM, even over prolonged periods.
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Affiliation(s)
- Smriti Rastogi
- Physiology, King George's Medical University, Lucknow, IND
| | - Narsingh Verma
- Physiology, King George's Medical University, Lucknow, IND
| | - Gourav Raghuwanshi
- Physiology, People's College of Medical Sciences and Research Centre, Bhopal, IND
| | | | - Virendra Atam
- Internal Medicine, King George's Medical University, Lucknow, IND
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