ABSTRACT India is witnessing a growing burden of early‐onset hypertension and cardiovascular disease, particularly among adults under the age of 40. Despite this trend, current national screening programs predominantly target individuals over 40, resulting in a significant gap in early detection and prevention efforts. This white paper addresses this gap by drawing on a mixed‐methods approach that combines an extensive review of national and international literature, health surveys, and hypertension guidelines with qualitative insights from 25 expert consultations. These consultations included cardiologists, endocrinologists, and public health specialists, and were conducted through structured one‐on‐one interviews and focused group discussions. The findings revealed that nearly 25% of Indian adults aged 30–39 are already hypertensive or pre‐hypertensive, with lifestyle‐related risk factors such as chronic stress, unhealthy diets, physical inactivity, and obesity contributing to early cardiovascular risk. Experts unanimously emphasized the widespread underdiagnosis and lack of awareness in this age group, highlighting missed opportunities for early intervention. A strong consensus emerged around the urgent need to lower the current screening threshold to age 30 and introduce first‐time cardiovascular assessments, including blood pressure, glucose, lipid profiles, and obesity metrics at this stage. The paper argues that implementing early screening through existing health infrastructure, workplace wellness initiatives, and digital health platforms is both epidemiologically sound and economically viable. A national policy shift in this direction could significantly improve early detection, reduce disease burden, and enhance long‐term health outcomes for the Indian population.
Obicetrapib, a next-generation cholesteryl ester transfer protein (CETP) inhibitor, is emerging as a potent therapeutic option to address residual cardiovascular risk in patients not achieving optimal outcomes with existing lipid-lowering therapies, such as statins, ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitors. Many high-risk individuals fail to meet recommended LDL cholesterol targets, and up to 40% experience recurrent cardiovascular events, highlighting the need for novel interventions. This review consolidates the evidence from Phase I–III trials (including TULIP, ROSE, BROADWAY, BROOKLYN and TANDEM) and meta-analyses. Take together, the results demonstrate that obicetrapib significantly reduces LDL cholesterol by 30–50%, apolipoprotein B by 20–30% and lipoprotein(a) by as much as 40-50%, while elevating HDL cholesterol levels by more than 100%. The average LDL cholesterol reduction was 0.92 mmol/l (35.4 mg/dl), with amplified effects when combined with ezetimibe. Obicetrapib achieves up to 97% inhibition of CETP activity and maintains a favourable safety profile. Additional metabolic benefits include decreased HbA1c and a lower incidence of new-onset diabetes. These results highlight obicetrapib’s robust efficacy across multiple lipid parameters and its contribution to atherogenic lipoprotein reduction, particularly lipoprotein(a), a marker of high residual risk. Overall, obicetrapib represents a meaningful advancement in cardiovascular risk management and is positioned as an important new agent for high-risk patients with persistent residual risk despite current standard-of-care therapies.
OBJECTIVEIn 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.METHODSThe 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.RESULTSThe 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.CONCLUSIONSThis 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.
In 2021 an estimated 74 million individuals had diabetes in India, almost all type 2 diabetes. More than half of patients with diabetes are estimated to be undiagnosed and more 90% have dyslipidemia that is associated with accelerated development of atherosclerotic cardiovascular disease (ASCVD). Patients of Indian descent with diabetes have multiple features that distinguish them from patients with diabetes in Western populations. These include characteristics such as earlier age of onset, higher frequency of features of the metabolic syndrome, more prevalent risk factors for ASCVD, and more aggressive course of ASCVD complications. In light of the unique features of diabetes and diabetic dyslipidemia in individuals of Indian descent, the Lipid Association of India developed this expert consensus statement to provide guidance for management of diabetic dyslipidemia in this very high risk population. The recommendations contained herein are the outgrowth of a series of 165 webinars conducted by the Lipid Association of India across the country from May 2020 to July 2021, involving 155 experts in endocrinology and cardiology and an additional 2880 physicians.
Fragile X syndrome (FXS) is a hereditary disease that predominantly leads to intellectual disability (ID) in boys. It is the second prominent cause of ID, which manifests as a result of the atypical development of the cytosine-guanine-guanine (CGG) region. This irregular extension of the CGG region gives rise to methylation and silencing of the fragile X mental retardation 1 (FMR1) gene, causing a loss of the fragile X mental retardation 1 protein (FMRP). This reduction or loss of FMRP is the main cause of ID. It has a multisystemic involvement showing neuropsychiatric features such as ID, speech and language delay, autism spectrum disorder, sensory hyperarousal, social anxiety, abnormal eye contact, shyness, and aggressive behaviour. It is also known to cause musculoskeletal symptoms, ocular symptoms, cardiac abnormalities, and gastrointestinal symptoms. The management is challenging, and there is no known cure for the disease; hence an early diagnosis of the condition is needed through prenatal screening offered to couples with familial history of ID before conception. The management rests on non-pharmacological modalities, including applied behaviour analysis, physical therapy, occupational therapy, speech-language therapy, and pharmacologic management through symptomatic treatment of comorbid behaviours and psychiatric problems and some forms of targeted therapy.
