Expert Opinion on Targeted Lipid Control for Very-high-risk Indian Patients - Bridging the Gap in Real-world Practice

Q: Why do very-high-risk dyslipidaemia patients often fail to achieve LDL-C targets?

Many patients do not reach target LDL cholesterol levels due to poor adherence and delayed treatment intensification despite available guidelines and potent lipid-lowering therapies.

Q: What LDL-C target is recommended for very-high-risk Indian patients?

The expert panel strongly recommends an LDL-C target of <55 mg/dl (<1.4 mmol/l) for very-high-risk patients.

Q: How should lipid-lowering therapy be tailored in practice?

A proposed 2×2 matrix tailors LLTs based on patient adherence and cardiovascular risk, emphasizing early initiation of combination therapy and inclisiran use for non-adherent patients.

Sep 30, 2026

Uploaded by Mimi

Despite robust clinical guidelines and potent lipid-lowering therapies, many very-high-risk dyslipidaemia patients fail to reach target LDL cholesterol levels, largely because of poor adherence and delayed treatment intensification. Two virtual meetings of senior cardiologists synthesized an expert framework via polling and shared inputs. The panel recommends an LDL-C target of <55 mg/dl (<1.4 mmol/l) and proposes a 2×2 approach linking LLT choice to adherence and CV risk, including early combination therapy and inclisiran for non-adherent patients. A simplified decision algorithm should be implemented to enable timely intensification and improve goal attainment.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Abstract

Keywords

Expert framework for targeted lipid control

LDL-C target for very-high-risk patients

2×2 tailoring based on adherence and CV risk

Early combination therapy and inclisiran for non-adherent patients

Simplified decision-making algorithm for clinical practice

Disclosures, Funding, and Copyright/License

EXPERT OPINION Dyslipidaemia Expert Opinion on Targeted Lipid Control for Very-high-risk Indian Patients: Bridging the Gap in Real-world Practice Kausik Ray ,1 Upendra Kaul ,2 Srinivasa Rao,3 Nakul Sinha,4 PK Sahoo,5 CK Ponde,6 JC Mohan,7 Tiny Nair ,8 Ashwani Mehta,9 Preeti Gupta 10 and Kamal Sharma 11 1. Department of Primary Care Public Health, Imperial College London, London, UK; 2. Heart Centre, Batra Hospital & Medical Research Centre, New Delhi, India; 3. CARE Hospitals, Hyderabad, India; 4. Cardiology, Max Hospital, Lucknow, India; 5. Interventional Cardiology, Apollo Hospitals, Bhubaneswar, India; 6. Department of Cardiology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India; 7. Institute of Heart and Vascular Diseases, Jaipur Golden Hospital, Delhi, India; 8. Department of Cardiology, PRS Hospital, Trivandrum, India; 9. Department of Cardiology, Sir Ganga Ram Hospital, New Delhi, India; 10. Department of Cardiology, VMMC and Safdarjung Hospital, New Delhi, India; 11. Interventional Cardiology, Sal Hospital and Medical Institute, Ahmedabad, India Abstract Despite robust clinical guidelines and the availability of potent lipid-lowering therapies (LLTs), many very-high-risk dyslipidaemia patients fail to achieve target LDL cholesterol (LDL-C) levels, primarily due to poor adherence and delayed treatment intensification. Two virtual meetings were convened involving a panel of senior cardiologists. Insights were synthesised into an expert framework, developed through polling and collective inputs from expert. The panel strongly recommends LDL-C target of <55 mg/dl (<1 .4 mmol/l) for very-high-risk patients. A 2 × 2 matrix was proposed to tailor LLTs based on patient adherence and CV risk, emphasising early initiation of combination therapy and use of inclisiran in non-adherent patients. Patients with very high baseline LDL-C require combination therapy with high-intensity statins, with add-on proprotein convertase subtilisin/kexin type 9 inhibitors, which significantly enhances LDL-C reduction and improves goal attainment. A simplified decisionmaking algorithm that accounts for adherence and promotes timely treatment intensification with combination LLTs needs to be implemented to effectively lower LDL-C in very-high-risk Indian patients in clinical practice. Keywords Cardiovascular disease, dyslipidaemia, lipid-lowering therapy, LDL cholesterol, treatment adherence, PCSK9 inhibitor Received: 2 June 2025 Accepted: 1 August 2025 Citation: European Cardiology Review 2025;20:e37. DOI: [https://doi.org/10.15420/ecr.2025.35](https://doi.org/10.15420/ecr.2025.35)[ ](https://doi.org/10.15420/ecr.2025.35)[Disclosure:](Disclosure: SR has received payment or honoraria from Bayers India)[ SR has received payment or honoraria from Bayers India](Disclosure: SR has received payment or honoraria from Bayers India), Lupin India, Dr. Reddy’s Laboratories India, Torrent Pharmaceuticals India, Sun Pharmaceutical Industries India, Boehringer Ingelheim India and Novo Nordisk India. KR has received unrestricted research grants from Imperial College London, Amgen, Sanofi, Regeneron, Daiichi Sankyo and Ultragenyx. KR has received consulting fees from Novartis, Daiichi Sankyo, Kowa, Esperion, Novo Nordisk, MSD, Lilly, Silence Therapeutics, AstraZeneca, New Amsterdam Pharma, Bayer, Beren Therapeutics, Cleerly, EmendoBio, Scribe, CRISPR, Vaxxinity, Amarin, Regeneron, Ultragenyx, Cargene and Resverlogix for serving as a member of the Scientific Committee or Ethics Committee of clinical trials and roles as Principal Investigator and Natural Language Inference. KR has received payment or honoraria from Novartis, Boehringer Ingelheim, AstraZeneca, Novo Nordisk, Viatris, Amarin, Biologix Pharma, Sanofi, Amgen, Esperion, Daiichi Sankyo and Macleods Pharma for CME and non-CME symposia at international meetings. JM has received payments or honoraria from Novo Nordisk, Lupin, Intas Pharmaceuticals, Emcure, USV, Dr R

FAQs

Why do very-high-risk dyslipidaemia patients often fail to achieve LDL-C targets?

Many patients do not reach target LDL cholesterol levels due to poor adherence and delayed treatment intensification despite available guidelines and potent lipid-lowering therapies.

What LDL-C target is recommended for very-high-risk Indian patients?

The expert panel strongly recommends an LDL-C target of <55 mg/dl (<1.4 mmol/l) for very-high-risk patients.

How should lipid-lowering therapy be tailored in practice?

A proposed 2×2 matrix tailors LLTs based on patient adherence and cardiovascular risk, emphasizing early initiation of combination therapy and inclisiran use for non-adherent patients.

Sep 30, 2026

Uploaded by Mimi