6 times greater risk of IHD / “Heart failure”
Uncontrolled HTN leads to IHD / Stroke / Kidney disease / Eye
disorders
Targeted BP for normal individuals < 130/90mmHg
Targeted BP for those with kidney failure / diabetes < 120/80mmHg
To reduce salt intake : < don’t add salt on table >
Avoid all rich foods (pickle / frozen foods / salted potato wafers)
To increase the intake of potassium + calcium rich foods, moderation or avoid of alcohol consumption and weight reductions helps to control BP

20 millions are diabetic in India (India is diabetic capital of world)
By 2025, total 300 millions are diabetic in the world
Expected increased incidence of DM in developing countries 170% than the developed countries 40%
3-5 fold increase in CAD in diabetics
Higher risk in diabetic women

Insulin resistance itself causes atheroma formation in arteries
Increased LDL cholesterol (bad cholesterol)
Decreased HDL cholesterol (good cholesterol)
Increased Triglycerides
Prone for small vessel diseases
Increased incidence of complications following procedures
Reblockage in bypass graft vessels after CABG (Bypass surgery) or restenosis in angioplasty vessels (PTCA)
Accelerated atherosclerosis due to endothelial dysfunction

Total cholesterol / LDL cholesterol / Triglycerides are “bad lipids”
HDL cholesterol “good lipid”

	Normal	High risk group
Total cholesterol	< 220	< 180mg/dl
LDL Cholesterol	< 130	< 100mg/dl
Triglycerides	< 200	< 150mg/dl
HDL Cholesterol	> 40	> 65mg/dl

a. Is cholesterol abnormality directly related to increased incidence of IHD?
Yes, according to MRFIT, PROGAM and ARIC trials.

b. Is LDL cholesterol reduction reduces coronary events?
Yes, according to trials like REVERSAL and PROVE-IT, benefit of aggressive treatment using drugs called statins benefit to reduce coronary events.

c. How much is the benefits of statins?
Using statins, if LDL-C is lowered by 20-60%, then coronary events are reduced up to 30% over a 5 year period (1% reduction in LDL Cholesterol reduces coronary events by 1%).

d. How early coronary atherosclerosis begins?
It has been postulated that atherosclerotic changes (fatty streak) begins very early in childhood, (as early as 9yrs) but it may not progress to obstructive disease in all and depends on variable coronary risk factors.

e. whether cholesterol levels measured early in life influence long term cardiovascular risk? Yes, according to study done on John Hopkins medical school, students with long term follow up suggested that high cholesterol levels in the third decade correlate with long term risk of myocardial infarction.
However as it is not appropriate to be used as primary prevention in younger population. Intensive life style modification to reduce coronary events should become a societal priority.

f. Is high HDL levels are more protective?
Yes, low HDL with high LDL has directly relationship with CAD. HDL cholesterol ferry LDL cholesterol from vessel wall augmenting peripheral catabolism of LDL.

g. Is high Triglyceride (TG) a risk for CAD?
Yes, especially a combination of low HDL and high Triglyceride among Indians is associated with increased CAD : More in group of diabetes and hypothyrodism.

h. Is fish oil helpful in high TG patients?
Yes, fish oil is rich in PUFA such as Eicosopentenoic acid or docosohexaenoic acid (Omega –3-FA). They lower TG and have antithrombotic effects.

i. What is Lipoprotien (a) and what is its importance?
LP (a) consists of LDL particle with its apo.B – 100 component linked to apo(a)
Positive correlation between LP(a) and vascular risk