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

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.