At BEAT 2025: National Cardiovascular Summit and Awards, the panel “Beyond Conventional Therapies: Standardising Cholesterol Care & LDL-C Protocols for Policy Impact” explored the urgent need to standardize cholesterol care and implement actionable LDL-C protocols for meaningful policy impact. Moderated by Dr. Tina Rawal, Senior Research Scientist, Public Health Foundation of India (PHFI), the discussion brought together leading experts to address early detection, prevention, and treatment strategies for cardiovascular disease in India.
Dr. Sandeep Bansal - Director, VMMC and Safdarjung Hospital, stated “ LDL is a major risk factor for cardiovascular disease, with a causal relationship clearly shown in multiple studies, including INTERHEART. Reducing LDL can significantly lower mortality. However, India currently lacks national guidelines on when and how often to measure cholesterol. While programs for diabetes and hypertension have been implemented successfully, cholesterol screening is still guided mainly by professional societies, which recommend starting from age 18.
Our research, presented at the European Society of Cardiology’s ‘EuropePrevent’ program, showed that even children aged 12–15 with a parent having diabetes exhibited early metabolic derangements. This highlights the need for earlier prevention strategies—not just LDL measurement, but comprehensive cardiovascular prevention.
Prevention must also start from birth. Evidence from programs like Swasthari Sasha shows that children with low birth weight are at higher risk of developing cardiovascular disease and diabetes later in life. Effective prevention, therefore, goes far beyond routine screening—it starts long before adulthood.”
Dr. Praveen Chandra, Chairman - Interventional Cardiology, Medanta Medicity, Gurgaon emphasised, “Every day, we see more patients asking why heart disease is increasing. Awareness and early detection are crucial, but genetically, we are also at higher risk for developing heart disease at a younger age. we need to start early. Ideally, everyone around 25–30 years of age should get a lipid profile done at least once. If results are normal and other risk factors are low, a healthy lifestyle is key. But if cholesterol is high, we need to bring it down, first through lifestyle measures—which most people ignore at 30–40 years old because they feel too young—and then, if necessary, through medication.
A big problem is denial. People often only act after a heart attack in the family or hearing news of a young person affected. Regular blood pressure checks and lipid profiles are simple yet vital steps. LDL cholesterol is the main target. High-risk individuals—those with previous heart issues, diabetes, high blood pressure, or high cholesterol—need stricter targets, sometimes below 40.
Achieving the target is more important than just taking the medicine. Statins, for example, are often misunderstood as harmful or unnecessary, but they are proven to prevent heart disease and are extremely safe. If lifestyle changes and statins are not enough, newer medications and injectables are available, including shots every 15 days or every six months.
Following these steps and reaching the recommended targets significantly reduces the risk of heart disease, future episodes, and death. Understanding and acting on this is critical, regardless of what social media myths suggest."
Dr. P. Ganeshkumar, Scientist E & Head, Division of Noncommunicable Diseases ICMR-NIE, said, “When we started the India Hypertension Control Initiative in 2017, we realized that most states didn’t have a clear treatment protocol. There were guidelines running from 50 to 500 pages, but for a primary care physician or a private practitioner, it wasn’t practical—they didn’t know where to start or how to manage patients effectively.
So, we introduced a simple hypertension treatment protocol based on three drugs. At the same time, we assessed the ground-level capacity and found that even basic resources, like validated blood pressure machines, were lacking.
During implementation across 26 states and 180 districts, we treated 51 lakh hypertension patients and 20 lakh diabetes patients. From our data, less than 10% were on statins, even though nearly 20% had high cholesterol—most weren’t even tested. To address this, we integrated cholesterol testing and dietary guidelines into the protocol in a few states.
Recently, consensus guidelines recommended that any patient with hypertension and diabetes should start on statins without waiting for cholesterol tests. Similarly, diabetics over 50 with a history of smoking, or hypertensive patients over 60 with complications, should also start statins immediately. This approach has a significant impact on preventing premature deaths from cardiovascular disease.
We successfully incorporated this into policy and protocols—starting statins at the point of diagnosis, especially for high-risk patients with uncontrolled diabetes or coexisting hypertension. However, there are still challenges: the capacity to understand these guidelines is low, and access to cholesterol testing in many areas remains limited.
The key takeaway is that we need practical, actionable protocols, not just long guidelines, and the inclusion of statins directly into treatment protocols is a crucial step forward."