Dyslipidemia is the single most important risk factor for development of coronary heart disease (CHD).
The special issue of the journal discusses some of the important and controversial aspects about
dyslipidemia. A state of the art article is on Familial Hypercholesterolemia (FH) an under diagnosed and
undertreated clinical entity. This article describes the criteria for diagnosis and management of FH which is
a neglected entity especially in India. It may be of special importance to Indians where CHD occurs at
a relatively young age and it is suggested that these patients should be screened for FH. It is hoped that this
article will draw the attention of the practicing clinicians to this disorder which is not rare and is treatable by
statins and newer drugs like PCSK9 Inhibitors thus may prevent malignant CHD in the young Indians.
The next article in this issue focuses on dyslipidemia in children and adolescents. Apart from FH this article
describes unhealthy lifestyles also as an important reason for dyslipidemia, obesity and diabetes.
It is suggested that screening for lipids should be done between 9-11 year of age and again between 17-21
years of age. Emphasis on healthy lifestyle like physical exercise and diet control is recommended. Another
article on looking beyond LDL cholesterol level (LDLc) at LDL particle number (LDLP) suggests that beyond
LDLc, people with predominantly small and dense LDL particle have a threefold risk of CHD. The large and
fluffy LDL may be protective. They emphasize LDL-P may be more appropriate cardiovascular risk marker
beyond LDLc. Another article is on the controversial role of Lipoprotein(a) as a risk factor for CHD. The major
guidelines have ignored Lp(a) as a risk factor but endorse it as a marker for premature CHD. Obviously more
studies are needed to clarify the issue. The last article discusses whether Non high density lipoprotein (HDLc)
is a superior cardiovascular risk factor as compared to LDLc for CHD? Based on several studies it is
suggested that the simple parameter of Non HDLc should be measured in all patients as a primary or co
primary target for evaluating the risk and lipid lowering and may be a superior risk factor to LDLc especially
when triglycerides are high. This issue also involves the summary of the latest ESC 2016 guidelines on the
management of dyslipidemia.
In the profiles in preventive cardiology, a short resume of Prof. JL Goldstein is presented. Prof. Goldstein had
won the noble prize for discovering the LDL receptor as the major molecule regulating cholesterol metabolism
and that it was genetically disrupted in the familial hypercholesterolemia.
Dr. S. C. Manchanda
Senior Consultant Cardiologist
Sir Ganga Ram Hospital, New Delhi, India
Dr. JPS Sawhney
Guest Editor, Chairman,
Department of Cardiology, Dharma Vira Heart Centre,
Sir Ganga Ram hospital, New Delhi, India
Familial hypercholesterolemia - An underdiagnosed and undertreated entity