Dyslipidaemia management

Red Flags

LDL-C ≥190 mg/dL — likely familial hypercholesterolaemia; high-intensity statin and family cascade screening^[1]
Triglycerides ≥1000 mg/dL — risk of acute pancreatitis; urgent triglyceride-lowering therapy^[1]
Established ASCVD with LDL-C above goal on maximally tolerated statin — add ezetimibe; consider PCSK9 inhibitor^[1]
Lp(a) ≥50 mg/dL with personal or family history of premature ASCVD — independent risk enhancer^[1]

Lifestyle modification^[1]
Saturated fat restriction, increased fibre, ≥150 min/week moderate aerobic activity, weight reduction if overweight, smoking cessation, alcohol moderation

Drug	Class	Adult	Paediatric	Notes
Atorvastatin^[1]	HMG-CoA reductase inhibitor (statin)	40–80 mg PO once daily for high-risk; 10–20 mg moderate-risk	—	First-line; LDL-C goal <70 mg/dL high-risk, <55 mg/dL very-high-risk ASCVD
Rosuvastatin^[1]	HMG-CoA reductase inhibitor	20–40 mg PO daily (high-intensity); 5–10 mg moderate	—	Alternative; preferred in renal impairment
Ezetimibe^[1]	Cholesterol absorption inhibitor	10 mg PO once daily	—	Add when statin alone insufficient; ~20% additional LDL-C reduction
Fenofibrate^[1]	Fibrate	145–160 mg PO once daily	—	For severe hypertriglyceridaemia (TG ≥500 mg/dL); avoid combining with statin if eGFR <60

Atorvastatin^[1]

HMG-CoA reductase inhibitor (statin)

First-line; LDL-C goal <70 mg/dL high-risk, <55 mg/dL very-high-risk ASCVD

Rosuvastatin^[1]

HMG-CoA reductase inhibitor

Alternative; preferred in renal impairment

Ezetimibe^[1]

Cholesterol absorption inhibitor

Add when statin alone insufficient; ~20% additional LDL-C reduction

Fenofibrate^[1]

Fibrate

For severe hypertriglyceridaemia (TG ≥500 mg/dL); avoid combining with statin if eGFR <60

Statins are taken lifelong — stopping causes LDL-C and cardiovascular risk to rebound^[1]
Mild muscle aches are common; severe muscle pain, weakness, or dark urine — stop the statin and seek care^[1]
LFTs / CK monitoring not routinely required unless symptoms — do not let lab fears delay therapy^[1]

Triglycerides ≥1000 mg/dL with abdominal painEmergency department — risk of acute pancreatitis^[1]
Suspected familial hypercholesterolaemiaLipid clinic for genetic testing and family cascade screening^[1]
Established ASCVD not at LDL-C goal on maximally tolerated statin + ezetimibeCardiology / lipid clinic for PCSK9 inhibitor^[1]
Statin intolerance with multiple statinsLipid clinic for alternative agents (bempedoic acid, ezetimibe monotherapy, PCSK9 inhibitor)^[1]

ICMR-aligned management of dyslipidaemia for primary and secondary cardiovascular prevention with statin-first stepped therapy.

1.ICMR Guidelines for Management of Dyslipidaemia; Lipid Association of India (LAI) Consensus Statement (2023)