Published: 2019-03-25

Consensus statement for the management of dyslipidemia and hypertension in the Indian population with diabetes

Jayagopal P. B., M. Srinivas Rao, R. Vijaykumar, Soumitra Kumar, Girish Parthan


The mortality rate from cardiovascular disease (CVD) in India is higher than the global figures (272 per 100,000 persons vs. 235 per 100,000 persons, respectively). Smoking, obesity, hypertension, diabetes and dyslipidemia are the known risk factors for atherosclerotic cardiovascular disease (ASCVD). The treatment of either condition aims to reduce the risk of ASCVD. This goal is achievable only when a holistic, simultaneous treatment is initiated and is monitored to reduce the blood glucose, blood cholesterol, and BP. India heralds a huge population of nearly 73 million people with diabetes. Diabetes is one of the major contributors of ASCVD, dyslipidemia and hypertension often coexist with diabetes. Patients diagnosed with either condition need risk stratification, followed by defining the treatment target for each risk category and developing appropriate treatment strategies based on the risk category. Unfortunately, there is no clear guideline that defines the treatment targets and subsequent management. This statement has been created based on the vast experience and an extensive literature review conducted by experts from multidisciplinary teams to address several treatment dilemmas that are routinely faced by clinicians when treating their patients with diabetes. An attempt is made to provide well-defined answers to these quandaries. This statement discusses screening, diagnosis, risk stratification, treatment targets, and management of dyslipidemia and/or hypertension in patients with diabetes and provides a roadmap for the treatment of Indian patients to curtail the risk of ASCVD.


Cardiovascular disease, Diabetes, Dyslipidaemia, Hypertension, Risk assessment, Target organ damage

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Karalliedde J, Gnudi L. Diabetes mellitus, a complex and heterogeneous disease, and the role of insulin resistance as a determinant of diabetic kidney disease. Nephrol Dialysis Transplantation. 2014;31(2):206-13.

International Diabetes Federation. IDF diabetes atlas. Available at: Accessed 7 June 2018.

Kaveeshwar SA, Cornwall J. The current state of diabetes mellitus in India. Aus Med J. 2014;7(1):45.

Bansode B, Nagarajan R. Diabetes: a review of awareness, comorbidities, and quality of life in India. J Social Heal Diab. 2017;5(02):77-82.

Yadav D, Mishra M, Tiwari A, Bisen PS, Goswamy HM, Prasad GB. Prevalence of dyslipidemia and hypertension in Indian type 2 diabetic patients with metabolic syndrome and its clinical significance. Osong Pub Heal Res Persp. 2014;5(3):169-75.

Taskinen MR. Diabetic dyslipidaemia. Atherosclerosis Supp. 2002;3(1):47-51.

Wexler DJ, Grant RW, Meigs JB, Nathan DM, Cagliero E. Sex disparities in treatment of cardiac risk factors in patients with type 2 diabetes. Diab Care. 2005;28(3):514-20.

Petrie JR, Guzik TJ, Touyz RM. Diabetes, hypertension, and cardiovascular disease: clinical insights and vascular mechanisms. Can J Cardiol. 2018;34(5):575-84.

Sowers JR. Recommendations for special populations: diabetes mellitus and the metabolic syndrome. Am J Hypertension. 2003;16(3):41S-5S.

Mancia G. The association between diabetes and hypertension: an overview of its clinical impact. Dialogues Cardiovasc Med. 2016;21:91-109.

Ban N, Yamada Y, Someya Y, Ihara Y, Adachi T, Kubota A, et al. Activating transcription factor-2 is a positive regulator in CaM kinase IV-induced human insulin gene expression. Diab. 2000;49(7):1142-8.

Dokken BB. The pathophysiology of cardiovascular disease and diabetes: beyond blood pressure and lipids. Diab Spectrum. 2008;21(3):160-5.

Torp C, Jeppesen J. Diabetes and hypertension and atherosclerotic cardiovascular disease related or separate entities often found together. Hypertension. 2011;57(5):887-8.

Berliner JA, Navab M, Fogelman AM, Frank JS, Demer LL, Edwards PA, et al. Atherosclerosis: basic mechanisms: oxidation, inflammation, and genetics. Circul. 1995;91(9):2488-96.

Joshi SR, Anjana RM, Deepa M, Pradeepa R, Bhansali A, Dhandania VK, et al. Prevalence of dyslipidemia in urban and rural India: the ICMR-INDIAB study. PloS One. 2014;9(5):e96808.

Bornfeldt KE, Tabas I. Insulin resistance, hyperglycemia, and atherosclerosis. Cell Metab. 2011;14(5):575-85.

Chen G, McAlister FA, Walker RL, Hemmelgarn BR, Campbell NR. Cardiovascular outcomes in Framingham participants with diabetes: the importance of blood pressure. Hypertension. 2011;57(5):891-7.

Low Wang CC, Hess CN, Hiatt WR, Goldfine AB. Clinical update: cardiovascular disease in diabetes mellitus: atherosclerotic cardiovascular disease and heart failure in type 2 diabetes mellitus–mechanisms, management, and clinical considerations. Circulation. 2016;133(24):2459-502.

Siragusa M, Sessa WC. Telmisartan exerts pleiotropic effects in endothelial cells and promotes endothelial cell quiescence and survival. Arterioscl Thrombosis Vascular Biol. 2013;33(8):1852-60.

Chauhan G, Spurgeon CJ, Tabassum R, Bhaskar S, Kulkarni SR, Mahajan A, et al. Impact of common variants of PPARG, KCNJ11, TCF7L2, SLC30A8, HHEX, CDKN2A, IGF2BP2, and CDKAL1 on the risk of type 2 diabetes in 5,164 Indians. Diab. 2010;59(8):2068-74.

Roberts CK, Hevener AL, Barnard RJ. Metabolic syndrome and insulin resistance: underlying causes and modification by exercise training. Comprehensive Physiol. 2013;3(1):1-58.

Menon VP, Edathadathil F, Sathyapalan D, Moni M, Don A, Balachandran S, et al. Assessment of 2013 AHA/ACC ASCVD risk scores with behavioral characteristics of an urban cohort in India: Preliminary analysis of Noncommunicable disease Initiatives and Research at AMrita (NIRAM) study. Med. 2016;95(49).

Jellinger PS, Handelsman Y, Rosenblit PD, Bloomgarden ZT, Fonseca VA, Garber AJ, et al. American Association of Clinical Endocrinologists and American College of Endocrinology guidelines for management of dyslipidemia and prevention of cardiovascular disease. Endocrine Prac. 2017;23(2):1-87.

McClelland RL, Nasir K, Budoff M, Blumenthal RS, Kronmal RA. Arterial age as a function of coronary artery calcium (from the Multi-Ethnic Study of Atherosclerosis [MESA]). Am J Cardiol. 2009;103(1):59-63.

Stevens RJ, Kothari V, Adler AI, Stratton IM, Holman RR. The UKPDS risk engine: a model for the risk of coronary heart disease in Type II diabetes (UKPDS 56). Clin Sci. 2001;101(6):671-9.

Board JB. Joint British Society’s consensus recommendations for the prevention of cardiovascular disease (JBS3). Heart. 2014;100(Suppl 2):ii1-67.

Laakso M, Lehto S, Penttilä I, Pyörälä K. Lipids and lipoproteins predicting coronary heart disease mortality and morbidity in patients with non-insulin-dependent diabetes. Circul. 1993;88(4):1421-30.

Ljungberg J, Holmgren A, Bergdahl IA, Hultdin J, Norberg M, Näslund U, et al. Lipoprotein (a) and the apolipoprotein B/A1 ratio independently associate with surgery for aortic stenosis only in patients with concomitant coronary artery disease. J Am Heart Assoc. 2017;6(12):e007160.

Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American college of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):1269-324.

Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA. 2004;291(2):210-5.

Resnick HE, Lindsay RS, McDermott MM, Devereux RB, Jones KL, Fabsitz RR, et al. Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the Strong Heart Study. Circul. 2004;109(6):733-9.

Touboul PJ, Hennerici MG, Meairs S, Adams H, Amarenco P, Bornstein N, et al. Mannheim carotid intima-media thickness consensus (2004–2006). Cerebrovascul Dis. 2007;23(1):75-80.

Lee BT, Ahmed FA, Hamm LL, Teran FJ, Chen CS, Liu Y, et al. Association of C-reactive protein, tumor necrosis factor-alpha, and interleukin-6 with chronic kidney disease. BMC Nephrol. 2015;16(1):77.

Wang XQ, Luo NS, CHEN ZQ, Lin YQ, GU MN, Chen YX. Atorvastatin attenuates TNF-alpha production via heme oxygenase-1 pathway in LPS-stimulated RAW264. 7 macrophages. Biomed Env Sci. 2014;27(10):786-93.

American Diabetes Association. Standards of medical care in diabetes-2018. Diab Care. 2018;41(Suppl 1):S1-S159.

Han E, Kim G, Lee JY, Lee YH, Kim BS, Lee BW, et al. Comparison between atorvastatin and rosuvastatin in renal function decline among patients with diabetes. Endocrinol Metab. 2017;32(2):274-80.

Sica DA. Centrally acting antihypertensive agents: an update. J Clin Hypertension. 2007;9(5):399-405.

Jagadeesh G, Balakumar P, Maung-U K. Pathophysiology and pharmacotherapy of cardiovascular disease. New York: Springer; 2015;853-868.

Nikolic K, Agbaba D. Imidazoline Antihypertensive Drugs: Selective I1‐Imidazoline Receptors Activation. Cardiovascular Therapeutics. 2012;30(4):209-16.

Pater C, Bhatnagar D, Berrou JP, Luszick J, Beckmann K. A novel approach to treatment of hypertension in diabetic patients-a multicenter, double-blind, randomized study comparing the efficacy of combination therapy of Eprosartan versus Ramipril with low-dose Hydrochlorothiazide and Moxonidine on blood pressure levels in patients with hypertension and associated diabetes mellitus type 2-rationale and design [ISRCTN55725285]. Current Controlled Trials Cardiovascular Med. 2004;5(1):9.