India is facing a frightening cardiovascular crisis. Heart disease strikes South Asians almost a decade earlier than in Western populations due to genetic predisposition and a combination of metabolic stress and lifestyle-related risk factors.
The problem is focused on LDL cholesterol, also known as 'bad cholesterol'. Prevention remains the best defence against heart disease, even if a revolutionary one-off gene-editing injection may soon rival daily statin therapy.
This increase has led to discussions about newer, more advanced ways of controlling cholesterol and reducing the long-term risk of heart disease.
What is LDL cholesterol and PCSK9?
LDL cholesterol, also called bad cholesterol, is one of the biggest contributors to heart disease. LDL is made in the liver and when in excess, is deposited inside the arteries. Over time this causes the blood vessels to thicken and narrow, which is called atherosclerosis and can cause heart attacks, strokes and even gangrene.
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The PCSK9 enzyme is important in this process. Doctors call it the body's 'garbage truck' for cholesterol. Its job is to help the liver absorb and break down LDL cholesterol floating around in the bloodstream.
If this process is inefficient, LDL cholesterol remains in the blood longer and this increases the risk of damage to arteries and cardiovascular disease.
Why even healthy-looking adults could be at risk?
Many Indians are genetically predisposed to high cholesterol and premature heart disease. This risk is further increased by diabetes, high blood pressure, smoking, stress, pollution, bad eating habits and lack of exercise.
That’s why even skinny, active, or outwardly healthy young adults can still be silently developing damage to their arteries over time. High triglycerides, uncontrolled blood pressure and hidden cholesterol problems can slowly take their toll on heart health without obvious warning symptoms.
Genome editing
One major development in the works is an experimental gene-editing treatment, which is backed by Eli Lilly. The treatment works by targeting the PCSK9 pathway to permanently enhance the body's control over LDL cholesterol.
Early trials with about 40 patients have shown promising results, with LDL cholesterol levels dropping by almost 50 per cent. Experts say this approach, combined with other cholesterol-lowering drugs like ezetimibe or bempedoic acid, may lead to even greater reductions.
Switching from daily pills for life to a single injection could revolutionise cholesterol treatment, especially for those people who are unable to take statins or whose cholesterol levels remain stubbornly high despite taking medication.
But doctors warn that the therapy is still experimental. Long-term side effects, costs and effectiveness compared to statins should be studied in large clinical trials.
Prevention still matters
Medical innovation is exciting, but prevention is still the best defence against heart disease. Regular health screenings, cholesterol checks, managing blood pressure, exercise, healthy eating, stress management and avoiding smoking still matter for protecting heart health.
While gene editing could affect future cardiovascular care, healthy daily habits remain the real basis of long-term cardiac protection.
(The author is the HOD and Consultant, Interventional Cardiology, Manipal Hospital, Old Airport Road)
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.