India’s cities are hurtling toward an American-style health crisis. As processed food becomes a tap away and urban life grows increasingly sedentary, high cholesterol – once a concern mainly among older, affluent groups – is now showing up across age brackets. Nearly one in three Indians has elevated cholesterol levels, doctors say, and treatment for many begins with a familiar therapy: statins.
A recent Wall Street Journal report spotlighted a new wave of statin alternatives, including gene-editing technologies being tested in the US. While India remains one of the world’s biggest manufacturers and suppliers of affordable generic statins, costly injectables are slowly entering the market.
“Decades of research and clinical trials show statins lower LDL cholesterol reliably and reduce heart attacks, strokes and deaths,” Dr Vikas Kataria, Senior Consulting Cardiologist and Head of Arrhythmia Services at Holy Family Hospital, Delhi, said explaining why statins are the first choice.
Statins work by blocking an enzyme in the liver that is crucial to cholesterol production.
“Seventy to eighty per cent of cholesterol comes from your own liver,” explained Dr Ripen Gupta, Principal Director and Unit Head of Cardiac Sciences at Max Hospitals. “The liver is the major chemical factory of the body that makes cholesterol.”
But doctors stress that patients aren’t immediately put on medication. “We look at underlying risk – whether there’s a high risk of a cardiovascular event in the next 10 years,” said Dr Gupta. “If the person is a heart patient, a stent patient or has high cholesterol, then this patient will be put on statins.”
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‘One-and-done’ therapy
A Phase 1 trial of a gene-editing drug from Switzerland-US company CRISPR Therapeutics showed a 49 per cent reduction in cholesterol levels over two months, and a 55 per cent drop in triglycerides. The idea, a preventive cardiologist told WSJ, is to create a “one-and-done” cholesterol therapy – a future where patients don’t need daily medication.
High triglycerides, when paired with cholesterol, fall under the broader condition dyslipidemia, which is rising across India. “It’s a major cardiovascular disease challenge for India,” said Dr Kataria.
India’s alternatives
For patients who cannot tolerate statins, doctors turn to other drugs.
Bempedoic acid: Prescribed when statins cause allergies or severe side effects. It blocks another step in the cholesterol pathway. But they are not necessarily as “effective”, Dr Gupta says.
Ezetimibe: Reduces cholesterol absorption. Often used alongside statins. “Sometimes statins alone are not enough,” he added.
India also has access to advanced injectables that are widely used abroad but still financially out of reach for most.
Inclisiran, taken twice a year, works through genetic silencing to curb production of the PCSK9 protein. PCSK9 inhibitors are also injectable.
But these drugs, costing around Rs 2-3 lakhs annually, are not mainstays.
“The guidelines are very clear. These are not given as alternatives, but are added on top of statins,” Dr Gupta said.
The debate comes amid a recent US recall of 1,00,000 bottles of statins for “failed dissolution specifications.” While a single-batch recall doesn’t threaten global supply chains, the incident puts the spotlight on India, which produces huge volumes of generic statins for domestic use and export. Any scrutiny of statins — their efficacy, quality, or safety – has outsized implications for patients and global markets.
(Edited by Stela Dey)