Published Jul 22, 2026 | 7:00 AM ⚊ Updated Jul 22, 2026 | 7:00 AM
Abdominal obesity emerged as the strongest predictor across every major lipid abnormality.
Synopsis: ICMR-INDIAB study finds that nearly 87.3 percent of Indian adults have at least one abnormal lipid parameter, with abdominal obesity emerging as the strongest independent predictor across every major lipid disorder. Researchers warn that millions of seemingly healthy Indians are carrying hidden cardiovascular risk.
India’s fight against heart disease may have found an unexpectedly simple warning sign: the waistline.
A landmark nationwide study by the Indian Council of Medical Research (ICMR) has found that 87.3 percent of Indian adults, nearly nine in every 10 people, have abnormal blood lipids, placing them at increased risk of heart disease and stroke. But among all the risk factors examined, abdominal obesity emerged as the single strongest predictor, outperforming age, smoking, hypertension and even diabetes in predicting dyslipidaemia.
Published in the Journal of Clinical Lipidology, the findings come from the ICMR-INDIAB study, India’s largest epidemiological survey of diabetes and metabolic disorders. Researchers analysed lipid profiles from 23,665 adults selected from a nationally representative sample covering all states and Union Territories.
The study paints a worrying picture of India’s cardiovascular health. While cholesterol has long been associated with ageing, obesity and unhealthy eating, researchers found that lipid abnormalities are now widespread across the population, often beginning in early adulthood and affecting millions who have no diabetes, hypertension or obvious signs of illness.
“Dyslipidemia is highly prevalent among Indian adults, especially at younger ages and among those with adverse glycemic status, obesity and hypertension,” the authors said. However, they noted that a substantial burden also exists among metabolically normal individuals, underscoring the need for broader lipid screening strategies and earlier preventive interventions.
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Dyslipidaemia refers to abnormal levels of fats in the blood, including cholesterol and triglycerides. Rather than one single disorder, it includes several abnormalities that together increase the risk of clogged arteries, heart attacks and strokes.
The ICMR researchers found that the epidemic is being driven not by high cholesterol alone but by low high-density lipoprotein (HDL) cholesterol, commonly known as “good cholesterol.”
Among Indian adults:
This means millions of Indians who believe they have “normal cholesterol” may still carry dangerous lipid abnormalities that increase cardiovascular risk.
“The findings underscore the pervasive dyslipidemia epidemic across urban and national Indian populations, dominated by low HDL cholesterol due to genetic predispositions in South Asians, high-carbohydrate diets, abdominal obesity, insulin resistance and sedentary lifestyles characteristic of rapid urbanisation,” the authors said.
Perhaps the study’s most important finding comes from its multivariable regression analysis, which examined factors independently associated with abnormal lipid levels after accounting for age, sex, smoking, alcohol use, education, physical activity, hypertension and diabetes.
Abdominal obesity emerged as the strongest predictor across every major lipid abnormality.
Compared with people without abdominal obesity, those with excess abdominal fat had:
No other variable demonstrated such consistently strong associations.
This distinction is particularly important for Indians because Body Mass Index (BMI) often fails to capture the type of fat that causes metabolic disease.
South Asians frequently develop visceral fat, fat deposited deep around abdominal organs, even when their overall weight appears normal. Unlike fat beneath the skin, visceral fat actively releases inflammatory chemicals and hormones that disrupt insulin function, increase triglycerides and lower protective HDL cholesterol.
The researchers said this reflects the well-recognised Asian Indian phenotype, characterised by increased abdominal fat, insulin resistance and atherogenic dyslipidaemia even at relatively normal BMI levels.
For Asian Indians, abdominal obesity is defined as a waist circumference of 90 cm or more in men and 80 cm or more in women, thresholds considerably lower than those used in many Western populations because cardiovascular risk develops earlier.
Contrary to popular belief, dyslipidaemia is no longer a disease of old age.
The study found that prevalence peaked between 30 and 39 years of age, with younger adults showing remarkably high rates of lipid abnormalities.
The regression analysis also showed that while older adults were more likely to have elevated LDL cholesterol and total cholesterol, younger adults had significantly greater odds of hypertriglyceridaemia and low HDL cholesterol, patterns closely linked to insulin resistance and central obesity.
The authors said the findings highlight “the emergence of cardiometabolic risk in young adulthood,” suggesting that waiting until middle age to screen for cholesterol may be too late for many Indians.
Another striking finding was the higher prevalence among women.
Overall dyslipidaemia affected 91.1 percent of women, compared with 83.5 percent of men. After adjusting for multiple factors, women remained 53 percent more likely to have dyslipidaemia and more than twice as likely to have low HDL cholesterol.
Researchers noted that sociocultural barriers limiting healthy behaviours among women may contribute to this burden and said future public health programmes should specifically address these challenges.
As expected, diabetes and hypertension substantially increased the risk of abnormal lipids.
People with diabetes had:
Hypertension also independently increased the likelihood of dyslipidaemia by 28 percent, hypercholesterolaemia by 51 percent and hypertriglyceridaemia by 57 percent.
“The substantial overlap of dyslipidemia with hypertension, obesity and diabetes observed in this study highlights the clustering of cardiometabolic risk factors, a phenomenon commonly attributed to underlying insulin resistance and metabolic dysfunction,” the authors said.
One of the study’s most concerning findings is that traditional screening strategies may be missing a huge section of the population.
Researchers estimated that around 40 percent of Indians with dyslipidaemia had none of the three major metabolic disorders commonly used to identify cardiovascular risk.
They had:
Yet they still had abnormal lipid levels.
This represents an estimated 354.7 million Indians.
“This subgroup represents individuals who would not typically be identified through conventional cardiometabolic risk screening strategies that focus on obesity, diabetes or hypertension,” the authors said.
“The substantial burden of dyslipidemia among metabolically normal individuals highlights the limitations of risk factor based screening and supports broader lipid screening strategies, particularly in Asian Indians, where adverse lipid profiles often occur in the absence of obesity, hypertension or diabetes.”
While abdominal obesity dominated the analysis, lifestyle factors continued to play an important role.
Sedentary individuals had 25 percent higher odds of dyslipidaemia, while current smokers were 35 percent more likely to have elevated triglycerides.
The researchers said the determinants of dyslipidaemia among South Asians are multifactorial, reflecting rapid urbanisation, declining physical activity, dietary changes and underlying genetic susceptibility.
They pointed to increasing consumption of ultra-processed foods rich in refined carbohydrates, added sugars, trans fats and sodium as important drivers of obesity and dyslipidaemia, particularly among younger Indians.
The narrowing gap between urban and rural India also signals changing lifestyles beyond metropolitan cities.
Although urban residents still had slightly higher prevalence, the authors said the high burden observed in rural India suggests dyslipidemia is “now a major public health concern across both rural and urban settings.” They attributed the trend to dietary transition, reduced physical activity, rising obesity and improved screening in rural areas.
The findings challenge the current approach to cardiovascular prevention, which often reserves lipid testing for older adults or people already diagnosed with diabetes or hypertension.
The researchers argue that existing cardiovascular risk prediction models may underestimate risk among Indians because they do not routinely account for Asian-specific BMI thresholds, impaired glucose tolerance or cumulative exposure to abnormal lipids beginning in young adulthood.
“Our findings support the need for future research on earlier risk stratification and targeted lipid-lowering therapy initiation in high-prevalence populations that may appear low risk by conventional assessment tools,” the authors said.
The study also suggests that something as simple as measuring waist circumference during routine health check-ups could identify people who need lipid screening long before symptoms appear.
Unlike diabetes, hypertension or obesity, dyslipidaemia rarely produces symptoms until years of damage have accumulated inside blood vessels.
That makes it one of the country’s most silent epidemics.
With cardiovascular disease already the leading cause of death in India, researchers say tackling abnormal lipids must become a public health priority.
“Enhanced awareness, early screening and effective communication of dyslipidemia-related risks to health policymakers, healthcare providers and communities are essential,” the authors said. They called for coordinated public health strategies and greater attention to barriers preventing healthy lifestyles, particularly among women, to reduce India’s growing cardiovascular disease burden.
