For diabetes patients, practical recommendations would be:
Start moderate-intensity statin therapy if:
Young — age 20-39 with microvascular complications or long-standing DM.
Older— age 40-75 without major risk factors.
Start high-intensity statin ± ezetimibe if the following factors are present with the goal of reducing LDLc ≥50%:
Multiple risk factors
ASCVD 10YR ≥20%
For adults >75, clinician-patient discussion is needed if statin were to be started or continued.
Diabetes Mellitus in Adults
In adults age 20-39 with diabetes mellitus + the following condition, it may be reasonable to start moderate statin therapy:
Long duration of diabetes
≥10 years of diabetes type 2
≥20 years of diabetes type 1
In adults age 40-75 with diabetes mellitus:
Irrespective of 10-year ASCVD risk, at least moderate-intensity statin is indicated.
If LDLc is 70-189 mg/dL, it is reasonable [but not necessary] to assess the 10-year ASCVD risk by using race and sex-specific ASCVD calculators.
In adults age >75 with diabetes mellitus:
Who are already on statin therapy, it is reasonable to continue statin therapy.
It may be reasonable to initiate statin therapy after a clinician–patient discussion of potential benefits and risks
In ALL adults with diabetes mellitus and:
Multiple ASCVD risk factors, it is reasonable to prescribe high-intensity statin with the goal of reducing LDLc ≥50%
10-year ASCVD risk of ≥20%, it may be reasonable to add ezetimibe to maximally tolerated statin therapy to reduce LDLc ≥50%