2018 Cholesterol Guidelines: Diabetes Mellitus

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.

GT

ALSO SEE:

Lipids Guidelines

Dyslipidemia

Atherosclerosis 


CIRCULATION

LIPID GUIDELINES

NOVEMBER 2018

Diabetes Mellitus in Adults

In adults age 20-39 with diabetes mellitus and the following condition, it may be reasonable to initiate moderate statin therapy:

  • ≥10 years of diabetes type 2

  • ≥20 years of diabetes type 1

  • Albuminuria ≥30

  • eGFR <60

  • Retinopathy

  • Neuropathy

  • ABI <0.9

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%

 
Diabetes and Dyslipidemia