• 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 

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CIRCULATION

LIPID GUIDELINES

NOVEMBER 2018

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
• Microvascular disease:
  • Nephropathy
    • Albuminuria ≥30
    • eGFR <60
  • Retinopathy
  • Neuropathy
• Macrovascular disease:
  • 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%

 

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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 + 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
• Microvascular disease:
  • Nephropathy
    • Albuminuria ≥30
    • eGFR <60
  • Retinopathy
  • Neuropathy
• Macrovascular disease:
  • 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%

 

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