Recommendations for Statin and Combination Treatment in Adults With Diabetes
| Age . | ASCVD . | Recommended statin intensity^ and combination treatment* . |
|---|---|---|
| <40 years | No | None† |
| Yes | High | |
| If LDL cholesterol ≥70 mg/dL (3.9 mmol/L) despite maximally tolerated statin dose, consider adding additional LDL-lowering therapy (such as ezetimibe or PCSK9 inhibitor)# | ||
| ≥40 years | No | Moderate‡ |
| Yes | High | |
| If LDL cholesterol ≥70 mg/dL (3.9 mmol/L) despite maximally tolerated statin dose, consider adding additional LDL-lowering therapy (such as ezetimibe or PCSK9 inhibitor) |
| Age . | ASCVD . | Recommended statin intensity^ and combination treatment* . |
|---|---|---|
| <40 years | No | None† |
| Yes | High | |
| If LDL cholesterol ≥70 mg/dL (3.9 mmol/L) despite maximally tolerated statin dose, consider adding additional LDL-lowering therapy (such as ezetimibe or PCSK9 inhibitor)# | ||
| ≥40 years | No | Moderate‡ |
| Yes | High | |
| If LDL cholesterol ≥70 mg/dL (3.9 mmol/L) despite maximally tolerated statin dose, consider adding additional LDL-lowering therapy (such as ezetimibe or PCSK9 inhibitor) |
In addition to lifestyle therapy.
For patients who do not tolerate the intended intensity of statin, the maximally tolerated statin dose should be used.
Moderate-intensity statin may be considered based on risk-benefit profile and presence of ASCVD risk factors. ASCVD risk factors include LDL cholesterol ≥100 mg/dL (2.6 mmol/L), high blood pressure, smoking, CKD, albuminuria, and family history of premature ASCVD.
High-intensity statin may be considered based on risk-benefit profile and presence of ASCVD risk factors.
Adults aged <40 years with prevalent ASCVD were not well represented in clinical trials of nonstatin-based LDL reduction. Before initiating combination lipid-lowering therapy, consider the potential for further ASCVD risk reduction, drug-specific adverse effects, and patient preferences.