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TABLE 8.

Recommendations for Statin and Combination Treatment in Adults With Diabetes

AgeASCVDRecommended 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) 
AgeASCVDRecommended 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 cholesterol100 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.

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