Measurement
- Order a fasting lipid panel (LDL, HDL, total cholesterol, and triglycerides)
- at diagnosis of diabetes, or initial diabetes visit;
- at least every 5 years if age <40 years, annually after 40; and
- at initiation of statin therapy and after dosing changes.
Treatment
- Provide patient-centered education and ongoing support for lifestyle interventions for all patients to reduce ASCVD1 risk: individualized nutrition therapy, physical activity and weight loss guidance, as well as smoking cessation counseling.
- Prescribe high intensity statin therapy for patients with ASCVD (Secondary Prevention).
- Prescribe moderate or high intensity statin therapy for all patients aged 40-75 years without ASCVD (Primary Prevention).
- Utilize a shared decision making model when considering moderate or high intensity statin therapy for patients aged <40 years without ASCVD but with one or more additional ASCVD risk factors independent of diabetes2.
- Discuss risk-benefit of statin therapy with patients aged >75 years without ASCVD; initiate or continue statin based on shared-decision-making.
- Consider bempedoic acid for patients with statin intolerance.
1 ASCVD (Atherosclerotic Cardiovascular Disease) is atherosclerosis affecting the vasculature that results in diseases of any of the following: heart (e.g. myocardial infarction, angina), the brain (e.g., stroke, transient ischemic attack), and the lower extremities (e.g. peripheral artery disease, limb ischemia).
2 Risk Factors independent of diabetes include: LDL cholesterol ≥100 mg/dL, smoking, hypertension, chronic kidney disease, albuminuria, or family history of premature ASCVD.
See Diabetes Treatment Algorithm: Lipid and Aspirin Therapy in Type 2 Diabetes for detailed guidance on statin therapy based on age and ASCVD risk. Statin dosing information is provided.
