Diabetes associated CVD disease and risk management: ADA 2020

Statin Treatment

  Primary Prevention

   Recommendations

• For patients with diabetes aged 40–75 years without atherosclerotic cardiovascular disease, use moderate-intensity statin therapy in addition to lifestyle therapy.
• For patients with diabetes aged 20–39 years with additional atherosclerotic cardiovascular disease risk factors, it may be reasonable to initiate statin therapy in addition to lifestyle therapy.
• In patients with diabetes at higher risk, especially those with multiple atherosclerotic cardiovascular disease risk factors or aged 50–70 years, it is reasonable to use high-intensity statin therapy.
• In adults with diabetes and 10-year atherosclerotic cardiovascular disease risk of 20% or higher, it may be reasonable to add ezetimibe to maximally tolerated statin therapy to reduce LDL cholesterol levels by 50% or more.

Secondary Prevention

Recommendations

• For patients of all ages with diabetes and atherosclerotic cardiovascular disease, high-intensity statin therapy should be added to lifestyle therapy.
• For patients with diabetes and atherosclerotic cardiovascular disease considered very high risk using specific criteria, if LDL cholesterol is ≥70 mg/dL on maximally tolerated statin dose, consider adding additional LDL-lowering therapy (such as ezetimibe or PCSK9 inhibitor). Ezetimibe may be preferred due to lower cost.
• For patients who do not tolerate the intended intensity, the maximally tolerated statin dose should be used.
• In adults with diabetes aged >75 years already on statin therapy, it is reasonable to continue statin treatment.
• In adults with diabetes aged >75 years, it may be reasonable to initiate statin therapy after discussion of potential benefits and risks.
• Statin therapy is contraindicated in pregnancy.