As presented here, the results from this recent poll highlight the complex decision-making process involved in deciding appropriate statin therapy for the prevention of ASCVD in patients with diabetes. The revised guidelines emphasize the importance of ASCVD risk assessment and recommend the inclusion of risk enhancers (diabetic-specific and non-specific) for initiating or modifying statin intensity to facilitate a more personalized approach for lipid management in patients with diabetes in primary prevention of ASCVD.
Patients with diabetes have an increased lifetime risk of ASCVD events compared to those without diabetes, and there does appear to be marked heterogeneity in the ASCVD risk. We compared the effects of high-intensity statin monotherapy versus moderate-intensity statin and ezetimibe combination therapy on major adverse. Note:For patients with diabetes and 10-year ASCVD risk of ≥20%, addition of ezetimibe, a nonstatin therapeutic agent to maximally tolerated statin therapy may be considered to reduce LDL-C levels by ≥50% (IIb).Ī Diabetes-specific risk enhancers: long duration (10 years of type 2 diabetes mellitus, ≥20 years of type 1 diabetes mellitus), albuminuria (≥30 mcg of albumin/mg creatinine), estimated glomerular filtration rate (eGFR) 160mg/dL (>4.1mmol/L, chronic kidney disease, metabolic syndrome, history of preeclampsia, history of premature menopause, inflammatory disease (especially rheumatoid arthritis, psoriasis, HIV), ethnicity (e.g., South Asian ancestry), persistently elevated triglycerides > 175mg/dl (>2.0mmol/L), Hs-CRP > 2mg/L, Lp(a) > 50mg/dl or >125nmol/L, Apo B > 130mg/dl, ankle-brachial index (ABI) < 0.9 Initiate statin therapy after clinician-patient discussion of potential benefits and risks of initiating statin therapy (IIb) Statin High Moderate Low Lipid-lower<30 Rosuvastatin 2040 mg 510 mg Atorvastatin 4080 mg 1020 mg Simvastatin 40 mg 10 mg Lovastatin. Definitions of High-, Moderate-, and Low-Intensity Statin. In primary prevention, statins are recommended for patients with LDL-C levels ≥190 mg/dL, patients with diabetes mellitus aged 40-75 years, and for those with no diabetes with LDL-C levels ≥70 mg/dL - 75 yearsĬontinue statin therapy if already on statin therapy (IIa) For use with the AACVPR Outpatient Cardiac Rehabilitation Registry. The 2018 American Heart Association (AHA)/American College of Cardiology (ACC)/ Multisociety guidelines for lipid management provide revised recommendations for the prevention of atherosclerotic cardiovascular disease (ASCVD).
This recent poll assessed our readers' statin prescription patterns in routine clinical practice in patients with diabetes but without established cardiovascular disease.
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