Recommendations for statin and combination treatment in adults with diabetes, 2018 ADA

ASCVD risk factors include LDL cholesterol ≥ 100 mg/dL (2.6 mmol/L), high blood pressure, smoking, chronic kidney disease, albuminuria, and family history of premature ASCVD

Recommendations 

● For patients of all ages with diabetes and atherosclerotic cardiovascular disease, high-intensity statin therapy should be added to lifestyle therapy. A 

● For patients with diabetes aged < 40 years with additional atherosclerotic cardiovascular disease risk factors, the patient and provider should consider using moderate intensity statin in addition to lifestyle therapy. C 

● For patients with diabetes aged 40– 75 years A and > 75 years B without atherosclerotic cardiovascular disease, use moderate-intensity statin in addition to lifestyle therapy. 

● In clinical practice, providers may need to adjust the intensity of statin therapy based on individual patient response to medication (e.g., side effects, tolerability, LDL cholesterol levels, or percent LDL reduction on statin therapy). For patients who do not tolerate the intended intensity of statin, the maximally tolerated statin dose should be used. E 

● For patients with diabetes and atherosclerotic cardiovascular disease, if LDL cholesterol is ≥ 70 mg/dL on maximally tolerated statin dose, consider adding additional LDL lowering therapy (such as ezetimibe or PCSK9 inhibitor) after evaluating the potential for further atherosclerotic cardiovascular disease risk reduction, drug-specific adverse effects, and patient preferences. Ezetimibe may be preferred due to lower cost. A 

●  Statin therapy is contraindicated in pregnancy. B