The most effective pharmacologic lipid treatment to reduce risk for CVD events is statin therapy. For patients who cannot tolerate a particular statin, it is reasonable to try using a different statin. If no statin is tolerated, consider a non-statin medication to lower LDL cholesterol; however, there is little evidence of CVD benefit from non-statin lipid medications.
For all patients with diabetes, initiate lifestyle therapy, then:
| Age |
ASCVD Risk Factors* |
Statin Therapy |
| <40 years |
None |
None |
| 1 or more |
Moderate or High Intensity |
| ASCVD** |
High Intensity |
| 40-75 years |
None |
Moderate Intensity |
| 1 or more |
High Intensity |
| ASCVD** |
High Intensity |
| >75 years |
None |
Moderate Intensity |
| 1 or more |
Moderate or High Intensity |
| ASCVD** |
High Intensity |
* ASCVD (Atherosclerotic Cardiovascular Disease) Risk Factors include: LDL ≥100mg/dL, smoking hypertension, chronic kidney disease, albuminuria, and family history of premature
** ASCVD is atherosclerosis affecting the vasculature of any of the following: heart, periphery (e.g., legs, carotids), and brain (e.g., stroke, transient ischemic attack
Statin Therapy
- Moderate Intensity: Atorvastatin 10-20 mg, Simvastatin 20-40 mg, Pravastatin 40mg, Lovastatin 40-80 mg, Fluvastatin 80 mg, Rosuvastatin 5-10 mg
- High intensity: Atorvastatin 40-80 mg, Rosuvastatin 20-40 mg
Notes:
- Check liver function before starting statin therapy and monitor periodically as indicated.
- Statins are contraindicated in pregnancy and nursing mothers. Consider pregnancy risk when prescribing statins for reproductive age women.
