Skip to site content

Diabetes Standards of Care & Clinical Practice Resources

Lipid Management

Cardiovascular disease (CVD) is a major cause of morbidity and mortality for individuals with diabetes. Appropriate use of statin therapy results in significant CVD risk reduction for adults with diabetes.

Standards of Care Topics

» View All Topics

Recommendations At-a-Glance
for All Topics

» Online version
» Print version [PDF – 453 KB]

Lipid Management Sections

Quickly jump to a section on this page by clicking on one of the links below.

 

Clinical Practice Recommendations

Recommendations for Lipid Management

Measurement

  • Order a lipid panel (total cholesterol, LDL, HDL, triglycerides):
    1. at diagnosis of diabetes
    2. if <40 years old and not on a statin, consider annual lipid panel
    3. at age 40 if not yet on a statin to establish treatment baseline
    4. as needed every 1-2 years (e.g., to evaluate adherence to lipid therapy)
  • See Diabetes Treatment Algorithm: Lipid and Aspirin Therapy in Type 2 Diabetes.

Treatment

  • Implement a treatment plan to achieve lipid management goals:
 

Statin Treatment Recommendations for People with Diabetes

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:

Lifestyle therapy
Lifestyle therapy
 

1 CVD Risk Factors include: LDL ≥100mg/dL, High Blood Pressure, Smoking, or Overweight/Obesity

2 Overt CVD includes people with a history of a cardiovascular event (heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization).

3 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

For a text description of the information in the diagram above:

  • Initiate lifestyle therapy for all patients with diabetes.
  • Patients <40 years of age:
    • Without CVD risk factors1, should not receive statin therapy.
    • With CVD risk factors1, should receive moderate or high intensity statin therapy3.
    • With overt CVD2, should receive high intensity statin therapy3.
  • Patients 40-75 years of age:
    • Without CVD risk factors1, should receive moderate intensity statin therapy3.
    • With CVD risk factors1, should receive high intensity statin therapy3.
    • With overt CVD2, should receive high intensity statin therapy3.
  • Patients >75 years of age:
    • Without CVD risk factors1, should receive moderate intensity statin therapy3.
    • With CVD risk factors1, should receive moderate or high intensity statin therapy3.
    • With overt CVD2, should receive high intensity statin therapy3.

1 CVD Risk Factors include: LDL ≥100mg/dL, High Blood Pressure, Smoking, or Overweight/Obesity

2 Overt CVD includes people with a history of a cardiovascular event (heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization).

3 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.

Clinician and Educator Resources

Diabetes Treatment Algorithm: Lipid and Aspirin Therapy in Type 2 Diabetes

SDPI Healthy Heart Toolkit

IHS Diabetes Treatment and Prevention


2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults Exit Disclaimer: You Are Leaving www.ihs.gov 

J Am Coll Cardiol. 2014;63(25_PA):2889-2934. doi:10.1016/j.jacc.2013.11.002


American Diabetes Association Standards of Medical Care in Diabetes - 2018 Exit Disclaimer: You Are Leaving www.ihs.gov 

Diabetes Care 2018 Jan; 41 (Supplement 1)


Update on Prevention of Cardiovascular Disease in Adults with Type 2 Diabetes Mellitus in Light of Recent Evidence: A Scientific Statement from the American Heart Association and the American Diabetes Association Exit Disclaimer: You Are Leaving www.ihs.gov  [PDF]

Diabetes Care 2015 Sep; 38 (9) 1777-1803; doi: 10.2337/dci15-0012


LIPIDS Pocket Guide Card Exit Disclaimer: You Are Leaving www.ihs.gov  [PDF]

VA/DoD Clinical Guidelines: The Management of Dyslipidemia for Cardiovascular Risk Reduction (Lipids) Exit Disclaimer: You Are Leaving www.ihs.gov 

Department of Veterans Affairs


ASCVD Risk Estimator Plus Exit Disclaimer: You Are Leaving www.ihs.gov 

American College of Cardiology


Framingham Heart Study Cardiovascular Disease (10-year Risk) Exit Disclaimer: You Are Leaving www.ihs.gov 

National Heart, Lung, and Blood Institute and Boston University


Calculator: Estimated Risk of Developing CHD in 10 Years Exit Disclaimer: You Are Leaving www.ihs.gov 

Strong Heart Study