Treatment of Hypercholesterolemia in Patients with Diabetes Mellitus

Numerous studies have shown that statins reduce cardiovascular events including stroke and mortality in diabetics. The American Diabetes Association 2013 guidelines recommend that diabetics at high risk for cardiovascular events should have their serum low-density lipoprotein(LDL) cholesterol reduced to <70 mg/dL with statins. Lower-risk diabetics should have their serum LDL cholesterol reduced to < 100 mg/dL. The 2013 American College of Cardiology/American Heart Association lipid guidelines recommend giving high-dose statins to adult diabetics aged ?75 years with atherosclerotic vascular disease (ASCVD) unless contraindicated with a class I indication and moderate-dose or high-dose statins to diabetics with ASCVD ?75 years with a class IIa indication. Diabetics ? 21 years with a serum LDL cholesterol of ?190 mg/dL should be treated with high-dose statins with a class I indication. For primary prevention in diabetics aged 40 to 75 years and serum LDL cholesterol between 70 to 189 mg/dL, moderate-dose statins should be given with a class I indication. For primary prevention in diabetics aged 40 to 75 years, a serum LDL cholesterol between 70 to 189 mg/dL, and a 10-year risk of ASCVD of ?7.5% calculated from the Pooled Heart Equation, high-dose statins should be given with a class IIa indication. For primary prevention in diabetics aged 21 to 39 years or older than 75 years and a serum LDL cholesterol between 70 to 189 mg/dL, moderate-dose statins or high-dose statins should be given with a class IIa indication. There is no additional ASCVD reduction from adding nonstatin therapy to further lower non-high-density lipoprotein (HDL) cholesterol once an LDL cholesterol goal has been reached. Clinical trials have found no lowering of cardiovascular events or mortality in diabetics treated with statins by addition of nicotinic acid, fibric acid derivatives, ezetemibe, or drugs that raise serum HDL cholesterol.