ADA: Statin therapy for all with diabetes, high CVD risk

The American Diabetes Association (ADA) is calling for all patients with diabetes who are at high risk for cardiovascular disease (CVD) to be treated with statins and lifestyle therapy, according to its recently published guidance in the January issue of Diabetes Care.

Patients with diabetes who are younger than 40 years and have increased cardiovascular risk are candidates for moderate-intensity statin therapy. For those less than 40 years with overt CVD, high-intensity statin therapy is recommended, according to Richard W. Grant, MD, MPH, chair of the ADA’s Professional Practice Committee.

Individuals who have diabetes and are 40 to 75 years with increased cardiovascular risk should be prescribed moderate-intensity statins, and those in that age group with additional cardiovascular risk factors should be treated more aggressively with high-dose statins. Patients with diabetes who are older than 75 years may be treated with moderate- to high-dose statins, but the treatment must be individualized based on risk profile and tolerability, said Grant, a research scientist with the Kaiser Permanente Division of Research.

“The big change here is to recommend starting either moderate- or high-intensity statins based on the patient’s risk profile,” he said, “rather than on LDL level. Since all patients with diabetes are at increased risk, it is just a matter of deciding whom to start on moderate- versus high-intensity statin doses.”

Blood pressure recommendations

In the revised ADA standards, diastolic blood pressure (DBP) targets of <90 mmHg are now recommended for patients with diabetes, instead of the more stringent target of <80 mmHg. Systolic blood pressure (SBP) targets of <140 mmHg for those with diabetes have been maintained.

“This [recommendation] is in harmonization with a recent publication by the Eighth Joint National Committee that recommended, for individuals over 18 years of age with diabetes, a DBP threshold of <90 mmHg and SBP <140 mmHg,” according to the revised standards.

However, the lower DBP targets (<80 mmHg) should still be considered in patients with diabetes who have a long life expectancy and those with chronic kidney disease and elevated urine albumin excretion, as stated in the updated recommendations.

Click here to read the new standards.