ABCD position statement on lipid modifying drug therapy in diabetes

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Cardiovascular disease (CVD) prevention in diabetes is a major therapeutic issue. There are currently several UK based published guidelines for the management of cardiovascular risk in diabetes. Treatment thresholds and targets for the use of lipid modifying drugs vary according to which guideline is consulted. In the light of the variations between guidelines, ABCD endorses an individual ‘tailored’ approach, underpinned by clinical and economic pragmatism. Assessment should include the presence of CVD and other risk factors as well as management of conditions which may alter the lipid profile.Compelling reasons to use statins in adults with diabetes include: clinically manifest CVD; high or marked elevation of LDL (often from a defined genetic cause); treated hypertension, or those with persistent proteinuria (microalbuminuria or proteinuria) or reduced filtration function (eGFR <60 ml/min); and include the majority of diabetes patients above 50 years of age without additional CVD risk factors. Due to limited trial data assessing lipid lowering and clinical outcome in the 30–50 year age group, a ‘tailored’ approach to statin use rather than a ‘statin for all’ should be applied to those with type 1 diabetes. Statin therapy for younger type 2 diabetes (children and those aged up to 40) also needs further clarification and should currently be restricted to those at highest CVD risk.

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