II. Management: Goals parallel those for known cardiovascular disease
- New 2015 guidelines (targeted risk) - Non-LDL focused
- Moderate Intensity Statin (e.g. Atorvastatin 20 mg) Indications
- Diabetes Mellitus without additional Cardiovascular Risk Factors
- High Intensity Statin (e.g. Atorvastatin 80 mg) Indications
- Cardiovascular disease or additional Cardiovascular Risk Factors OR
- Framingham Score >7.5% (esp. age over 50 years old)
- Moderate Intensity Statin (e.g. Atorvastatin 20 mg) Indications
- Old guidelines (targeted specific values)
- LDL Cholesterol <100 mg/dl
- Lower LDL to <70 mg/dl in Diabetes with known Coronary Artery Disease or
- Lower LDL by 30% if LDL baseline is near 100 mg/dl
- HDL Cholesterol >40 mg/dl
- Triglycerides <150 mg/dl
- LDL Cholesterol <100 mg/dl
- References
III. Management: AntiHyperlipidemic Selection
- Management: Statins
- Statins are the preferred AntiHyperlipidemic agents in Diabetes Mellitus
- Indications: Statin agent use despite lipids in target range
- Known Coronary Artery Disease
- Age 40-75 years and one Cardiovascular Risk Factor (most Type I and Type II patients)
- Age <40 or >75 years old and additional Cardiac Risk Factors
- Management: LDL Cholesterol - Adjunctive agents (Statins alone are preferred)
- See LDL Cholesterol
- Colesevelam (Welchol)
- Also lowers A1C by 0.5%
- Do not use in Hypertriglyceridemia
- Zieve (2007) Clin Ther 29(1):74-83 [PubMed]
- Niacin
- Initial studies suggested benefit in Diabetes Mellitus
- However Cardiovascular Risk Reduction is in question (despite improved lab values)
- Management: Triglycerides and normal to low LDL Cholesterol
- Optimizing glycemic control results in improved Serum Triglycerides
- Consider Fenofibrate (Tricor)