What is the recommended low-density lipoprotein (LDL) target for primary prevention in diabetic patients?

From the Guidelines

The recommended LDL target for primary prevention in diabetic patients should be less than 70 mg/dL (<1.8 mmol/L), especially for those with additional ASCVD risk factors, as supported by the most recent guidelines 1. To achieve this target, moderate to high-intensity statin therapy is recommended for diabetic patients aged ≥40 years, with consideration of high-intensity therapy in the context of additional ASCVD risk factors. Key points to consider in primary prevention for diabetic patients include:

• Moderate-dose statin therapy is recommended for those aged ≥40 years, although high-intensity therapy should be considered in the context of additional ASCVD risk factors 1.
• The evidence is strong for people with diabetes aged 40–75 years, an age-group well represented in statin trials showing benefit 1.
• Individuals with diabetes who are at higher cardiovascular risk, especially those with one or more ASCVD risk factors, should be prescribed high-intensity statin therapy to reduce LDL cholesterol by ≥50% from baseline and to target an LDL cholesterol of <70 mg/dL (<1.8 mmol/L) 1. Regular monitoring of lipid levels every 3-6 months until the target is reached, then annually, is important to ensure the effectiveness of the treatment and to make any necessary adjustments. The aggressive LDL targets are recommended because diabetes significantly increases cardiovascular risk, and achieving these targets can help reduce the risk of cardiovascular events in diabetic patients.

From the Research

LDL Target for Primary Prevention in Diabetic Patients

The recommended low-density lipoprotein (LDL) target for primary prevention in diabetic patients is a topic of interest in several studies.

• According to 2, the target LDL-C was defined as < 70 mg/dL for moderate to high and < 100 mg/dL for low-risk groups of ASCVD.
• A study published in 3 suggests that achieving LDL cholesterol target levels < 1.81 mmol/L (< 70 mg/dL) may provide extra cardiovascular protection in patients at high risk.
• Another study 4 suggests that the physiologically normal levels of low-density lipoprotein cholesterol (LDL-C) and the thresholds for development of atherosclerosis and adverse coronary events are in the 30- to 70-mg/dl range.

Factors Associated with Achieving LDL-C Targets

Several factors are associated with achieving LDL-C targets in diabetic patients, including:

• Female gender 2
• Poor adherence to statins 2
• Poor glycemic control 2
• Inadequate physical activity 2

Treatment Options

Treatment options for primary prevention in diabetic patients include:

• Statins 5, 2, 6, 4
• Ezetimibe 6, 4
• Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors 5, 6, 4
• Bempedoic acid 5