From the Research
The target for low-density lipoprotein (LDL) in patients with diabetes mellitus of over 10 years duration is generally less than 70 mg/dL (or less than 1.8 mmol/L). This more aggressive LDL target is recommended because long-standing diabetes is considered a high cardiovascular risk equivalent, similar to established cardiovascular disease 1. To achieve this target, high-intensity statin therapy is typically the first-line treatment, such as atorvastatin 40-80 mg daily or rosuvastatin 20-40 mg daily. If statins alone are insufficient to reach the target, additional medications like ezetimibe 10 mg daily may be added. For patients who cannot tolerate statins or who remain above goal despite maximum tolerated statin therapy plus ezetimibe, PCSK9 inhibitors (evolocumab or alirocumab) might be considered.
Some key points to consider in managing LDL levels in patients with long-standing diabetes include:
- The importance of high-intensity statin therapy as the first-line treatment 2
- The potential need for additional medications, such as ezetimibe, to reach the target LDL level 3
- The consideration of PCSK9 inhibitors for patients who cannot tolerate statins or who remain above goal despite maximum tolerated statin therapy plus ezetimibe
- The need for regular monitoring of LDL levels and adjustment of treatment as needed to ensure that the target level is achieved and maintained 1
It's also important to note that the management of LDL levels in patients with diabetes is not just about achieving a specific target level, but also about reducing the overall risk of cardiovascular disease. This can be achieved through a combination of lifestyle modifications, such as diet and exercise, and pharmacological treatments, such as statins and other lipid-lowering medications 4, 5.