From the Guidelines
For patients with Diabetes Mellitus (DM), the recommended Low-Density Lipoprotein (LDL) cholesterol level should be below 100 mg/dL (2.6 mmol/L), with an optimal target of less than 70 mg/dL (1.8 mmol/L) for those at high risk of cardiovascular disease and less than 55 mg/dL (1.4 mmol/L) for those at very high risk. These guidelines are based on the most recent evidence from the 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD 1.
Key Recommendations
- In patients with T2DM at moderate CV risk, an LDL-C target of <2.6 mmol/L (<100 mg/dL) is recommended
- In patients with T2DM at high CV risk, an LDL-C target of <1.8 mmol/L (<70 mg/dL) and LDL-C reduction of at least 50% is recommended
- In patients with T2DM at very high CV risk, an LDL-C target of <1.4 mmol/L (<55 mg/dL) and LDL-C reduction of at least 50% is recommended
To achieve these targets, patients with DM should focus on both lifestyle modifications and, if necessary, medication. Lifestyle changes include:
- Adopting a heart-healthy diet low in saturated fats and high in fiber
- Regular exercise (at least 150 minutes of moderate-intensity aerobic activity per week)
- Weight management
- Smoking cessation
If lifestyle changes alone are insufficient, statins are typically the first-line medication prescribed, with dosages tailored to individual needs and tolerability, as recommended by the 2019 ESC guidelines 1.
It's crucial for patients with DM to have their LDL levels checked at least annually, or more frequently if they're working to lower their levels or adjust medication. The heightened focus on LDL control in patients with DM is due to the compound effect of diabetes and high cholesterol on blood vessel damage, which significantly increases the risk of cardiovascular events. By maintaining strict control over LDL levels, patients with DM can substantially reduce their risk of heart attacks, strokes, and other cardiovascular complications.
From the Research
LDL Guidelines for Patients with Diabetes Mellitus
The guidelines for Low-Density Lipoprotein (LDL) cholesterol levels in patients with Diabetes Mellitus (DM) are as follows:
- The primary lipid target is an LDL-C <100 mg/dL 2, 3, 4
- For very high-risk patients, the optional LDL goal is <70 mg/dL 5, 2, 3, 4
- Some guidelines recommend a more aggressive target of ≤55 mg/dL for patients with T2D and established atherosclerotic CV disease 6
Achieving LDL Goals
- Statins are the first-line therapy for lowering LDL levels 2, 3
- Combination therapy with other lipid-lowering agents may be necessary to achieve lipid goals 5, 2, 3
- Nonpharmacologic interventions, such as diet and exercise, are also important for managing dyslipidemia 2, 3
Prevalence of LDL Goal Achievement
- Only 15.7% of very-high-risk patients had an LDL <70 mg/dL 5
- Approximately 25% of patients will require more than two lipid-lowering drugs at maximal doses to attain an LDL goal of <70 mg/dL 5
- In routine practice, only 1:3 high-risk patients with T2D and CV disease had LDL-C <70 mg/dL and 1:6 had LDL-C <55 mg/dL 6