From the Guidelines
For a 60-year-old male with diabetes mellitus, aspirin therapy (75–162 mg/day) is recommended as a primary prevention strategy due to his increased cardiovascular risk. According to the standards of medical care in diabetes 1, men aged >50 years with at least one additional major risk factor are considered at high risk for cardiovascular disease. Given the patient's age and diabetes status, he likely falls into this category. Aspirin has been shown to be effective in reducing cardiovascular morbidity and mortality in high-risk patients with diabetes 1.
However, it's also important to consider the more recent guidelines on primary prevention of cardiovascular disease 1, which emphasize the importance of statin therapy for patients with diabetes aged 40-75 years, as it significantly reduces the risk of ASCVD events. Statin therapy, such as atorvastatin 10-20 mg daily or rosuvastatin 5-10 mg daily, should be prioritized for primary prevention in this patient population, given its proven benefit in reducing cardiovascular risk 1.
Key points to consider in this patient's care include:
- Diabetes is a coronary heart disease risk equivalent, meaning patients have a similar risk of cardiovascular events as those with established coronary disease
- Statins work by inhibiting HMG-CoA reductase, reducing cholesterol synthesis and increasing LDL receptor expression, which lowers LDL cholesterol levels
- Aspirin therapy may still be considered in addition to statin therapy, but its use should be individualized based on the patient's specific risk factors and bleeding risk 1.
From the Research
Primary Prevention Measures for a 60-year-old Male with Diabetes Mellitus
The patient in question is a 60-year-old male with diabetes mellitus (DM) who has been started on antidiabetic agents. Considering his age and health condition, the primary prevention measure would focus on reducing the risk of cardiovascular disease (CVD), a leading cause of morbidity and mortality in individuals with DM.
Statin Therapy for Primary Prevention
- The US Preventive Services Task Force recommends statin use for the primary prevention of CVD events and all-cause mortality in adults aged 40 to 75 years with no history of CVD and who have one or more CVD risk factors (including diabetes) and an estimated 10-year CVD event risk of 10% or greater 2.
- For adults aged 40 to 75 years with one or more CVD risk factors and an estimated 10-year CVD risk of 7.5% to less than 10%, the task force recommends that clinicians selectively offer a statin for primary prevention 2.
- Clinical practice guidelines also recommend statin therapy for people with DM ages 40 to 75 years 3.
- A study published in 2024 found that statin therapy for primary prevention in old and very old adults (aged 75 years or older) reduced the incidence of major CVDs without increasing the risk of severe adverse effects 4.
Considerations for the Patient
- Given the patient's age (60 years) and diagnosis of DM, statin therapy would be a recommended primary prevention measure to reduce the risk of CVD events and all-cause mortality 2, 3, 5.
- The patient's healthcare provider should discuss the benefits and risks of statin therapy with him, considering his individual risk factors and health status 3, 6.