From the Guidelines
The LDL goal for a patient with diabetes mellitus (DM) and no atherosclerotic cardiovascular disease (ASCVD) is less than 70 mg/dL (<1.8 mmol/L) for those aged 40-75 years with at least one ASCVD risk factor, as recommended by the 2025 standards of care in diabetes 1. To achieve this goal, high-intensity statin therapy is recommended for patients with DM and additional ASCVD risk factors. The specific statin and dosage will depend on the individual patient's risk factors and medical history. Some key points to consider when managing LDL levels in diabetic patients without ASCVD include:
- Age: Patients aged 40-75 years with at least one ASCVD risk factor should receive high-intensity statin therapy 1.
- ASCVD risk factors: The presence of additional ASCVD risk factors, such as hypertension or smoking, increases the risk of cardiovascular events and supports the use of high-intensity statin therapy 1.
- Statin therapy: High-intensity statin therapy, such as atorvastatin or rosuvastatin, is recommended for patients with DM and additional ASCVD risk factors 1.
- Lifestyle modifications: A heart-healthy diet, regular physical activity, weight management, smoking cessation, and blood glucose control are essential for reducing cardiovascular risk in diabetic patients 1.
- Monitoring: Regular monitoring of lipid levels and liver function tests is important to assess treatment efficacy and safety 1. It may be reasonable to add ezetimibe or a PCSK9 inhibitor to maximum tolerated statin therapy if the LDL goal is not achieved, as stated in the 2025 standards of care in diabetes 1.
From the Research
LDL Goal for Patients with Diabetes Mellitus and No ASCVD
- The LDL goal for patients with diabetes mellitus and no atherosclerotic cardiovascular disease (ASCVD) is less than 100 mg/dL, according to a study published in 2011 2.
- Another study published in 2023 found that strict lowering of LDL-C to ≤ 70 mg/dL did not decrease the risk of major adverse cardiovascular events (MACE) but was associated with an increased diabetes progression in patients with diabetes without preexisting ASCVD 3.
- The American College of Cardiology's (ACC) 2013 and 2018 guidelines recommend an LDL-C goal of < 70 mg/dL for patients with diabetes at high risk for ASCVD events 4.
- A study published in 2019 suggested that patients at "extreme" ASCVD risk may require extremely low targeted LDL-C goals, such as < 55 mg/dL 5.
Considerations for LDL Goal
- The choice of LDL goal may depend on the individual patient's risk factors and medical history.
- Patients with diabetes and no ASCVD may not require as aggressive LDL lowering as those with established ASCVD.
- The use of statins and other lipid-lowering therapies should be tailored to the individual patient's needs and risk profile, as supported by studies on PCSK9 inhibitors and cardiovascular outcomes 6.