Seventy to seventy-five percent of adult patients with diabetes die of macrovascular disease, specifically coronary, carotid and/or peripheral vascular disease. Diabetes is considered a myocardial infarction risk equivalent to ASCVD risk. Dyslipidemia is a known risk factor for macrovascular disease. Patients with diabetes develop more atherosclerosis than patients without diabetes with the same quantitative lipoprotein profiles. In most patients with diabetes, use of a statin can reduce major vascular events. Beneficial effects of statins on cardiovascular risk reduction may go beyond their quantitative effects on lipid levels.
For those with a diagnosis of diabetes who are younger than 40 or older than 75, statin therapy decisions should be individualized based on considerations of ASCVD risk reduction benefits, potential adverse effects and drug interactions, and patient preferences.
For additional information on statin therapy, refer to the ICSI Lipid Management in Adults guideline.
The current evidence does not support the use of combination therapy with statins and other lipid drugs for most patients with T2DM. The National Institutes of Health-sponsored ACCORD lipid study showed no significant reduction in myocardial infarct, stroke or cardiovascular death with a fibrate-statin combination compared to statin monotherapy. However, a subgroup analysis of the primary outcome suggested that there was a gender effect with a possible benefit for men and possible harm for women, as well as a possible benefit for men and women with both low HDL (< 34 mg/dL) and elevated triglycerides (> 204 mg/dL). AIM-HIGH was a study designed to evaluate the cardiovascular outcomes with niacin and statin combination therapy compared to statin monotherapy in patients with coronary heart disease, including a subgroup with diabetes. The study was stopped early in 2011 because of lack of benefit compared to statin therapy alone, including the diabetes subgroup (AIM-HIGH Investigators, 2011).