Statin therapy is recommended for patients with type 1 diabetes (T1DM) in various clinical scenarios, according to different guidelines:
General recommendations
- The ADA 2024 guidelines suggest initiating moderate-intensity statin therapy, in addition to lifestyle therapy, in patients aged 40–75 years with diabetes without atherosclerotic cardiovascular disease (ASCVD)
- For patients of all ages with diabetes and ASCVD, high-intensity statin therapy is recommended by the ADA 2024 guidelines
- The ADA 2024 guidelines also recommend high-intensity statin therapy to target an LDL-C reduction of ≥50% from baseline and an LDL-C goal of <55 mg/dL (<1.4 mmol/L) in patients with diabetes and ASCVD
Specific patient groups
- For patients aged >75 years, the ADA 2024 guidelines suggest initiating moderate-intensity statin therapy after a discussion of potential benefits and risks; continuation of statin therapy is also considered in this age group if they are already on statin therapy
- The ADA 2024 guidelines also suggest initiating statin therapy, in addition to lifestyle therapy, in patients aged 20–39 years with diabetes with additional ASCVD risk factors
- The ESC 2023 guidelines suggest initiating statin therapy for LDL-C lowering to reduce cardiovascular risk in patients aged >40 years with T1DM without a history of cardiovascular disease (CVD)
- For patients aged <40 years with T1DM and other risk factors of CVD or microvascular end-organ damage or 10-year CVD risk ≥10%, the ESC 2023 guidelines suggest initiating statin therapy to reduce CVD risk
High-risk patients
- The EAS/ESC 2020 guidelines recommend initiating statin therapy in high- or very high-risk patients with T1DM
- The ADA 2024 guidelines recommend high-intensity statin therapy to reduce LDL-C by ≥50% of baseline and to target an LDL-C goal of <70 mg/dL (<1.8 mmol/L) in patients aged 40–75 years with diabetes at higher cardiovascular risk, including patients with ≥1 ASCVD risk factors
Contraindications
- Statins should not be used during pregnancy, as per the ADA 2024 guidelines
In summary, statin therapy is recommended for patients with type 1 diabetes across various age groups and risk profiles according to guidelines from the ADA and ESC. The decision to initiate statin therapy should be based on individual cardiovascular risk factors, age, and the presence of ASCVD, with careful consideration of contraindications such as pregnancy.