II. Management: Goals parallel those for known cardiovascular disease

  1. New 2015 guidelines (targeted risk) - Non-LDL focused
    1. Moderate Intensity Statin (e.g. Atorvastatin 20 mg) Indications
      1. Diabetes Mellitus without additional Cardiovascular Risk Factors
    2. High Intensity Statin (e.g. Atorvastatin 80 mg) Indications
      1. Cardiovascular disease or additional Cardiovascular Risk Factors OR
      2. Framingham Score >7.5% (esp. age over 50 years old)
  2. Old guidelines (targeted specific values)
    1. LDL Cholesterol <100 mg/dl
      1. Lower LDL to <70 mg/dl in Diabetes with known Coronary Artery Disease or
      2. Lower LDL by 30% if LDL baseline is near 100 mg/dl
    2. HDL Cholesterol >40 mg/dl
    3. Triglycerides <150 mg/dl
  3. References
    1. Stone (2014) J Am Coll Cardiol 63(25 Pt B):2889-934 +PMID:24239923 [PubMed]

III. Management: AntiHyperlipidemic Selection

  1. Management: Statins
    1. Statins are the preferred AntiHyperlipidemic agents in Diabetes Mellitus
    2. Indications: Statin agent use despite lipids in target range
      1. Known Coronary Artery Disease
      2. Age 40-75 years and one Cardiovascular Risk Factor (most Type I and Type II patients)
      3. Age <40 or >75 years old and additional Cardiac Risk Factors
  2. Management: LDL Cholesterol - Adjunctive agents (Statins alone are preferred)
    1. See LDL Cholesterol
    2. Colesevelam (Welchol)
      1. Also lowers A1C by 0.5%
      2. Do not use in Hypertriglyceridemia
      3. Zieve (2007) Clin Ther 29(1):74-83 [PubMed]
    3. Niacin
      1. Initial studies suggested benefit in Diabetes Mellitus
        1. Grundy (2002) Arch Intern Med 162:1568-76 [PubMed]
      2. However Cardiovascular Risk Reduction is in question (despite improved lab values)
        1. Ito (2012) Ann Pharmacother 46(10):1368-81 [PubMed]
  3. Management: Triglycerides and normal to low LDL Cholesterol
    1. Optimizing glycemic control results in improved serum Triglycerides
    2. Consider Fenofibrate (Tricor)

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