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Changes to NICE advice on lipid modification in people with diabetes

NICE clinical guideline 181 is an important update of the 2008 NICE guideline on lipid modification as it takes account of evolving evidence and cost-effectiveness, with the range of statins available as generic drugs having expanded during the intervening years. People with type 1 and type 2 diabetes should have a 10-year CVD risk assessment performed using the QRISK®2 assessment tool. Generally speaking, atorvastatin appears to be the statin of choice, at a dose of 20 mg.

by Colin Kenny, GP, Dromore

Cardiovascular disease (CVD) is a leading cause of death in people with diabetes. NICE clinical guideline 181 states that a risk assessment should be performed on a (non-fasting) lipid profile using the QRISK®2 risk assessment tool in people up to the age of 84. Atorvastatin 20 mg should be offered for the primary prevention of CVD in people with type 2 diabetes who have a 10% or greater 10-year risk of developing CVD. This statin should also be offered for the primary prevention of CVD in people with type 1 diabetes who are over 40 years, have had diabetes for more than 10 years, have established nephropathy, or have other CVD risk factors.

Women of child-bearing potential should be informed of the potential teratogenic risk of statins and advised to stop taking statins if pregnancy is a possibility (women planning pregnancy should be advised to stop taking statins 3 months before attempting to conceive and to not restart statins until breastfeeding is completed).

Fibrates, nicotinic acids, and bile acid sequestrants (or omega-3 fatty acid compounds) should not be routinely offered for the prevention of CVD, alone or in combination with a statin, because there is no evidence of benefit. Ezetimibe is still recommended in restricted circumstances, where there is primary hypercholesterolaemia.

To access the full guideline, click here (free to access)

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