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)