What are the considerations for using high-intensity statin therapy in patients with diabetes mellitus 40-75 years of age?
High-intensity statin therapy is preferred in patients with diabetes mellitus as they age or develop risk modifiers such as the occurrence of a first ASCVD event. This is due to the increased morbidity and mortality associated with diabetes mellitus in this age range, as well as the fact that trials using moderate-intensity statin therapy demonstrate significant benefit in such individuals, but the residual risk in the statin treatment groups in these trials remained high. The benefits of statin therapy are related to both global risk and intensity of treatment, and no RCTs of high-intensity statin therapy have been carried out in cohorts of patients exclusively with diabetes mellitus. Therefore, the decision to upgrade statin treatment from moderate to high intensity should include an evaluation of the individual's global risk, the potential for benefit from a high-intensity statin versus the potential for adverse effects or drug-drug interactions, as well as patient preferences and values.