INTRODUCTION

The American Diabetes Association (ADA) standards of care for diabetes state that statin therapy should be initiated in individuals with diabetes and other cardiovascular risk factors with a target LDL cholesterol of <100 mg/dl. Furthermore, a possible target LDL of <70 mg/dl is stated in patients with diabetes and cardiovascular disease. In this mini-review, we examine the evidence that exists regarding LDL cholesterol–based treatment goals in individuals with diabetes. From our review of the current literature, it is evident that the majority of clinical trials were designed using a fixed dose of statins and not in an LDL cholesterol–based “treat-to-target” approach (thus differing from the common design of blood glucose control trials). This leads us to reassess the current guidelines with special emphasis on the very-low-risk and very-high-risk individuals with diabetes, where the evidence is less robust. We conclude that in this subset of individuals with diabetes, statin therapy should be based on the existing evidence and prescribed in a fixed-dose manner.

Published yearly, the ADA standards of clinical care portray the principle guidelines of diabetes care based on the constantly evolving body of evidence for the treatment of patients with diabetes. The 2008 standards of care state the following for statin use in diabetic individuals (1):

1. Statin therapy should be added to lifestyle therapy, regardless of baseline lipid levels, for diabetic patients a) with overt cardiovascular disease (CVD) (A: level of evidence as described in the ADA evidence-grading system [Table 1]); the primary goal is an LDL cholesterol <100 mg/dl (<2.6 mmol/l) (A); a lower LDL cholesterol goal of 70 mg/dl (1.8 mmol/l), using a high dose of a statin, is an option (E); and b) without CVD who are over the age of 40 years and have one or more other CVD risk factor. The …