NICE guidance - hyperlipidaemia management in type II diabetes

Summary points from the guidance are included in this section (1). For detailed information then consult the full guideline (1):

Primary prevention for people with type 1 diabetes

• statin treatment should be considered for the primary prevention of CVD in all adults with type 1 diabetes
• statin treatment should be offered for the primary prevention of CVD to adults with type 1 diabetes who:  
  • are older than 40 years or
  • have had diabetes for more than 10 years or
  • have established nephropathy or
  • have other CVD risk factors
  • start treatment for adults with type 1 diabetes with atorvastatin 20 mg

Primary prevention for people with type 2 diabetes

• atorvastatin 20 mg should be offered for the primary prevention of CVD to people with type 2 diabetes who have a 10% or greater 10-year risk of developing CVD 
  • estimate the level of risk using the QRISK2 assessment tool

Follow-up of people started on statin treatment

• total cholesterol, HDL cholesterol and non-HDL cholesterol should be measured in all people who have been started on high-intensity statin treatment at 3 months of treatment and aim for a greater than 40% reduction in non-HDL cholesterol. If a greater than 40% reduction in non-HDL cholesterol is not achieved:
  • discuss adherence and timing of dose
  • optimise adherence to diet and lifestyle measures
  • consider increasing the dose if started on less than atorvastatin 80 mg and the person is judged to be at higher risk because of comorbidities, risk score or using clinical judgement
• LFTs
  • measure baseline liver transaminase enzymes (alanine aminotransferase or aspartate aminotransferase) before starting a statin
  • measure liver transaminase within 3 months of starting treatment and at 12 months, but not again unless clinically indicated
  • do not routinely exclude from statin therapy people who have liver transaminase levels that are raised but are less than 3 times the upper limit of normal.

Statins are contraindicated in pregnancy:

• advise women of childbearing potential of the potential teratogenic risk of statins and to stop taking them if pregnancy is a possibility
• advise women planning pregnancy to stop taking statins 3 months before they attempt to conceive and to not restart them until breastfeeding is finished

Ezetimibe

• people with primary hypercholesterolaemia should be considered for ezetimibe treatment in line with Ezetimibe for the treatment of primary (heterozygousfamilial and non-familial) hypercholesterolaemia

Reference:

• (1) NICE (July 2014).Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease.