A patient aged 40-75 with diabetes presents for follow-up. What should the statin recommendations be?

• A. Moderate-intensity statin therapy without calculating 10-year risk
• B. High-intensity statin therapy for all
• C. No statin unless ASCVD present
• D. Ezetimibe added to statin

Answer: (A)

In adults aged 40–75 with diabetes, starting statin therapy for primary prevention is recommended regardless of calculated 10-year ASCVD risk. Diabetes itself places patients at higher risk, so a moderate-intensity statin is indicated to lower LDL by roughly 30–49% and reduce ASCVD events without the greater side effects profile that comes with higher-dose therapy. This approach is preferred over waiting for an elevated 10-year risk score or treating only after ASCVD develops.

Choosing a moderate-intensity statin (for example, a statin that typically lowers LDL by about a third) strikes a balance between beneficio and tolerability. High-intensity statin therapy for everyone isn’t necessary unless there are additional high-risk features or very high baseline risk. Not treating with statins in a diabetic patient without ASCVD misses a proven preventive measure. Adding ezetimibe is usually reserved for cases where LDL targets aren’t reached with maximally tolerated statin, or if statin therapy isn’t tolerated, rather than as initial therapy.