Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Management of hyperlipidaemia in patients with diabetes mellitus or cardiovascular disease (CVD) involves a comprehensive approach:
- Initial assessment: Measure a non-fasting full lipid profile if not already done as part of cardiovascular risk assessment. Assess and treat comorbidities and secondary causes of dyslipidaemia such as uncontrolled diabetes, liver disease, and nephrotic syndrome before initiating lipid-lowering treatment NICE CKS,NICE CKS.
- Statin therapy: Do not withhold statin treatment in people with diabetes due to increased HbA1c or blood glucose levels. For primary prevention in type 1 diabetes, offer statins to adults over 40 years, or with diabetes duration over 10 years, nephropathy, or other CVD risk factors, starting with atorvastatin 20 mg NICE CKS,NICE NG238.
- Targets and intensity: For secondary prevention of CVD, aim for LDL cholesterol ≤2.0 mmol/L or non-HDL cholesterol ≤2.6 mmol/L. Offer high-intensity statins such as atorvastatin 80 mg unless contraindicated or patient prefers lower doses NICE NG238. In type 2 diabetes, aim for >40% reduction in non-HDL cholesterol, considering dose up-titration of atorvastatin as appropriate NICE CKS,NICE CKS.
- Monitoring: Repeat liver transaminases and full lipid profile 2–3 months after starting or changing treatment, then liver function at 12 months unless clinically indicated. Monitor for muscle symptoms and measure creatine kinase if symptoms develop NICE CKS,NICE NG238.
- Additional considerations: Chronic kidney disease does not preclude statin use but requires dose adjustments based on CKD stage. Optimize management of other CVD risk factors including blood pressure and lifestyle factors NICE CKS,NICE CKS,NICE NG238.
- Referral: Refer for specialist assessment if total cholesterol >9.0 mmol/L or non-HDL cholesterol >7.5 mmol/L, or if triglycerides are very high (>10 mmol/L) despite addressing secondary causes NICE CKS,NICE CKS.