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Statin therapy is recommended in all patients with diabetic renal disease and/or established macrovascular disease or a 5 year CVD risk > 15% aiming for a target LDL cholesterol (LDLc) < 1.4 mmol/L
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Statin therapy should be titrated based on non-fasting lipid studies every 3 – 6 months until the target LDLc is reached
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Rosuvastatin should be considered in all patients who can not reach the target LDLc on maximal tolerated doses of atorvastatin or simvastatin (special authority required but many patients with diabetes will qualify for funding due to burden/risk of complications and/or ethnicity)
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Ezetimibe should be added if the LDL cholesterol is > 2 mmol/L on the maximal dose of tolerated statin therapy (special authority required)
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The role of statin +/- ezetimibe therapy should be discussed with all patients with a 5 year CVD risk between 5 – 15%
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Should also discuss in those with a 5 year CVD risk of < 5% if young and/or a strong family history of premature cardiovascular disease and/or history of familial hypercholestraemia (can use Dutch lipid score to calculate)
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Ensure effective contraception in women of child bearing age
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For those unable to reach target, PSKC9 inhibitors are potent reducers of LDL cholesterol but are not funded and are very expensive
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Bezafibrate and gemfibrozil have not been shown to reduce mortality in patients with diabetes, but may be used in macular oedema or to treat significant hypertriglyceraemia (> 10 mmol/L) that persists after lifestyle management and optimisation of glycaemic control (especially insulin). Beware of the increased risk of muscle adverse effects/rhabdomyolysis with concomitant statin and fibrate therapy