Cholesterol-Lowering Therapy for High-Risk Patients with T2DM

Risk Assessment and Treatment Goals

The European Society of Cardiology recommends that patients with T2DM and smoking status are classified as "very high cardiovascular risk" and should have an LDL-C target of <1.4 mmol/L (<55 mg/dL) and LDL-C reduction of at least 50% from baseline 1, 2, 3
A secondary goal of non-HDL-C <2.2 mmol/L (<85 mg/dL) should be targeted for patients with T2DM at very high CV risk 2

The European Society of Cardiology recommends ezetimibe 10 mg daily as the first alternative for patients with statin intolerance, which can provide 15-25% LDL-C reduction 1, 2
If LDL-C targets are not achieved with ezetimibe alone, adding a PCSK9 inhibitor (evolocumab, alirocumab, or inclisiran) is recommended to provide an additional 50-60% LDL-C reduction 1, 2

The European Society of Cardiology recommends SGLT2 inhibitors (empagliflozin, canagliflozin, or dapagliflozin) to reduce cardiovascular events in T2DM patients at high CV risk 2, 4
GLP-1 receptor agonists (liraglutide, semaglutide, or dulaglutide) should also be considered to reduce cardiovascular events in patients with T2DM 2, 5
Empagliflozin has a Class I recommendation to reduce the risk of death in patients with T2DM and cardiovascular disease 4

Regular lipid profile monitoring is essential to assess treatment efficacy in patients with T2DM 2
Women of childbearing potential should not receive statins or their alternatives without appropriate contraception, as recommended by the European Society of Cardiology 2
Smoking cessation is a critical component of overall cardiovascular risk reduction in patients with T2DM 1