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Statin therapy is recommended in all patients with established macrovascular disease or a 5 year CVD risk > 15% aiming for a target LDL cholesterol < 1.8 mmol/L
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Ezetimibe should be added if the 5 year CVD risk is > 15% and 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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Statin therapy is also recommended in diabetic renal disease regardless of CVD risk
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Ensure adequate contraception in women of child bearing age
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Lipid lowering therapy should be titrated based on non-fasting lipid studies every 3 – 6 months until the target LDL concentration is reached
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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)