New Lipid Goals for Higher Risk Individuals

If you are taking the CDCES or BC-ADM exam in 2023, these new lipid targets for high risk individuals and treatment interventions are important to know.

For all of us who serve people with diabetes, evidence from many trials demonstrated that these more intensive LDL cholesterol targets will save lives and decrease CV disease. By sharing this information with our colleagues and teams, we can be a part of improving outcomes and quality of life.

The following content summarizes the 2023 updated ADA guidelines as outlined in Standard 10 – Cardiovascular Disease and Risk Management.

New LDL Treatment Targets for Higher Risk Individuals

Primary PreventionPeople without ASCVD

The guidelines have remained the same for lower risk individuals with diabetes aged 40–75 years without atherosclerotic cardiovascular disease, “Start moderate-intensity statin therapy in addition to lifestyle therapy”.  They also are the same for people with diabetes aged 20–39 years with additional atherosclerotic cardiovascular disease risk factors, “Based on individual assessment, initiate statin therapy in addition to lifestyle therapy.”

More Intensive LDL for High Risk Individuals

In the category of primary prevention for people with diabetes aged 40–75 at higher cardiovascular risk (LDL >100, HTN, Smoke, CKD, albuminuria, family hx ACSVD), the goals have been intensified.

  • High-intensity statin therapy is recommended to reduce LDL cholesterol by at least 50% of baseline and to target an LDL cholesterol goal of <70 mg/dL. 
  • For people with diabetes aged 40–75 years at higher cardiovascular risk, especially those with multiple atherosclerotic cardiovascular disease risk factors and an LDL cholesterol of 70 mg/dL or greater, it may be reasonable to add ezetimibe or a PCSK9 inhibitor to maximum tolerated statin therapy. 

More Intensive LDL Goals for People with Atherosclerotic Cardiovascular Disease:

Secondary Prevention goals have also been intensified.

For people of all ages with diabetes and atherosclerotic cardiovascular disease:

  • Add high-intensity statin to lifestyle therapy.
  • Target LDL cholesterol reduction of 50% or greater from baseline and an LDL cholesterol goal of <55 mg/dL.

  • Addition of ezetimibe or a PCSK9 inhibitor with proven benefit in this population is recommended if goal is not achieved on maximum tolerated statin therapy. 

In 2022, the ADA Standards did not include specific LDL targets for people with diabetes. However, based on recent study results, the committee updated the 2023 guidelines to reflect the latest research findings. To learn more about the study findings, Standard 10 – Cardiovascular Disease and Risk Management. 

Cholesterol Medication Cheat Sheets

Keeping track of medications for hypertension and cholesterol can seem daunting. We have put together a Lipid Medication Cheat Sheet along with summary information for each class that is important to know for certification exams and is very useful in clinical practice. 

Lipid and Hypertension Medication Cheat Sheet

Getting LDL to Target Matters

Together, we can improve the quality of life and outcomes for people living with diabetes. Getting LDL cholesterol levels to target is an important interventions to maintain health. Thank you for reading this article and advocating for the best evidence-based care.


Want to learn more about this question? Join us for our

Level 2 | ADA Standards of Care CE Course | 2.0 CEs

Updates air live between Feb. 2, 2023, at 11:30 am PST

This course, updated annually, is an essential review for anyone in the field of diabetes. Join Coach Beverly as she summarizes the 2023 updates to the American Diabetes Association’s Standards of Medical Care in Diabetes and provides critical teaching points and content for healthcare professionals involved in diabetes care and education.

Objectives:

  1. List significant changes and updates to the 2023 ADA Standards of Medical Care.
  2. State 3 updates on new blood pressure and lipid goals.
  3. Identify 5 key elements of the position statement.
  4. Discuss how to apply the Standards in the clinical setting and in preparation for exam success.

Intended Audience:  This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in staying up to date on current practices of care for people with prediabetes, diabetes and other related conditions.

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

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  • Level 1 focuses on the fundamentals and introduces each topic area for the exam.
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  • ADCES Review Guide for the Diabetes Care and Education Specialist Exam – 5th Edition – Revised – The ADCES Review Guide is a fantastic independent study tool and comprehensive resource for the Diabetes Care and Education Specialist Exam. This book includes 480 + multiple-choice questions and strategies for preparing for and taking the exam with an answer key with rationales for all questions! 
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