Treatment
12
Hyperlipidemia
➤ In patients aged 65 years and older with diabetes, ES recommends an
annual lipid profile. (1|⊕⊕
)
➤ In patients aged 65 years and older with diabetes, ES recommends statin
therapy and the use of an annual lipid profile to achieve the recommended
levels for reducing absolute CVD events and all-cause mortality. (1|⊕⊕⊕⊕)
Technical Remarks:
▶ The Writing Committee did not rigorously evaluate the evidence for specific
LDL-C targets in this population, so we refrained from endorsing specific LDL-C
targets in this guideline.
▶ For patients aged 80 years old and older or with short life expectancy, ES advocates
that LDL-C goal levels should not be so strict.
➤ In patients aged 65 years and older with diabetes, ES suggests that
if statin therapy is inadequate for reaching the LDL-C reduction goal,
either because of side effects or because the LDL-C target is elusive,
then alternative or additional approaches (such as including ezetimibe
or proprotein convertase subtilisin/kexin type 9 inhibitors) should be
initiated. (2|⊕
)
➤ In patients aged 65 years and older with diabetes and fasting triglycerides
>500 mg/dL, ES recommends the use of fish oil and/or fenofibrate to
reduce the risk of pancreatitis. (1|⊕⊕
)
Congestive Heart Failure
➤ In patients aged 65 years and older who have diabetes and CHF, ES advises
treatment in accordance with published clinical practice guidelines on
CHF. (UGPS)
➤ In patients aged 65 years and older who have diabetes and CHF, the
following oral hypoglycemic agents should be prescribed with caution in
order to prevent worsening of heart failure:
• Glinides
• Rosiglitazone
• Pioglitazone
• DPP4 inhibitors (UGPS)
Atherosclerosis
➤ In patients aged 65 years and older with diabetes and a history of
atherosclerotic cardiovascular disease, ES recommends low-dosage
aspirin (75–162 mg/day) for secondary prevention of CVD after careful
assessment of bleeding risk and collaborative decision-making with the
patient, family, and other caregivers. (1|⊕⊕
)
