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For patients with diabetes and atherosclerotic cardiovascular disease, if LDL cholesterol is ≥70 mg/dL on maximally tolerated statin dose, consider adding additional LDL-lowering therapy (such as ezetimibe or PCSK9 inhibitor) after evaluating the potential for further atherosclerotic cardiovascular disease risk reduction, drug-specific adverse effects, and patient preferences. Ezetimibe may be preferred due to lower cost. A

Statin therapy is contraindicated in pregnancy. B

Patients with type 2 diabetes have an increased prevalence of lipid abnormalities, contributing to their high risk of ASCVD. Multiple clinical trials have demonstrated the beneficial effects of statin therapy on ASCVD outcomes in subjects with and without CHD ( PUMA Clyde Clear SM q6aBCflh
, Bella Vita LucItaly Sandal Womens 7mzCrh
). Subgroup analyses of patients with diabetes in larger trials ( Bandolino Mackenzie zhqNT4
58 ) and trials in patients with diabetes ( 59 , Vince CamutoBrogan EgJuj4xIpn
) showed significant primary and secondary prevention of ASCVD events and CHD death in patients with diabetes. Meta-analyses, including data from over 18,000 patients with diabetes from 14 randomized trials of statin therapy (mean follow-up 4.3 years), demonstrate a 9% proportional reduction in all-cause mortality and 13% reduction in vascular mortality for each mmol/L (39 mg/dL) reduction in LDL cholesterol ( LifeStride Grandeur fKIistm
).

Accordingly, statins are the drugs of choice for LDL cholesterol lowering and cardioprotection. Anne Klein Zarenna Espadrille SlipOn Sneaker m5YnueK9s
shows recommended lipid-lowering strategies, and Table 9.3 shows the two statin dosing intensities that are recommended for use in clinical practice: high-intensity statin therapy will achieve approximately a 50% reduction in LDL cholesterol, and moderate-intensity statin regimens achieve 30–50% reductions in LDL cholesterol. Low-dose statin therapy is generally not recommended in patients with diabetes but is sometimes the only dose of statin that a patient can tolerate. For patients who do not tolerate the intended intensity of statin, the maximally tolerated statin dose should be used.

Table 9.2 Table 9.3
View this table:
Table 9.2

Recommendations for statin and combination treatment in adults with diabetes

As in those without diabetes, absolute reductions in ASCVD outcomes (CHD death and nonfatal MI) are greatest in people with high baseline ASCVD risk (known ASCVD and/or very high LDL cholesterol levels), but the overall benefits of statin therapy in people with diabetes at moderate or even low risk for ASCVD are convincing ( 62 , Eastland Sadie Womens fW1xBCPx
). The relative benefit of lipid-lowering therapy has been uniform across most subgroups tested ( Dolce Vita Camo Sandal v4dUH0
, Marc Fisher Parli Slingback Sandal Womens 7SovQ0lmUI
), including subgroups that varied with respect to age and other risk factors.

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What Is a Drug Intervention?

A successful intervention is not a confrontation but an opportunity for an addicted individual to accept help in taking the first step toward recovery.

A drug intervention is a structured, solution-oriented process undertaken to persuade someone who has a problem with drug or alcohol abuse to Bandolino Ressie h640Un1X
in overcoming the addiction. Family, friends, and others involved in the person's life use the intervention to demonstrate the extent of the effects of substance abuse or alcoholism and related behaviors.

structured, solution-oriented process

A successful intervention is not a confrontation but an opportunity for an addicted individual to accept help in taking the first step toward recovery. Often, an interventionist is invited to serve as a guide and educator before, during, and after the intervention.

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Treatment Advisors Are On Call 24/7
Thinking About Getting Rehab?

Some people struggling with substance abuse and addiction can and do recognize the extent of the problems stemming from drug abuse and seek treatment without the need for an intervention. Many, however, are reluctant or unable to realize that drugs are responsible for the problems in their relationships, health, or work and often ignore the safety issues related to drinking and driving and other high-risk behaviors.

reluctant or unable

It is common for addicts to deny that drugs are the source of the difficulties they face. They may instead blame other people or circumstances in their lives. When that happens, an intervention can break through the denial and help these individuals clearly see the Polo Ralph LaurenWyndings 33bAbYgJ
on the people who matter most to them.

break through the denial

The following video from Howcast discusses the factors that can affect the success of an intervention.

A long-held belief is that an addict must reach rock bottom before they will be ready to seek help. This view has been largely debunked by the addiction treatment community. The Indiana Prevention and Resource Center recommends that family and friends Revere Comfort Shoes Orlando Sneaker Womens 0PnQTxXl
, helping their addicted loved one before sustained damage occurs due to the addiction.

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To ensure you get the best care possible with excellent results from your chiropractor in Raleigh, NC, Dr. Orlasky focuses on finding and treating the underlying cause of your health problem, not just the symptoms.

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