Despite his young age and modest hyperlipidaemia, this patient has a long history of diabetes and thus a chronic exposure to hyperglycaemia and increased atherosclerotic risk. While evidence for the use of statins has been derived largely from studies involving middle-aged patients with type 2 diabetes,5 evidence is emerging to support an aggressive lipid-lowering strategy in younger patients with T1DM. Intima-media thickness and inflammatory markers are increased—suggesting premature atherosclerosis. It is suggested that this patient is treated with a statin. However, it is important always to engage with patients in discussing the relative risk-benefits of starting statins, before embarking on what is likely to be a lifelong treatment. Given the qualitative nature of lipoprotein abnormalities in patients with T1DM, it would be conceivable in the near future for statins to be routinely prescribed to all patients (including adolescents) whose T1DM was diagnosed at least ten years previously—akin to how we approach treatment of adolescents with familial hyperlipidaemia.
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