Among this group will also be indi- viduals with recent or newly diagnosed diabetes mellitus for whom the impact of diabetes mellitus on ASCVD risk is not well known. It may there- fore be reasonable to have a clinician patient dis- cussion in which the potential benefits and risks of initiating statin therapy in this age group are reviewed. 7. There is limited information on ASCVD rates among individuals 20 to 39 years of age with diabetes mellitus and no information on whether statin therapy is beneficial in these individuals. Available evidence indicates that although rates of ASCVD are low in those <30 years of age, they increase with timeS4.3-6,S4.3-17,S4.3-20,S4.3-23 and may reach intermediate-risk levels by 30 to 39 years of age, especially in individuals with long- standing type 2 diabetes mellitus,S4.3-17 who may have more advanced subclinical coronary athero- sclerosis than do nondiabetic subjects,S4.3-21 and in those with type 1 diabetes mellitus of >20 years ASCVD rates will also be influ- enced by hypertension and diabetic microvascu- lar complications that may be prevalent in these Thus, it may be reasonable to have a discussion about initiating moderate- intensity statin therapy with patients who have had type 2 diabetes mellitus for at least 10 years or type 1 diabetes mellitus for at least 20 years and with patients with 1 or more major CVD risk factors or complications, such as diabetic nephropathy or albuminuria 30 mcg albumin/mg creatinine),S4.3-25 or an ABI of (Table 5). 4.4. Primary Prevention Primary prevention of ASCVD over the life span requires attention to prevention or management of ASCVD risk factors beginning early in life (Figure 2). One major AS- CVD risk factor is elevated serum cholesterol, usually identified clinically as measured LDL-C. Screening can be performed with fasting or nonfasting measurement of lipids. 