Because the decision to upgrade statin treatment from moderate to high intensity is influenced by the level of ASCVD risk, the PCE risk estimator in adults 40 to 75 years of age with diabetes mellitus has utility in refining treatment decisions in these patients.S4.3-10,S4.3-11 The ASCVD risk score, however, does not determine whether statin intensity should be increased. Rather, it begins an evaluation that includes clinician judg- ment of the individual s global risk, the potential for benefit from a high-intensity statin versus the potential for adverse effects or drug-drug interac- tions and evaluation should also include patient preferences and values. 3. The occurrence of a first ASCVD event in patients 40 to 75 years of age with diabetes mellitus is associated with increased morbidity and mortality compared with those without diabetes mellitus, which places a particularly high premium on pri- mary prevention in those with diabetes mellitus in that age range. Although trials using moderate- intensity statin therapy demonstrate significant benefit in such individuals, the residual risk in the statin treatment groups in these trials remained high (eg, 8.5% had major cardiovascular events in Strong general evidence indicates that the benefit from statin therapy is related to both global risk and intensity of treatment,S4.3-12 and no RCTs of high-intensity statin therapy have been carried out in cohorts of patients exclusively with diabetes mellitus. On the basis of these con- siderations and the fact that patients with diabe- tes mellitus have a higher trajectory of lifetime risk than do those without diabetes mellitus, high- intensity statin therapy is preferred in patients with diabetes mellitus as they age or develop risk modifiers (Table 5). 4. 