4 Lipid modification therapy in people with type 1 diabetes What is the effectiveness of statins and/or other low-density lipoprotein (LDL) cholesterol-lowering treatment in people with type 1 diabetes? Why this is important People with type 1 diabetes have increased CVD risk derived from age, sex, glycaemia, blood pressure, renal function and lipid levels as identified in epidemiological studies. Long-term glycaemic control is associated with better outcomes but no trial has investigated the efficacy of statin therapy or other LDL-cholesterol-lowering therapies exclusively in people with type 1 diabetes. 5 Comparative effectiveness and risks of alternative doses of atorvastatin What is the clinical effectiveness and rate of adverse events of statin therapy using atorvastatin 20 mg per day compared with atorvastatin 40 mg per day and atorvastatin 80 mg per day in people without established CVD? Why this is important This guideline has established that atorvastatin 20 mg is clinically and cost effective for the primary prevention of CVD and should be recommended for those at 10% risk of cardiovascular events as assessed using the QRISK2 calculator. However, this analysis looked at the effectiveness of treatment shown by 'high-intensity' statins as a group, as it was not possible to establish the relative effectiveness of atorvastatin 20 mg, 40 mg and 80 mg using trial data. Trial data with clinical outcomes exists for atorvastatin 80 mg against atorvastatin 10 mg only. The rates of adverse events resulting from different doses of atorvastatin in routine clinical practice are also uncertain and would need to be considered in combination with effectiveness in assessing the relative costs and benefits of different doses of atorvastatin. 