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. ASCVD risk increases incrementally with age in In one long-term cohort study of type 2 diabetes mellitus with- out ASCVD, incident rates of MI averaged 25.6 in those >75 years of age, while another in a type 1 diabetes mellitus cohort found the 10-year fatal CVD risk in those >75 years of age was 70% in men and 40% in Although no controlled statin tri- als in people >75 years of age are available, a meta-analysis of the JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) and HOPE-3 (Heart Outcomes Prevention Evaluation) trials dem- onstrated similar benefits in ASCVD reduc- tion among those >70 of age versus <70 years Although that study included few patients with diabetes mellitus, it does support the continuation of moderate- or high-intensity statin therapy for primary prevention in those >75 years of age with diabetes mellitus, who comprise 21% of the population in this age category. The clinician should note that the benefit may be off- set by limited life span or increased susceptibility to adverse events in patients in this age group. Table 5. Diabetes-Specific Risk Enhancers That Are Independent of Other Risk Factors in Diabetes Mellitus Risk Enhancers Long duration ( 10 years for type 2 diabetes mellitusS4.3-20 or 20 years for type 1 diabetes mellitusS4.3-6 Albuminuria 30 mcg of albumin/mg creatinineS4.3-25 ABI indicates ankle-brachial index; and eGFR, estimated glomerular filtration rate. CLINICAL STATEMENTS AND GUIDELINES 5. 