COR LOE Recommendations I A In adults 40 to 75 years of age with diabetes mellitus, regardless of estimated 10-year ASCVD risk, moderate-intensity statin therapy is indicated.S4.3-1 S4.3-9 IIa B-NR In adults 40 to 75 years of age with diabetes mellitus and an LDL-C level of 70 to 189 mg/dL (1.7 to 4.8 mmol/L), it is reasonable to assess the 10-year risk of a first ASCVD event by using the race and sex-specific PCE to help stratify ASCVD risk.S4.3-10,S4.3-11 IIa B-R In adults with diabetes mellitus who have multiple ASCVD risk factors, it is reasonable to prescribe high-intensity statin therapy with the aim to reduce LDL-C levels by 50% IIa B-NR In adults older than 75 years of age with diabetes mellitus and who are already on statin therapy, it is reasonable to continue IIb C-LD In adults with diabetes mellitus and 10-year ASCVD risk of 20% or higher, it may be reasonable to add ezetimibe to maximally tolerated statin therapy to reduce LDL-C levels by 50% or more.S4.3-14,S4.3-15 IIb C-LD In adults older than 75 years with diabetes mellitus, it may be reasonable to initiate statin therapy after a clinician patient discussion of potential benefits and IIb C-LD In adults 20 to 39 years of age with diabetes mellitus that is either of long duration ( 10 years of type 2 diabetes mellitus, 20 years of type 1 diabetes mellitus), albuminuria ( 30 mcg of albumin/mg creatinine), estimated glomerular filtration rate (eGFR) , retinopathy, neuropathy, or ankle-brachial index (ABI; <0.9), it may be reasonable to initiate statin Synopsis Although most adults 40 to 75 years of age with dia- betes mellitus are at intermediate or high-risk of their first ASCVD event,S4.3-5,S4.3-6,S4.3-8,S4.3-9 evaluation of AS- CVD risk will help refine risk estimates and therapeu- tic decision-making. Because primary-prevention trials demonstrate that moderate-intensity statin therapy in large cohorts with diabetes mellitus provides significant this treatment is indicated in such individuals. 