3.3.3.2 Age <40 Years and/‍or Type 1 Di­a­betes.

Very lit­tle clin­i­cal trial ev­i­dence ex­ists for pa­tients with type 2 di­a­betes under the age of 40 years or for pa­tients with type 1 di­a­betes of any age. For pe­di­atric rec­om­men­da­tions, see Sec­tion 13 “Chil­dren and Ado­les­cents.” In the Heart Pro­tec­tion Study (lower age limit 40 years), the sub­group of ~600 pa­tients with type 1 di­a­betes had a pro­por­tion­ate­ly sim­i­lar, al­though not sta­tis­ti­cal­ly significant, re­duc­tion in risk as pa­tients with type 2 di­a­betes (80). Even though the data are not defini­tive, sim­i­lar statin treat­ment ap­proaches should be con­sid­ered for pa­tients with type 1 or type 2 di­a­betes, par­tic­u­lar­ly in the pres­ence of other car­dio­vas­cu­lar risk fac­tors. Pa­tients below the age of 40 have lower risk of de­vel­op­ing a car­dio­vas­cu­lar event over a 10-year hori­zon; how­ev­er, their life­time risk of de­vel­op­ing car­dio­vas­cu­lar dis­ease and suf­fer­ing an MI, stroke, or car­dio­vas­cu­lar death is high. For pa­tients under the age of 40 years and/‍or who have type 1 di­a­betes with other ASCVD risk fac­tors, we rec­om­mend that the pa­tient and health care pro­vider dis­cuss the rel­a­tive benefits and risks and con­sid­er the use of mod­er­ate-‍in­ten­si­ty statin ther­a­py. Please refer to “Type 1 Di­a­betes Mel­li­tus and Car­dio­vas­cu­lar Dis­ease: A Sci­en­tific State­ment From the Amer­i­can Heart As­so­ci­a­tion and Amer­i­can Di­a­betes As­so­ci­a­tion” (91) for ad­di­tional dis­cussion.