From the Guidelines
All diabetic patients with established cardiovascular disease or at high risk for cardiovascular disease should be on a statin, with a goal of reducing LDL cholesterol by ≥50% from baseline and achieving an LDL cholesterol level of <55 mg/dL or <70 mg/dL, depending on individual risk factors. This recommendation is based on the most recent and highest quality evidence from the 2025 standards of care in diabetes, which emphasizes the importance of high-intensity statin therapy in reducing cardiovascular event rates in high-risk individuals with established cardiovascular disease 1.
The benefits of statin therapy in people with diabetes are well-established, with absolute reductions in ASCVD outcomes (CHD death and nonfatal MI) being greatest in those with high baseline ASCVD risk 1. For primary prevention, moderate-dose statin therapy is recommended for those aged ≥40 years, although high-intensity therapy should be considered in the context of additional ASCVD risk factors 1.
Some key points to consider when prescribing statin therapy to diabetic patients include:
- The maximum tolerated statin dose should be used for individuals who do not tolerate the intended intensity of statin 1
- The decision to add a nonstatin agent, such as ezetimibe or a PCSK9 inhibitor, should be made following a clinician-patient discussion about the net benefit, safety, and cost of combination therapy 1
- Lifestyle modifications, including diet, exercise, and smoking cessation, remain fundamental components of diabetes management alongside medication considerations
- The decision to start statin therapy should be individualized through discussion between patient and healthcare provider, weighing potential benefits against risks 1
From the Research
Statin Therapy in Diabetic Patients
- The use of statin therapy in diabetic patients is a topic of ongoing debate, with some studies suggesting that all diabetics should be on a statin, while others recommend a more individualized approach 2, 3, 4.
- The standards of medical care in diabetes recommend that statin therapy is added to lifestyle therapy for diabetic patients with overt cardiovascular disease or without cardiovascular disease who are over the age of 40 years and have one or more other cardiovascular disease risk factors 2.
- However, the frequency of statin-associated adverse effects and statin intolerance in clinical practice is high, especially at the muscle level, which may limit the use of statins in some diabetic patients 2.
Benefits and Risks of Statin Therapy
- Statin therapy has been shown to reduce the risk of cardiovascular disease events in diabetic patients, particularly those with high cardiovascular risk 3, 4, 5, 6.
- However, statin therapy has also been associated with an increased risk of new-onset type 2 diabetes mellitus, particularly with the use of high-intensity statins 3.
- The risk-benefit ratio of statin therapy in diabetic patients depends on the individual's cardiovascular risk profile and the presence of other risk factors for diabetes and cardiovascular disease 3, 4.
Individualized Approach to Statin Therapy
- An individualized approach to statin therapy is recommended, taking into account the patient's cardiovascular risk profile, diabetes status, and other risk factors 4, 6.
- Low-intensity statin therapy may be sufficient for patients at low or intermediate cardiovascular risk, while high-intensity statin therapy may be necessary for patients at high cardiovascular risk 4.
- The use of statin therapy should be tailored to the individual's cardiovascular risk and tolerance to potential adverse effects, with the goal of achieving guidelines-directed LDL goals 6.