Statins May Help More People With Type 2 Diabetes Than Doctors Once Thought

New evidence hints that statins may protect a wider range of people with type 2 diabetes than previously assumed.

A major cohort study reports that statin therapy is linked to lower rates of death and serious cardiovascular events in adults living with type 2 diabetes, including people whose predicted 10 year risk of cardiovascular disease is considered low.

The results address a long-debated question about whether those at the lowest risk gain anything from taking statins for prevention. Instead, the findings suggest these medications may offer wider protection than many experts previously expected.

The findings are published in Annals of Internal Medicine.

Statins are a widely used class of prescription medicines that lower levels of LDL cholesterol, often called “bad” cholesterol. They work by reducing the liver’s cholesterol production, which can slow the buildup of fatty plaques in blood vessels. Because blocked arteries can lead to heart attacks and strokes, statins are commonly used to prevent these outcomes.

Statins and Type 2 Diabetes Risk

This preventive approach is especially relevant for people with type 2 diabetes. Over time, diabetes can damage blood vessels and increase the likelihood of cardiovascular disease, sometimes well before noticeable symptoms appear.

When statins are used for “primary prevention,” it means they are started before a person has had a heart attack, stroke, or another major cardiovascular event.

Inside the Long-Term Cohort Study

Researchers from the University of Hong Kong and colleagues analyzed U.K. primary care records from the IQVIA Medical Research Data (IMRD) database. The study included people ages 25 to 84 who were diagnosed with T2DM between 2005 and 2016.

The team used a cohort design with target trial emulation, an approach that aims to mimic what a randomized trial would have looked like using real-world data.

Participants were grouped into four QRISK3 categories based on predicted 10-year cardiovascular risk: low (<10%), intermediate (10% to 19%), high (20% to 29%), and very high (≥30%). Outcomes were tracked for up to 10 years.

What they found

Across the full range of predicted risk, statin initiation was associated with lower all-cause mortality and fewer major cardiovascular disease (CVD) events over 10 years.

The clearest example came from the low-risk group, where benefit has been most uncertain:

• All-cause mortality (low-risk group): Statin initiation was linked to an absolute reduction of 0.53% in deaths over 10 years. In relative terms, the risk was about 20% lower for statin initiators compared with noninitiators.
• Major CVD events (low-risk group): Statin initiation was linked to an absolute reduction of 0.83% in major CVD over 10 years. Relative risk was about 22% lower for statin initiators.

In other words, even among people whose predicted 10-year risk was below 10%, starting a statin was associated with measurable reductions in both death and serious cardiovascular events over the following decade.

Safety Findings and Clinical Implications

The study also evaluated potential side effects. The authors reported a very small increase in myopathy in one risk group, which refers to muscle problems that can range from soreness or weakness to more significant muscle injury in rare cases. However, the study did not find an increased risk of liver issues.

The researchers concluded that clinicians should weigh the benefits of statins for all adults with type 2 diabetes, even when short-term predicted cardiovascular disease risk is low.

Reference: “Effectiveness and Safety of Statins in Type 2 Diabetes According to Baseline Cardiovascular Risk” by Vincent Ka Chun Yan, Joseph Edgar Blais, John-Michael Gamble, Esther Wai Yin Chan, Ian Chi Kei Wong and Eric Yuk Fai Wan, 29 December 2025, Annals of Internal Medicine.
DOI: 10.7326/ANNALS-25-00662

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