Best statin therapy for diabetes

In this article:

• The relationship between diabetes and cardiovascular disease
• Top recommended statins for people with diabetes
• About statin intensity
• Statins in people with prediabetes
• Statins in people with Type 2 diabetes
• Statins after a heart attack
• Statins comparison chart
• Special considerations for people with diabetes taking statins

In this article

• The relationship between diabetes and cardiovascular disease
• Top recommended statins for people with diabetes
• About statin intensity
• Statins in people with prediabetes
• Statins in people with Type 2 diabetes
• Statins after a heart attack
• Statins comparison chart
• Special considerations for people with diabetes taking statins

Statins are a class of medications prescribed to treat high cholesterol and reduce the risk of serious cardiovascular events like heart attacks and strokes. They work by blocking an enzyme in the liver responsible for making cholesterol. Although statins are primarily used to prevent serious heart complications, they’re commonly prescribed to people with diabetes because diabetes greatly increases the risk of cardiovascular disease, which can cause heart attacks and strokes. At the same time, research shows that statins may raise blood sugar levels, which can affect people with diabetes or a risk of diabetes. 

This article explores the connection between statins and diabetes, including how statins may affect blood sugar, which statins may be preferred in people with diabetes, and what to discuss with your healthcare provider before starting or continuing treatment.

The relationship between diabetes and cardiovascular disease

People with diabetes are more likely to develop heart disease, including high blood pressure, heart attacks, and heart failure. According to the Centers for Disease Control and Prevention (CDC), adults with Type 2 diabetes are nearly twice as likely to develop heart disease compared to those without diabetes. For people with Type 1 diabetes, the risk can be up to 10 times higher.

Managing blood sugar and cholesterol levels is important to lower the risk of heart disease. That’s why healthcare providers often prescribe statins to people with diabetes, especially those with additional cardiovascular risk factors. However, statins can slightly raise blood sugar levels by affecting how the body responds to insulin, a concern for people already managing diabetes. 

In 2012, the Food and Drug Administration (FDA) announced that all statins should carry a warning about their potential to increase fasting blood sugar and hemoglobin A1c (HbA1c) levels in people who take them. Clinical trials have found that statin use is associated with a 9%–12% increased risk of developing Type 2 diabetes. Some observational studies have reported even higher risks, particularly with high-intensity statin therapy.

Still, the cardiovascular benefits of statins often outweigh these risks. A meta-analysis found that statin therapy in people with diabetes reduced their risk of major cardiovascular events by 27%–30% compared to those not taking a statin. Starting statin therapy earlier may offer even greater protection. A 2025 study showed that people with diabetes who delayed statin therapy had significantly higher rates of heart disease than those who began treatment when first prescribed. 

Top recommended statins for people with diabetes

There’s no single best statin for people with diabetes, but healthcare providers typically choose one based on a person’s medical history and overall risk of heart disease. The American Diabetes Association’s (ADA’s) clinical guidelines recommend statin therapy for primary and secondary prevention of cardiovascular disease. That is, whether someone has ever had a heart attack or stroke before, starting statin therapy can lower their risk of heart disease and future cardiovascular events. This is especially important for preventing atherosclerosis, the hardening of arteries caused by high cholesterol, says Kristen Fuller, MD, a family medicine physician in Mammoth Lakes, California. 

The ADA guidelines suggest the following:

• Moderate-intensity statin therapy is recommended for people ages 40–70 with diabetes but no history of atherosclerotic cardiovascular disease (ASCVD), in combination with lifestyle changes.
• High-intensity statin therapy is recommended for those at higher cardiovascular risk, with known ASCVD, or with a history of heart attack or stroke.
• People 20–39 with ASCVD risk factors should consider starting statin therapy in addition to lifestyle changes. 

About statin intensity  Statin intensity refers to a specific type and strength of statin that is expected to lower “bad cholesterol,” or low-density lipoprotein (LDL) cholesterol, by a certain amount.  Low-intensity statins can lower LDL cholesterol by less than 30% Moderate-intensity statins lower LDL cholesterol by 30%–49% High-intensity statins lower LDL cholesterol by 50% or more

RELATED: What is considered a high dose of atorvastatin?

Statins in people with prediabetes

For people with prediabetes, statin therapy can help prevent heart disease, but some studies suggest certain statins may be more supportive in blood sugar control than others.

• Lipitor (atorvastatin): High-intensity doses have been associated with greater increases in HbA1c compared to moderate-intensity atorvastatin and other statins.
• Crestor (rosuvastatin): Similar trends have been observed with rosuvastatin, where higher doses may be more likely to raise HbA1c levels.
• Zocor (simvastatin): People with prediabetes taking low- to moderate-intensity simvastatin had higher HbA1c levels compared to those on atorvastatin, pitavastatin, or placebo.
• Livalo (pitavastatin): Those on moderate-intensity pitavastatin had the lowest HbA1c levels compared to those on high-intensity atorvastatin and moderate-intensity simvastatin.
• Pravachol (pravastatin): Though there haven’t been many recent studies on pravastatin’s effect on blood sugar, one study published in 2001 found pravastatin therapy lowered the risk of developing diabetes by 30% in people with normal fasting blood glucose. 

Statins in people with Type 2 diabetes

For people already diagnosed with Type 2 diabetes, statins are a key part of preventing major adverse cardiovascular events. However, research shows some differences in how statins may affect blood sugar control in this population:

• Atorvastatin: Some research has found that high-intensity atorvastatin may slightly raise HbA1c levels compared to placebo or moderate-intensity dosing. High-intensity atorvastatin was also associated with higher fasting glucose compared to placebo, moderate-intensity doses, and other statins such as rosuvastatin and simvastatin.
• Simvastatin: Moderate-intensity simvastatin was shown to reduce HbA1c in people with Type 2 diabetes compared to high-intensity atorvastatin and rosuvastatin.
• Pitavastatin: Moderate-intensity pitavastatin may lower HbA1c in people with Type 2 diabetes, potentially making it a preferred option for those concerned about glucose control.

Statins after a heart attack

Secondary prevention is when someone starts a treatment to prevent major adverse cardiovascular events after they’ve already had a stroke or heart attack. In people with diabetes who are using statins for secondary prevention, high-intensity statin therapy is recommended by the ADA to prevent a future event. However, high-intensity statins can impact someone’s blood sugar control more.

One study found no significant difference in new diabetes diagnoses between moderate- and high-intensity atorvastatin in people with diabetes and a history of heart attack. In addition, high-intensity rosuvastatin was associated with a higher risk of developing Type 2 diabetes in this population.

Statins comparison chart
Name	Moderate intensity	High intensity	Cost without insurance*	Savings
Lipitor (atorvastatin)	10–20 mg	40–80 mg	$679 for 30, 40 mg tablets of brand-name Lipitor; or $124 for 30, 40 mg tablets of generic atorvastatin	Get coupon
Crestor (rosuvastatin)	5–10 mg	20–40 mg	$360 for 30, 10 mg tablets of brand-name Crestor; or $7.71 for 30, 10 mg tablets of generic rosuvastatin	Get coupon
Zocor (simvastatin)	20–40 mg	–	$339 for one bottle of 30 tablets of brand-name Zocor; or $233 for 90, 20 mg tablets of generic simvastatin	Get coupon
Livalo (pitavastatin)	1–4 mg	–	$444 for 30, 2 mg tablets of brand-name Livalo; or $353 for 30, 2 mg tablets of generic pitavastatin	Get coupon
Pravachol (pravastatin)	40–80 mg	–	$345 for 90, 40 mg tablets of generic pravastatin sodium	Get coupon

*Cost at time of publication. Drug prices fluctuate and vary by pharmacy. 

Special considerations for people with diabetes taking statins

While research shows that some statins, especially at higher doses, may slightly affect blood sugar levels, the cardiovascular benefits of statin therapy typically outweigh these risks for most people with diabetes. Statins remain an important tool to prevent heart attacks and strokes, which people with diabetes are at significantly higher risk of.

Importantly, healthcare providers don’t usually recommend one specific statin over another based solely on diabetes status. Instead, they choose a statin based on a person’s age, cardiovascular risk, medication history, and potential side effects. “I personally don’t have one statin I prefer for diabetes,” says Austin Shuxiao, MD, an internal medicine physician and medical director of PeachIV in New York City. 

If someone experiences side effects such as muscle pain or elevated blood sugar, healthcare providers may adjust the dose or switch to a different statin with a better profile for that individual. “I use other statins when patients present to me already on another statin, or if they have intolerable side effects,” Dr. Shuxiao shares. 

In addition, the ADA and CDC recommend statin therapy along with lifestyle changes to support heart and metabolic health. Specific recommendations may include “daily exercise, eating a heart-healthy diabetes diet, avoiding alcohol and smoking, and maintaining a healthy weight,” Dr. Fuller says.

Ongoing communication with your healthcare provider is important in order to create an individualized treatment plan that works for you. Talk to your healthcare provider if you notice any new symptoms or have concerns about your blood sugar while taking a statin. A hemoglobin A1c lab can easily be added to your routine blood work. With the right guidance, statin therapy can be a safe and effective part of managing both your heart health and diabetes.