If you have diabetes, you’re at a higher risk for heart disease and stroke. This makes it especially important to control other risk factors for cardiovascular problems, such as high cholesterol.

Too much cholesterol can increase cardiovascular risk by clogging your blood vessels.

Fortunately, medications called statins are effective at lowering low-density lipoprotein (LDL) cholesterol. This type of cholesterol is often referred to as “bad cholesterol.”

Which statin is most appropriate for you if you have diabetes? It depends on your overall cardiovascular risk.

In general, if you have diabetes, the American Diabetes Association (ADA) recommends a moderate- or high-intensity statin, in addition to changes to nutrition and activity levels.

Several different types of statins exist. Some are more potent than others. They all help lower cholesterol by interfering with a substance your liver needs to make cholesterol.

Statins have become some of the most widely prescribed cholesterol medications in the world. They include atorvastatin (Lipitor), rosuvastatin (Crestor), and other generic and brand name versions.

There are no longer specific levels of “good” and “bad” cholesterol that everyone should have to be considered healthy. The numbers still provide a guideline, but each person has different individual health factors that determine their risk for developing heart disease.

This means that your ideal cholesterol levels and treatment recommendations may differ from someone else’s.

Guidelines presented by the American College of Cardiology and the ADA expanded the number of people who should use statins.

Doctors previously based their decision to prescribe a statin primarily on a person’s LDL score. Now other factors are considered.

In general, if you have diabetes, statins are recommended if you meet any of the following criteria:

  • have a diagnosis of cardiovascular disease
  • are age 40 or older
  • are ages 20 to 39 and have additional risk factors for cardiovascular disease

In its guidelines, ADA recommends that all adults over age 40 with diabetes take moderate-potency statins in addition to lifestyle therapy.

The ADA’s reasoning is that controlling risk factors will help lower your overall chances of developing heart disease. These risk factors may include:

  • high cholesterol
  • high blood pressure
  • having overweight or obesity
  • smoking
  • drinking a lot of alcohol
  • a high level of sodium, saturated fat, or trans fat in your diet
  • a lower level of physical activity

The fewer risk factors you have, the better your odds of avoiding a heart attack or stroke.

Diabetes poses an additional threat to your cardiovascular health because over time, the extra glucose in your blood can injure your blood vessels.

Damaged blood vessels can disrupt blood flow to your heart and brain. This raises the risk of a heart attack or stroke.

Diabetes can also affect your cholesterol by lowering high-density lipoprotein (HDL), or “good,” cholesterol and raising levels of LDL cholesterol.

This is called diabetic dyslipidemia. It can occur even if diabetes is managed.

According to a 2016 research review, multiple studies have indicated that statins may increase blood sugar and the risk of diabetes.

In 2012, the Food and Drug Administration (FDA) changed statin safety labels to indicate that these medications may be associated with increased blood sugar levels.

Another 2016 review found that statins tended to increase glucose levels in people with diabetes. However, studies were mixed regarding the specific effects of each statin.

Research from 2017 and a study from 2020 also found that higher doses and longer use of statins may be linked to an increased risk of developing diabetes.

While the overall chance of developing diabetes was small, atorvastatin and rosuvastatin carried the largest risk.

These same studies suggested that the following statins may have the lowest risk of increasing blood sugar:

  • pravastatin
  • fluvastatin
  • pitavastatin

Pravastatin and fluvastatin may even help control glucose, though more research is needed.

Despite the potential risks, the FDA still recommends statins for their cardiovascular benefits.

The right statin for you will depend on your:

  • LDL level
  • risk factors for heart disease
  • tolerance of the medication

As mentioned, the ADA recommends moderate- and high-intensity statins for people with diabetes.

In general, the ADA suggests using a lower potency statin for a person with diabetes only when they can’t tolerate a higher dose. Pravastatin (Pravachol) and lovastatin (Altoprev) are two lower-potency options.

If you need to combat high cholesterol more aggressively, your doctor may prescribe rosuvastatin (Crestor), which is the most powerful statin, or atorvastatin (Lipitor) at higher doses.

Atorvastatin at lower to moderate doses and simvastatin (Zocor) have moderate potency.

Your ability to tolerate a particular statin is an important consideration. Your doctor may start you on a strong statin and switch the type of statin or lower your dosage if needed.

Some doctors, however, choose to start with the mildest option and work their way up if your cholesterol numbers don’t come down enough.

Statins have multiple health benefits. These include:

  • lowering cholesterol
  • decreasing the risk of stroke and heart disease
  • lowering the risk of blood clots
  • reducing the need for an angioplasty or other procedure to increase blood flow in an artery

The benefits of statins are increased for people with a higher risk of having a stroke or a heart attack. The cardiovascular benefits also grow over time as you continue to take a statin.

Statins are usually tolerated well, but they can have some side effects. These may include:

Getting used to the medication, switching to a different type of statin, or taking a lower dose may solve the problem.

Many side effects of statins are rare, and some have conflicting or no evidence. More research is needed on the side effects of statins.

According to the FDA, the benefits of statins are likely higher than the risks.

Statins may interact with other medications, so tell your doctor which medicines you’re taking. You also shouldn’t take statins if you’re pregnant or have certain liver conditions.

Managing your cholesterol and diabetes takes more than medications alone. You and your healthcare provider should discuss other ways, such as exercise and diet, to maintain healthy blood glucose and LDL levels.

If your LDL numbers or other risk factors are high and you have diabetes, statins are recommended. You should talk to your doctor about:

  • your target levels of LDL cholesterol
  • the risks and benefits of statins
  • the side effects of statins
  • how to respond to any side effects of statins
  • any medications you’re currently taking that may interact with statins

Once you start taking statins, check with your doctor first if you want to stop taking them or change to a different medication. This is especially important if you recently had a heart attack or stroke.

There are many ways to improve your heart health. If you have diabetes and already have cardiovascular disease or a 10-year increased risk of heart attack, statin therapy may help prevent a heart attack or stroke.

Daily diabetes tip

We’ve talked before about the importance of monitoring LDL cholesterol to help prevent heart disease and stroke. The ADA recommends that most people with diabetes take statins, depending on their age and other risk factors. These medications are designed to reduce the risks that cardiovascular dangers present.

Talk with your doctor about which type of statin may be appropriate for you.

Healthline