Statin use for primary prevention in patients with type 2 diabetes (T2D) was associated with reductions in all-cause mortality and major cardiovascular disease (CVD) across a spectrum of predicted cardiovascular risk, according to research published by investigators in Annals of Internal Medicine.1
Reductions were observed among patients with low, intermediate, high, and very high 10-year predicted CVD risk, suggesting that statins may have a stronger protective value than previously considered, even in patients with low predicted risk.1,2
How Did Statins Impact Cardiovascular Mortality Across a Spectrum of Risk?
Investigator Insights – What Pharmacists Should Know
- Statins provide cardiovascular benefit in adults with T2D even at low short-term risk, suggesting traditional risk tools may underestimate long-term risk.
- Pharmacists can flag eligible patients not on statins and support shared decision-making by discussing benefits, safety, and preventive gaps with prescribers and patients.
- Emphasize the rarity of serious muscle or liver effects, encourage adherence, and monitor for muscle symptoms with appropriate baseline labs.
Study Methods
Investigators from the University of Hong Kong utilized information from the IQVIA Medical Research Data—UK database to conduct a cohort study using target trial emulation. Patients aged 25 to 84 years diagnosed with T2D between 2005 and 2016 and who were followed for up to 10 years were included in the trial. Importantly, none of the patients reported serious liver or heart problems prior to study initiation.1
Patients were compared based on statin initiation versus no initiation. Propensity score matching was used to match statin initiators to noninitiators in a 1:4 ratio within 4 QRISK3 strata of 10-year predicted cardiovascular risk. Patients were stratified into low (> 10%), intermediate (10%–19%), high (20%–29%), and very high (≥ 30%) 10-year risk.1
Absolute risk differences (RDs) and risk ratios (RRs) at 10 years of follow-up were analyzed for all-cause mortality and major CVD, in addition to myopathy and liver dysfunction.1
Results
At the 10-year follow-up point, statin initiation was associated with reductions in major CVD and all-cause mortality across QRISK3 strata. For patients at low predicted risk, RDs and RRs were –0.53% (95% CI, –0.90% to –0.08%) and 0.80 (95% CI, 0.67 to 0.97), respectively, for all-cause mortality and –0.83% (95% CI, –1.28% to –0.34%) and 0.78 (95% CI, 0.66 to 0.91), respectively, for major CVD.1
The authors observed a slightly increased risk of myopathy—diseases that affect skeletal muscles and lead to weakness—only in the moderate-risk stratum. On a positive note, there was no associated increased risk for liver dysfunction in any stratum.1,2
Some limitations of the study were acknowledged, including under-ascertainment of some key hospitalization outcomes and the presence of unmeasured confounding. Still, the results demonstrate the broad protective power of statins for use in primary prevention and suggest that more patients than previously assumed could benefit from initiation.1
Pharmacists Can Encourage Eligible Patients to Initiate Statins, Reduce CVD Risk
In an interview, study investigator Eric Yuk Fai Wan, PhD, BSc, MSc, associate professor at the Department of Family Medicine and Primary Care at the University of Hong Kong School of Clinical Medicine, outlined a series of steps pharmacists can take to better identify appropriate candidates for statin initiation while supporting shared decision-making with prescribers.
Wan explained that pharmacists can proactively flag patients with T2D who harbor elevated low-density lipoprotein (LDL) cholesterol but are not yet on a statin. Pharmacists can also review medication profiles to identify and ameliorate gaps in preventive therapy. Most importantly, pharmacists can facilitate shared discussions with patients by explaining the expected safety, benefits, and long-term reduction in CVS risk with statin initiation.
Wan and his colleagues observed the slightly increased risk of myopathy in moderate-risk patients. For pharmacists, they can reassure patients that any serious muscle or liver complications related to statin initiation are rare, according to Wan. Patients should be encouraged to remain adherent to statins, as benefits continue to accumulate in the long term. Pharmacists should ensure patients are consistently monitored, especially for new or worsening muscle symptoms, and review baseline liver tests when necessary.
“Pharmacists should recognize that adults with [T2D] benefit from statins even when their short‑term cardiovascular risk is low,” Wan said. “This means risk calculators may underestimate long‑term risk, and statins should be considered more broadly—especially when LDL cholesterol is elevated.”
REFERENCES
1. Yan VKC, Blais JE, Gamble J, et al. Effectiveness and safety of statins in type 2 diabetes according to baseline cardiovascular risk: A target trial emulation study. Ann Intern Med. Published Online December 30, 2025. Accessed January 7, 2026. doi:10.7326/ANNALS-25-00662
2. Statins significantly reduce mortality risk for adults with diabetes, regardless of cardiovascular risk. American College of Physicians. News Release. EurekAlert! Released December 29, 2025. Accessed January 7, 2026. https://www.eurekalert.org/news-releases/1110823
3. Myopathy. Cleveland Clinic. Last Updated January 20, 2022. Accessed January 7, 2026. https://my.clevelandclinic.org/health/diseases/17256-myopathy
