Should all diabetic patients receive statins?

Diabetes is known to play a causal role in promoting both microvascular and macrovascular complications. Reducing rates of end-organ damage has been a key objective of multiple clinical trials. In addition to the roles of glycemic and blood pressure control, it is evident that lipid reduction via statin therapy independently helps to reduce the risk of primary and secondary vascular events. This effect seems to remain intact across a broad range of lipid levels, suggesting additional mechanisms for efficacy of statin medications beyond cholesterol reduction. The demonstrated safety and data from recent trials lend support to the argument that all people with diabetes should be started on statin therapy regardless of their cholesterol level. It is also plausible that treating the underlying mechanisms of vascular dysfunction, inflammation, and injury so prevalent in diabetic patients would have similar implications for the patient identified as having insulin resistance or metabolic syndrome.