Should Statins Be Used in Patients with High Risk of Diabetes?

3-hydroxy-3-methylglutaryl co-enzyme-A (HMG-CoA) reductase inhibitors, more commonly known as statins, have been the mainstay of lipid-lowering therapy. Statins effectively and consistently reduce low-density lipoprotein cholesterol and have demonstrated beneficial effects in reducing atherosclerotic cardiovascular disease (ASCVD) risk in both the primary and secondary prevention setting. They are also one of the most widely used lipid-lowering drugs around the world. In patients with diabetes, existing guidelines recommend initiation of at least a moderate-intensity statin in patients between 40 and 75 years old , for its ASCVD benefit. Despite all their benefits, statins have been implicated in increasing the risk of new -onset diabetes as well as worsening glycaemic control. As such, this debate aims to discuss the conundrum of statin use in patients with high risk of diabetes and whether the ASCVD benefit truly outweighs the risk of worsening glycaemic control.