Statins and Type 1 Diabetes: Impact on Cardiovascular Outcomes and surrogates. Systematic Review and meta-analysis
Karen Feriz-Bonelo1,2,3, Pablo Corral4, María Bernarda Iriarte-Durán5,6
1Servicio de Endocrinología, Departamento de Medicina Interna, Fundación Valle del Lili, Cali, Colombia. karen.feriz@fvl.org.co.
Insights
Statins significantly reduce cardiovascular events and improve lipid profiles in type 1 diabetes patients without prior heart disease. This suggests statins are a viable preventive strategy for this high-risk group.
Area of Science:
- Cardiology
- Endocrinology
- Pharmacology
Background:
- Atherosclerotic cardiovascular disease (ASCVD) is the primary cause of mortality in type 1 diabetes (T1D) patients.
- Dyslipidemia is a common risk factor contributing to ASCVD in this population.
- Limited data exist on statin efficacy for primary prevention of ASCVD in T1D.
Purpose of the Study:
- To systematically review the impact of statin therapy on clinical and surrogate atherosclerosis outcomes.
- To evaluate statins in T1D patients without established ASCVD for primary prevention.
- To assess effects on major adverse cardiovascular events (MACE) and lipid profiles.
Main Methods:
- Systematic review adhering to PRISMA guidelines.
- Searches conducted in PubMed, EMBASE, and Epistemonikos up to June 2025.
- Included eleven studies (nine RCTs, two cohort studies); six eligible for meta-analysis.
Main Results:
- Statin use showed a significant reduction in MACE (HR 0.77; low certainty).
- Mean low-density lipoprotein cholesterol (LDL-C) decreased by 30.3 mg/dL (moderate certainty).
- Improvements observed in ApoB and non-HDL cholesterol levels.
Conclusions:
- Statin therapy is associated with improved lipid profiles and reduced MACE in T1D patients without ASCVD.
- Findings support considering statins for primary prevention in this population.
- Further prospective studies focusing on hard outcomes are needed to refine patient selection.
Purpose Of Review:
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in patients living with type 1 diabetes (T1D). Dyslipidemia is a frequent risk factor in this population. Although statin therapy has demonstrated cardiovascular (CV) benefits in diabetes overall, specific evidence in T1D remains limited. This systematic review aims to evaluate the impact of statins on clinical and surrogate atherosclerosis-related outcomes in patients with T1D without established ASCVD.
Recent Findings:
Statin use was associated with a significant reduction in the risk of major adverse cardiovascular events (MACE), with a pooled hazard ratio (HR) of 0.77 (95% CI: 0.70-0.84; low certainty), and a mean low-density lipoprotein cholesterol (LDL-C) reduction of 30.3 mg/dL (95% CI: -47.02 to -13.58; moderate certainty). Reductions in ApoB and non-HDL cholesterol were also reported. We conducted a systematic review following PRISMA guidelines. Searches were performed in PubMed, EMBASE, and Epistemonikos from inception to June 2025 using terms related to T1D, statins, and primary prevention. Eleven studies were included-nine randomized controlled trials (RCTs) and two cohort studies. Six (four RCTs and two cohorts) were eligible for meta-analysis of two primary outcomes; the remaining were summarized narratively. Statin use in T1D patients without ASCVD was associated with improved lipid profiles and reduced MACE. These findings support considering statins as a preventive strategy in this population, although prospective studies with hard outcomes are needed to better identify patients most likely to benefit.
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