Statins and Type 1 Diabetes: Impact on Cardiovascular Outcomes and surrogates. Systematic Review and meta-analysis

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.

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.