What Can Diabetics Take for Cholesterol? Medications and Lifestyle

October 8, 2025 •

3 min read

People with diabetes are at double the risk of developing heart disease, making it crucial to manage cholesterol effectively. A primary concern for those living with diabetes is high LDL, or 'bad' cholesterol, and triglycerides, which can increase the risk of heart attacks and strokes. By understanding what diabetics can take for cholesterol, individuals can make informed decisions in partnership with their healthcare providers to protect their cardiovascular health.

Quick Summary

This article outlines the primary medical treatments for managing cholesterol in individuals with diabetes, including first-line statin therapy and newer non-statin options. It also details essential lifestyle modifications, such as dietary adjustments and exercise, critical for lowering LDL cholesterol and improving overall heart health. Information covers a comparison of medication types and their mechanisms.

Key Points

Statins are First-Line Treatment: For most diabetics, statins are the primary medication for lowering high LDL ('bad') cholesterol and are crucial for reducing cardiovascular risk.
Non-Statin Options Exist: Ezetimibe and PCSK9 inhibitors are available for patients who cannot tolerate statins or need additional LDL lowering, with some, like ezetimibe, showing particular benefit for diabetics.
Lifestyle Changes Are Essential: A heart-healthy diet rich in fiber, healthy fats, and lean protein, along with consistent aerobic and strength-training exercise, is fundamental to effective cholesterol management.
Diabetic Dyslipidemia Requires Aggressive Management: The specific lipid profile common in diabetes (high triglycerides, low HDL, dense LDL) necessitates a proactive approach to prevent or slow the progression of ASCVD.
Medication Choice is Individualized: The best medication or combination depends on individual factors, including LDL levels, other risk factors, and drug tolerance, and should be decided in consultation with a doctor.
Benefits of Statins Outweigh Risks: Although statins can slightly raise blood sugar in some cases, the significant reduction in heart attack and stroke risk makes them a vital therapy for many diabetics.
Consider Non-LDL Targets: For patients with high triglycerides, fibrates or high-dose omega-3 fatty acids may be considered alongside or instead of statins.

Understanding Diabetic Dyslipidemia

Diabetes often leads to a condition called diabetic dyslipidemia, characterized by a specific lipid profile that includes high triglycerides, low HDL ('good') cholesterol, and an increase in small, dense LDL ('bad') cholesterol particles. This atherogenic profile significantly elevates the risk of atherosclerotic cardiovascular disease (ASCVD), including heart attack and stroke. Effective management of dyslipidemia is a cornerstone of diabetes care, with lifestyle interventions and medications working together to mitigate this risk.

First-Line Pharmacological Treatment: Statins

Statins are the first-line and most common class of medication prescribed for managing cholesterol in diabetics. These drugs work by inhibiting an enzyme in the liver called HMG-CoA reductase, a key step in cholesterol production. They help lower LDL-C levels, can modestly increase HDL-C, and lower triglycerides. While statins may slightly increase blood sugar, their cardiovascular benefits for most diabetics generally outweigh this risk. {Link: Healthline https://www.healthline.com/health/statins-for-diabetics-which-is-best}

Non-Statin Therapies for Cholesterol

Non-statin medications are available for those who cannot tolerate statins or need additional cholesterol lowering, often used as add-on treatments. Ezetimibe (Zetia) inhibits cholesterol absorption in the small intestine. PCSK9 Inhibitors (e.g., Alirocumab, Evolocumab) are injectable medications that increase the liver's ability to remove LDL. Bile Acid Sequestrants (BAS) (e.g., Colesevelam) bind bile acids, prompting the liver to use more cholesterol. Fibrates (e.g., Fenofibrate) primarily lower high triglycerides and raise HDL. Omega-3 Fatty Acids (e.g., Icosapent ethyl) can supplement statins for diabetic patients with high triglycerides. {Link: DrOracle https://www.droracle.ai/articles/150992/best-statin-for-diabetes}

The Importance of Lifestyle Changes

Combining medication with healthy lifestyle changes is crucial. Diet, exercise, and weight management are vital for managing dyslipidemia in diabetics.

Dietary Adjustments:

Increase Soluble Fiber: Foods like oats, beans, and certain fruits help remove cholesterol.
Choose Healthy Fats: Opt for unsaturated fats from sources like olive oil and fish instead of saturated and trans fats.
Limit Processed Foods: Reduce snacks and sugary items high in unhealthy components.
Follow Established Plans: Mediterranean or DASH diets are beneficial for blood sugar and cholesterol control.

Physical Activity:

Aerobic Exercise: Activities like walking or cycling improve HDL and lower triglycerides. Aim for at least 150 minutes weekly.
Strength Training: Resistance exercises can help improve cholesterol levels and insulin sensitivity.

Medication Comparison for Diabetics


Drug Class	Primary Mechanism	Primary Benefit for Diabetics	Key Considerations
Statins	Inhibits cholesterol production in the liver.	Potent LDL lowering; cornerstone therapy for cardiovascular risk reduction.	Potential for minor blood sugar increase; myalgia (muscle aches) possible side effect.
Ezetimibe	Blocks intestinal cholesterol absorption.	Effective add-on to statins for further LDL reduction; useful for statin intolerance.	Well-tolerated; often paired with a statin for dual-action therapy.
PCSK9 Inhibitors	Increases liver's ability to clear LDL from bloodstream.	Very potent LDL lowering; for high-risk patients not at goal on statins.	Injectable medication; high cost is a significant factor.
Fibrates	Lowers triglycerides by stimulating lipoprotein lipase activity.	Reduces severe hypertriglyceridemia; may raise HDL.	Not a primary LDL-lowering agent; combination with some statins requires caution.
Bile Acid Sequestrants	Binds bile acids in the intestine.	Reduces LDL; colesevelam variant also lowers HbA1c in some patients.	Gastrointestinal side effects common; can raise triglycerides in some cases.
Omega-3 Fatty Acids	Reduces liver's production of triglycerides.	Lowers severe hypertriglyceridemia, especially in high-risk individuals.	Requires high doses for efficacy; risk of atrial fibrillation with some forms.

Conclusion: A Multifactorial Approach

Managing cholesterol for diabetics requires a combined approach of medication and lifestyle changes. Statins are the primary treatment for lowering LDL and reducing cardiovascular risk, often supported by a heart-healthy diet and regular exercise. For those needing more intensive treatment, non-statin options like ezetimibe and PCSK9 inhibitors are available. Working closely with a healthcare provider is key to finding the right balance of treatments to achieve optimal cardiovascular health and reduce the risk of heart disease and stroke.

Frequently Asked Questions

Yes, statins are widely recommended for diabetics. While some studies have shown a small increased risk of higher blood sugar or new-onset diabetes, major health organizations like the CDC and FDA conclude that the cardiovascular benefits of statin therapy overwhelmingly outweigh this risk for most patients.

There is no single 'best' statin for all diabetics, as it depends on individual factors. For significant LDL reduction, high-intensity statins like rosuvastatin (Crestor) or atorvastatin (Lipitor) are often used. However, some studies suggest certain statins like pravastatin or fluvastatin may have a lower risk of affecting blood sugar.

For many diabetics, diet and exercise are not sufficient on their own to manage cholesterol and cardiovascular risk. While a heart-healthy, high-fiber diet is crucial, most individuals will also require medication like a statin to reach target cholesterol levels and achieve optimal risk reduction.

If a patient experiences statin intolerance, such as muscle pain, a doctor may lower the dose or switch to a different statin. Other options include adding or switching to non-statin medications like ezetimibe or a PCSK9 inhibitor.

Ezetimibe works by inhibiting the absorption of cholesterol from food and bile in the intestine, rather than blocking the liver's production of cholesterol like statins. This complementary action makes it an effective add-on therapy for further LDL reduction.

Fibrates are primarily used to lower high triglyceride levels and modestly raise HDL cholesterol, not to be the primary agent for lowering LDL. They are indicated for severe hypertriglyceridemia, which is a common issue in diabetic dyslipidemia.

The most impactful lifestyle changes include a diet high in fiber (oats, beans) and healthy fats (avocado, olive oil), avoiding saturated and trans fats, and engaging in regular exercise (combining aerobic activity and strength training).