Why diabetics get cholesterol tablets even with “normal” lipid reports
Patient's Query
Doctor, I have diabetes and my friend does not. Both of us are obese and we are almost the same age, 42 and 43. We did a lipid profile (blood cholesterol report) together.
Our LDL values were similar, and honestly my friend’s LDL was even about 20 points higher than mine. Still, the doctor started a cholesterol tablet for me and told my friend only diet and exercise. That surprised me because my report looks “normal” on paper.
Is cholesterol medicine really needed for all diabetics? Is it given for treatment or just for prevention? I am worried about taking one more tablet daily if it is not necessary. Please explain why the rules are different for me.
Doctor Answers
You are asking a very reasonable question.
In diabetes, we do not look at the lipid profile (blood cholesterol report) the same way as in a non-diabetic person, because diabetes itself raises heart and stroke risk. So many cholesterol tablets, mainly statins, are given as prevention, not because your LDL is “very high.”
Here is a simple way to understand it.
Imagine two things moving through the same plastic pipe. One is cotton, the other is small stones. Even if the weight looks similar, stones damage the pipe more. In diabetes, LDL particles are often more atherogenic (more harmful to arteries), and the blood vessels are already more vulnerable.
That is why targets are stricter. Many guidelines recommend statins for most adults with diabetes aged 40 to 75, even if LDL is not very high, because it lowers future heart attack and stroke risk.
The kerosene example also fits. You keep only a small amount near the kitchen to reduce danger. In diabetes, we aim to keep LDL lower, to reduce “fuel” for artery blockage over years.
Typical targets used commonly:
- Primary prevention in diabetes (age 40 to 75): LDL goal often below 70 mg/dL
- Secondary prevention (previous heart attack, stent, stroke): LDL goal often below 55 mg/dL
So your friend may not qualify yet, but you do, because diabetes changes the risk category. Treatment is always individualized, so discuss your exact plan with your doctor.
References:
- https://diabetesjournals.org/care/article/49/Supplement_1/S216/163933/10-Cardiovascular-Disease-and-Risk-Management
- https://professional.diabetes.org/sites/dpro/files/2025-03/kdbh-lipidmanagement-0225.pdf
- https://www.ahajournals.org/doi/10.1161/cir.0000000000000625
Disclaimer: The information provided in this Q&A is for educational purposes only and should not be considered as medical advice. Always consult with a qualified healthcare professional for personalized medical guidance and treatment recommendations.