Starting statins soon after a type 2 diabetes diagnosis may do more than protect the heart, suggests a nationwide Danish study of more than 132 000 people, which found that people beginning statin treatment within a year of diagnosis had a 15% lower relative risk of developing dementia over 10 years than those who did not.
The research was presented at ESC Congress in Munich last month and published in The Lancet Regional Health – Europe.
As populations age, the number of people living with dementia is expected to increase substantially. Because there are currently no effective treatments capable of preventing or reversing most forms of dementia, researchers are increasingly focused on identifying factors that could reduce the likelihood of developing the condition.
According to the Lancet Commission, nearly half of dementia cases could theoretically be prevented by addressing 14 modifiable risk factors. One of those factors involves managing cholesterol beginning in midlife.
“Detecting and treating high levels of low-density lipoprotein cholesterol (LDL-C) from midlife is one such highlighted risk factor,” said presenter, Dr Tummas Ternhamar from Copenhagen University Hospital, Denmark.
This issue may be especially relevant for people with type 2 diabetes. High LDL-C is common among these patients, while diabetes itself is recognised as a risk factor for cognitive decline and dementia.
“We hypothesised that early initiation of LDL-C-lowering statins after type 2 diabetes diagnosis could be associated with a lower risk of dementia,” said Ternhamar. “And we tested this in a large nationwide study using analysis methods to emulate a randomised trial and reduce some of the bias associated with observational studies.”
Tracking more than 132 000 people
Using Danish national registers, researchers identified 132 585 people who had not previously taken statins and who developed type 2 diabetes between 2006 and 2019. They were followed until the end of 2021, and medical records were examined for diagnoses of all-cause dementia.
The researchers used a clone-censor-weight design to compare dementia rates according to when statin therapy began. One group did not start statins within five years of receiving a diabetes diagnosis. A second group began statins early, within one year of diagnosis, while a third began treatment later, between one and five years after diagnosis.
During a median follow-up period of 7.1 years, 2.7% of participants developed dementia.
Lower risk
Compared with people who did not begin statin therapy, those who started statins within the first year after being diagnosed with type 2 diabetes had a 15% lower relative risk of dementia over 10 years.
Starting treatment later was also associated with a benefit, although the association was smaller. People who began statins between one and five years after diagnosis had a 10% lower relative risk of dementia over 10 years. Similar results were observed in women and men.
Ternhamar said that in individuals developing type 2 diabetes, statins were associated with a lower risk of dementia, most pronounced in those with early initiation.
“Statins seem to be underused in patients with type 2 diabetes, despite their protective effects against cardiovascular disease. Our findings suggest another potentially important reason to ensure that patients with type 2 diabetes and high LDL-C receive timely statin treatment.”
Findings cannot prove statins prevent dementia
The results suggest that beginning statin therapy sooner after a type 2 diabetes diagnosis may have potential benefits beyond the drugs’ established role in protecting cardiovascular health. However, because the research was observational, it cannot establish that taking statins directly prevents dementia.
Commenting on the findings, Professor Isabel Goncalves, a member of the ESC Communication Committee, said: “People with type 2 diabetes already have a higher risk of dementia and are advised to lower cholesterol to reduce their risk of heart attack and stroke.
“This study suggests that starting statins soon after a type 2 diabetes diagnosis may also be linked to a modest reduction in dementia risk, with greater benefit than delaying treatment. Because statins are widely available and inexpensive, the findings are potentially important.
“However, this was an observational study, so it cannot prove that statins prevent dementia. The results should therefore support further research and help inform discussions between patients and clinicians.”
Study details
Association between timing of statin treatment after diabetes diagnosis and risk of dementia: a nationwide observational study
Tummas Ternhamara, Mia Ø. Johansenb, Børge Nordestgaard, Shoaib Afzal.
Published in The Lancet Regional Health – Europe on 27 August 2026
Summary
Background
The burden of dementia is projected to rise with ageing populations, particularly in those with diabetes; however, there are no effective treatments, and attention has turned to prevention through treatment of modifiable risk factors such as low-density lipoprotein cholesterol. We tested the hypothesis that early initiation of statin treatment following type 2 diabetes diagnosis is associated with lower risk of all-cause dementia than delayed or no initiation.
Methods
Using nationwide registers, we identified 132,585 statin-naïve individuals in Denmark developing type 2 diabetes from 2006 through 2019. Follow-up was until dementia, death, emigration, or December 31, 2021. Using a clone-censor weighting design emulating a target trial we compared: i) no statin within 5 years after diagnosis (reference), ii) late statin (start at 1–5 years), and iii) early statin (start at ≤ 1 year). The primary outcome was 10-year risk of all-cause dementia based on Aalen-Johansen survival curves with death treated as competing risk.
Findings
During median 7.1 years of follow-up (interquartile range: 3.8–9.9 years), 3592/132,585 = 2.7% developed dementia. Estimated 10-year absolute risks of dementia from the weighted Aalen-Johansen analysis were 3.9% in those with no statin initiation, 3.3% in those with early statin initiation, and 3.5% in those with late statin initiation. Following diabetes diagnosis and compared to no statin initiation, early statin treatment was associated with 15% lower relative risk of dementia at 10 years (95% confidence interval: 9%–21%) while the corresponding relative risk for late statin treatment was 10% lower (3%–15%). Corresponding absolute risk differences were 0.59% (0.34%–0.86%) and 0.38% (0.12%–0.61%) lower, respectively.
Interpretation
In statin-naïve individuals developing type 2 diabetes, statin therapy was associated with lower relative and absolute risks of dementia, most pronounced in those with early statin initiation. There is a need for trial evidence to confirm the findings.
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