For decades, Americans have been told to keep their LDL cholesterol — the so-called “bad” cholesterol — as low as possible to protect their hearts. But new research out of Italy suggests that when LDL drops too low, something unexpected may happen: the risk of type 2 diabetes rises.
And here’s the twist — it doesn’t matter whether someone is taking statins or not.
A large analysis published in Cardiovascular Diabetology examined more than 13,000 adults and found that people with very low LDL cholesterol were far more likely to develop type 2 diabetes over time. The finding held true for statin users and for people who had never touched the medication.
Study finds diabetes risk rises as LDL drops
The research team reviewed digital health records from over 200,000 adults across southern Italy, ultimately narrowing their dataset to 13,674 people with no history of diabetes, heart disease, or other life-limiting conditions. The average participant was 62 years old, and just over half were male.
More than half of the group was already taking statins to control their cholesterol. Over roughly six years of follow-up, 13% of the overall cohort developed type 2 diabetes. But the distribution wasn’t even:
20% of statin users developed diabetes
6% of non-statin users developed diabetes
Researchers then sorted everyone by their LDL levels — from very low to very high. The pattern was striking:
The lower the LDL, the higher the risk of diabetes.
And the group with the very highest LDL levels had the lowest diabetes incidence of all.
Participants with the lowest LDL levels also tended to have more risk factors: they were older, had higher BMI, more hypertension, and were more often on statins — but even after accounting for these differences, the trend persisted.
Why could low LDL be linked to diabetes?
LDL cholesterol isn’t just a villain in heart disease — the body actually relies on cholesterol to function. Cells involved in insulin production and regulation depend on cholesterol balance, and extremely low LDL levels may disrupt those processes.
Researchers suggest that when LDL falls too far, insulin secretion may falter or insulin resistance may climb, creating a metabolic environment that allows type 2 diabetes to develop more easily.
Should people stop lowering LDL? Not even close.
Despite the findings, the overall message for the public is not to panic. Lowering LDL remains one of the most powerful strategies to prevent heart attacks and strokes — the leading killers in the U.S.
Statins and other cholesterol-lowering therapies still can provide cardiovascular benefits, and for most people, those benefits far outweigh the modest increase in diabetes risk.
But the study does raise a new point:
People with very low LDL — whether naturally or from medication — may need more frequent monitoring of their blood sugar, especially if they’re older, carrying extra weight, or already showing borderline glucose levels.
More tools than ever to manage cholesterol
For people who need LDL control but worry about metabolic effects, the treatment landscape is expanding. Non-statin therapies such as ezetimibe and PCSK9-targeted drugs can significantly lower LDL while offering flexibility for those who need individualized care.
The bottom line: Cholesterol management isn’t one-size-fits-all.
And extremely low LDL may be a new early warning sign for diabetes risk — one that could help clinicians tailor care long before problems arise.
Medical Disclaimer:
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider before making changes to your health regimen.
