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In Brief Diabetes is considered a risk equivalent for coronary heart disease (CHD). The use of statins for primary and secondary prevention in patients with diabetes is well established and supported by robust data from randomized, controlled trials and national guidelines. The American Diabetes Association recommends that individuals with diabetes and a history of cardiovascular disease (CVD), as well as those > 40 years of age without CVD but with CVD risk factors, should be treated with a statin regardless of their baseline LDL cholesterol concentration. This review explains the rationale behind considering diabetes a CHD risk equivalent and summarizes the data for statin use in adults with diabetes without (primary prevention) and with (secondary prevention) established CVD. Although individuals with diabetes are at an increased risk for CVD and benefit from statin therapy, the risk of CVD in people with diabetes is heterogeneous. It therefore may be reasonable to match the intensity of statin therapy with patients' baseline CVD risk.