Objective: To investigate whether hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) prevent the development of diabetic retinopathy. Methods: We conducted a nested case-control study among patients at the Birmingham Veterans Affairs Medical Center, Birmingham, Alabama. Within a study population of male diabetic patients (n=6441), we identified incident cases of diabetic retinopathy diagnosed between January 1, 1997, and December 31, 2001 (n=114). Control subjects were selected using incidence density sampling and were matched for diabetes duration. Information regarding filled statin prescriptions was obtained for cases and controls. Results: Cases and controls did not differ regarding overall statin use in crude analysis (odds ratio, 1.01; 95% confidence interval, 0.64-1.59) and in multivariate analyses adjusted for age, race, and coexisting medical conditions (odds ratio, 1.00; 95% confidence interval, 0.60-1.67). Conclusion: The results of this study do not support an association between statins and diabetic retinopathy. ©2007 American Medical Association. All rights reserved.