We examined the effect of atorvastatin (and placebo) on tumour necrosis factor (TNF)a, soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intercellular cell adhesion molecule-1 (sICAM-1) in patients with type 2 diabetes without prior cardiovascular disease (CVD) and investigated whether adhesion molecules were associated with incident CVD. Baseline and follow-up concentrations of TNFa, sVCAM-1 and sICAM-1 were measured in patients from the Collaborative AtoRvastatin Diabetes Study (CARDS). Patients had a mean age of 61 years (standard deviation = 8) and 70% were men. TNFa 2.20 pg/mL (1.82-2.86), sVCAM-1 865 ng/mL (729-1059) and sICAM-1 619 ng/mL (533-753) concentrations (median, interquartile range 25, 75%) were similar at baseline in atorvastatin (given values) and placebo groups and not significantly different at 2 years. The multivariable hazard ratios for the associations between sVCAM-1 and sICAM-1 (doubling the concentration) and CVD were, 0.82 (95% confidence interval (CI) 0.66-1.0) and 0.59 (95% CI 0.50-0.71), respectively. In conclusion atorvastatin had no significant effect on TNFa, sVCAM-1 or sICAM-1 levels in type 2 diabetic patients without a prior history of CVD compared with placebo. In addition, both sVCAM-1 and sICAM-1 concentrations were associated with a decreased risk of CVD.