Cholesterol and Statins

[Outlier]

I think you've done brilliantly!

Was it a fasting blood test? I was told not to "bother" for Hb1ac and the result was being lectured about my cholesterol readings (though not praised for my amazing blood glucose results). I'm a fast learner, and ever since have done a water fast before any blood test. I've done a lot of research and decided not to take statins, but I am not recommending this as a course of action, simply saying that the option exists. We have a fair bit of good useful information on this Board which is worth researching (I'm sure somebody more forum-savvy than I am can provide a link) and that might help you with your decision.

 

[HSSS]

It is your decision what tests to have and what medications to take. All the dr does is advise.

Using total numbers is pointless and a tick box exercise. A full fasted breakdown including triglycerides is the first point of call. Then it’s about understanding what the numbers and ratios are, and aren’t, telling you about your personal risk and the pros and cons of statins. It’s also worth noting that LDL is calculated not measured making certain dietary assumptions and comes in different types that aren’t differentiated in standard testing yet have a huge difference in outcome.

This mammoth thread has evidence galore on the subject. The advice to go on statins is often made by the QRISK3 calculator and I think it’s over 10% they recommend statins. https://qrisk.org/

Personally I think any benefits are minimal to me as amid life woman with decent ratios and HDL and the negatives are far more concerning. I’ve declined the offer of statins more than once when total has been between 5 and 8 and have several times asked for the test to be taken off the blood test order because I’m fed up of the badgering despite being well under the 10%.

 

[ravensmitten]

I might email/consult my practise and ask for breakdown of actual numbers as punching some numbers aside from the HDL on that QRISK3 thing, I think it was that 10% is what they meant, and not that the cholesterol was on 10 lol whatever that means anyway. I think if it was alarm bells might have been going off.

She did say 10% chance of maybe having a problem in next ten years if my cholesterol didn’t come down which she was happy I’m taking visible steps toward.

I usually ask things like this but 10% of what baseline?, who, when, me, a population, 100 people? 1 million, why isn’t it 90% chance of something “might not” happening etc

 

[Bildad]

As @HSSS says it is your choice what if any medication you take. I have just had my annual blood tests and was not advised to fast but as @Outlier I always water fast before. My total cholesterol is always high but the ratios are well within the recommended levels and after much reading on here and elsewhere decided that I would rather not take statins. Every gp visit I am strongly advised to take statins and every visit I decline! I am a bit of a numbers geek and like to know what my levels are so always have the test done. Read round on this thread and other statin info and make your own mind up.

 

[HSSS]

I might email/consult my practise and ask for breakdown of actual numbers as punching some numbers aside from the HDL on that QRISK3 thing, I think it was that 10% is what they meant, and not that the cholesterol was on 10 lol whatever that means anyway. I think if it was alarm bells might have been going off.

She did say 10% chance of maybe having a problem in next ten years if my cholesterol didn’t come down which she was happy I’m taking visible steps toward.

I usually ask things like this but 10% of what baseline?, who, when, me, a population, 100 people? 1 million, why isn’t it 90% chance of something “might not” happening etc

I think the qrisk page explains 10% of what.

“It presents the average risk of people with the same risk factors as those entered for that person”
So if 100 people entered identical numbers in the calculator 10 would have a heart attack or stroke. 90 wouldn’t. On a population basis that may be true but when living a street away or having perfect control or terrible control or time since diagnosis or how long your levels have been like this are not even factors I think it’s a VERY blunt tool.

 

[Donnadoobie]

Just been told my cholesterol levels were at 10. ( or 10% risk or something like that?) saying its only just over the level where they start to offer medication but as I'd made significant changes to my diet since Jan (low carb) and was tested only in Feb it might not be nesc if I didn't want to take medication.

Which of course I'd rather avoid if I can do by doing something differently myself first. So we both agreed to decline and test again in 6 months time.

Should have asked more questions, she did outline a risk in the next ten years but I'm sure she wasn't that good with stats when I looked it up.

Think it is a 10% risk rather than 10. Test again in 6 months and relax. You are doing fine.

 

[ravensmitten]

I think the qrisk page explains 10% of what.

“It presents the average risk of people with the same risk factors as those entered for that person”
So if 100 people entered identical numbers in the calculator 10 would have a heart attack or stroke. 90 wouldn’t. On a population basis that may be true but when living a street away or having perfect control or terrible control or time since diagnosis or how long your levels have been like this are not even factors I think it’s a VERY blunt tool.

Thanks, yes I meant at the time, you know when in the flow of conversation and you seem to get moved along, I forgot to backtrack a bit. l'esprit de l'escalier...

She was sort of skipping around a bit and trying not to sound too dramatic as my young daughter was with me as was off school with a poorly tummy so I was conscious of that also. At first it was my cholesterol was 10... then a 10% risk then its only on the cusp, just over what we usually offer medication for.

and then there was something about a 10% chance of me having a fatal event in the next ten years if I didn't bring the levels down, even though she said that might not happen ever, lol - so I did walk away a little confused.

Ta, I just looked at that and and it was far clearer, punched a few numbers in and to get to 10.3% and not lower or higher, I toyed with the hdl number/ratio and that seemed to work out was 5.3 to get it to the 10.3% she mentioned to me, with weight age, height and blood pressure and obs t2 ticked.

She did say she was happy to wait it out and test again as I'm 40lbs lighter than the last time I saw her, so she knew I wasn't pulling her leg over lifestyle changes ala "it's okay doc I only have one beer a week!"


Aha, maybe as blunt a tool as bmi? if I were to be so blunt myself.

 

[ravensmitten]

Think it is a 10% risk rather than 10. Test again in 6 months and relax. You are doing fine.

Thanks, bit of health anxiety due to me not asking the questions I should have I guess lol

I suppose they would have pushed the medication thing more if I wasn't bothering and the numbers were that high.

 

[Donnadoobie]

I think my risk has gone up from 11% in September last year but is probably around 13/14% meaning there is 85/86% chance I might have a heart attack or stroke. I will take my chances. My Mum had high cholesterol and was prescribed statins. After few months she felt really weird in her head, she felt so bad she stopped taking them, which says a lot, as she always followed doctors orders! From that point, she went downhill, slowly but surely until she was diagnosed with dementia. She died aged 88. The last 3 years of her life were lost. But she had an amazing 85 years. Who can ask for more?!

 

[Donnadoobie]

I think you've done brilliantly!

Was it a fasting blood test? I was told not to "bother" for Hb1ac and the result was being lectured about my cholesterol readings (though not praised for my amazing blood glucose results). I'm a fast learner, and ever since have done a water fast before any blood test. I've done a lot of research and decided not to take statins, but I am not recommending this as a course of action, simply saying that the option exists. We have a fair bit of good useful information on this Board which is worth researching (I'm sure somebody more forum-savvy than I am can provide a link) and that might help you with your decision.

I fasted for the cholesterol one and the appointment was so late in the morning, so they took it as a fasting one, even though I had specifically asked for this to be added to the notes. This means the triglycerides were not recorded, however my HDL was only 0.95, which is not great, so trigs was probably rubbish too. I am at a loss of what to do as I was so strict, lots of olive oil, fatty fish, barely any berries, nothing. Feel really demoralised. Will brush myself off, write to the Gp, as I don’t think I will stand scrutiny in a telephone call, I will cave, hopefully having a retest at the end of the summer.

I have a holiday away at Easter and a few days away in May as well as my birthday, so will settle down for June , July and August for another test and hope for the best. I honestly don’t know what to do for the best..

 

[HSSS]

I think my risk has gone up from 11% in September last year but is probably around 13/14% meaning there is 85/86% chance I might have a heart attack or stroke.

That isn’t what it means. It means 11 out of 100 people with the same results (that are questioned on the calculator) as you will have such an event. (Not that you have an 85% chance of having one).

Those 11 people may have a lot of factors that are not the same as yours but those aren’t being measured in this test - or they may be your life style twin. They may have had those numbers a long time or a short time. They may have moved to that postcode recently or lived there all their lives. This calculator is one measure to consider. You need to look at the whole picture and make your choice whatever that may be. There are additional tests that can be done (ldl particle size or CAC scan to look for actual issues not theoretical ones but good luck persuading an nhs dr to do them)

 

[Donnadoobie]

That isn’t what it means. It means 11 out of 100 people with the same results (that are questioned on the calculator) as you will have such an event. (Not that you have an 85% chance of having one).

Those 11 people may have a lot of factors that are not the same as yours but those aren’t being measured in this test - or they may be your life style twin. They may have had those numbers a long time or a short time. They may have moved to that postcode recently or lived there all their lives. This calculator is one measure to consider. You need to look at the whole picture and make your choice whatever that may be. There are additional tests that can be done (ldl particle size or CAC scan to look for actual issues not theoretical ones but good luck persuading an nhs dr to do them)

Yes I meant to say there was an 85% chance if me not having one. You are right and it is all relative to how they get their calculations.

Considering a CAC test, will have to go private though.

I am a fit person. Walk regularly 3/4 miles and in the spring summer I run 2/3 times a week. I eat a low carb diet and on,y ever use olive or avocado oils to cook with or out on salads. There must be something I have missed for it to be so bad. My HDL is low so I am guessing my trigs will be high. I am on beta blockers, have been since I was 24 and see that this raises cholesterol, including triglycerides, so may need to discuss this with the Gp.

 

[AndBreathe]

I have not posted on this forum for a few years but today, I am so at a loss of what to do that I thought I would vent my frustrations.



I am pre diabetic and have managed to keep my glucose levels around 40-43 over the past 8 years. Could be better but I am managing it.



Cholesterol on the other hand is not playing ball and a few years ago I had a test come back at 7.8, Gp gave me 3 months to retake and it came back at 5.8. A pat on the back and off I went. Then a couple of years later it came back as 8, given another 3 months and I got it to 5.6.



Last year, I was sprung another test without warning and, you guessed it, it came back at 8.9! She was adamant I went on statins but I bought another 3 months and even though I had a holiday and a wedding in between but thought if I kept to plan the rest of the time I would be ok. It came back at 6.8, they were much happier and asked for a 6 month review.



I came back from Scotland on 2nd January and Knuckled down to a good way of eating. No alcohol, oily fish 3 times a week, tried avocados and discovered I am allergic to them but persevered using only olive oils and avocado oil to cook with and have with salads, ditched the mayo and low carb bread cooked everything from scratch and ate nuts as a snack. Reduced the few carbs I ate and I upped my supplements, taking Plant sterols, berberine and lecithin 3 times a day and drinking Inulin before bed. I was so focussed.

I booked a blood test for 23rd March and yesterday off I went. Got the results back today and it has come back as 7.5! I am devastated. I had tried so hard and all for nothing. Now they will definitely want me on a statin, something I have tried to avoid but the thing that most upsets me is because I tried so hard.



Not sure where I go from here. Saw what statins did to my lovely mum and they scare me. I have felt like crying all day. I am feeling “ what is the point?!”



A1c was 43, better than 46 last year and I have lost a stone since my test in May 22.



If you made it this far thanks for reading.

Hi Donna, you are obviously extremely disappointed with your numbers.

Whilst 7.5 is outside most of the parameters the NHS look at, it's a bit of a meaningless total without knowing the breakdown of the number - LDL, HDL and Triglycerides.
My cholesterol always has a high total (higher than my GP would like it), but the breakdowns are very good, so we are at a position my old GP (she moved away - boo-hoo! Bting her back!) used to refer to an "inconveniently large number", before moving along.

If you have your breakdown it'd be super-useful if you could post it, and that would likely lead to more informative feedback.

And well done on the lower A1c. Take the wins where youcan. There'll always be someone to see a downside in anything.

Welcome back.
Edited to say it looks like my laptop missed a few replies to you, so forgive me if I repeat what others have said, Donna.

 

[Ryhia]

Yes my numbers were 10 and I was referred to the lipid clinic in 2020. The only good thing that came out of that was they did an Apob test along with the usual bloods. Apob levels are supposed to be a better indication of CVD risk. The lipid clinic also talked about my the Qrisk score - the Qrisk calculator is found here https://qrisk.org/. The scoring is actually a post code lottery depending on where you live. I cannot get my risk down below 9% simply because of age and where I live. My Qrisk score came back at19% when i included diabetes (even though I have kept my bloods under control for the last 4 years) and having high cholesterol. I refused the statin that was offered as I had read so much adverse information. I did try to drop the cholesterol by changing my diet, even started using plant stanols but my memory started to be suspect - not sure if that's just old age but didn't want to risk it as other folk on this forum have recorded memory issues with statins so did not want to chance that the plant stanols were affecting my memory. I modified my diet which helped to a certain extent, got my bloods down to 7.6 but none of the medics were happy and wanted me on a high dose of statins. The lipid consultant basically said my issue was what I was eating and that i needed to change my diet. So if I ate more carbs, my cholesterol was likely come down however if I up my carbs my blood levels start to rise. Bit of a no win situation.

Dave Feldman of Cholesterolcode.com has done a lot of research regarding Cholesterol - his cholesterol was really high so he started experimenting on himself. He suggested that eating something between 90 and 120 gms of carbs a day may bring cholesterol down. If you can manage that and still keep bloods on track it may be worth a try. You can potentially also hack your cholesterol, (again something that Dave tried) by believe it or not, eating very few calories for 3 days, then eating lots of calories (around 3000) a day for 3 days whilst still keeping to low carb. I tried that and it does work after a fashion but its really an uncomfortable process and I certainly put on weight. I note that the experiment has now been removed not sure why. I am fortunate, in that I have my own lipid tester - its just a finger prick test and does record a little lower than a hospital veinous test but it does mean if I want I can keep a tab on what my lipids are doing. I got so fed up and stressed with what the medics were trying to force me into, that my doc has now put on my notes that I should not be hassled about my cholesterol.

A few weeks ago, I decided to check my lipids, I hadn't actually tested them for quite a while and certainly had not tried to interfere with levels recently. My cholesterol showed up at 5.44 which was quite a pleasant surprise. Its still too high for the medics but certainly fine with me. The only thing was that my ratios were actually worse. My Trigs had risen although still under 1 and my HDL had gone down to 1.3. I think the changes may have been caused by introducing low carb bread to my diet, just a guess but adding fibre is supposed to help.

 

[Donnadoobie]

Thank you Ryhia, that was really helpful.

Yes, getting the balance between sugar and cholesterol is a nightmare. Sadly for me, my HDL was low 0.95 and I suspect my trigs were high. I had asked for a fasting test and I fasted but the test was late morning and with all the chat, I forgot to mention it, even though I had asked for a note to be given to the nurse and it was treated as non fasting. Triglycerides were not recorded. I think triglycerides and HDL are a better indicator but seem elusive to me.

For 3 months I had no alcohol, not even a sip. Reduced berry intake and low carb bread. Ate fatty fish 3 times a week. Used extra virgin olive oil, Carbs were from cauliflower and celariac mainly. Lived a clean life. So this feels like a very cruel result. Although exercise has been limited, due to weather, working hours and a shoulder issue.

Two factors I will discuss with my Gp ( don’t like her either which doesn’t help) is that I have been on beta blockers for hypertension since 1987. Interestingly my bp has been perfect averaging 116/70. Beta blockers raise cholesterol and in particular triglycerides so will seek an alternative from her. Also I have been dealing with severe pain from a flare up of calcified tendinitis in my rotator cuff and have read that pain and stress, lack of sleep etc also raises LDL and lowers HDL.

I am going to go and enjoy the next few weeks, relax a bit, I have trips to our apartment in Spain for Easter, family in Scotland and family in another part of Spain in May. Will come back knuckle down and get another lipid profile test at the end of August. Will try the 800 BSD again, which worked wonders before and see if I can swerve these statins again.

Will look into a cholesterol monitor. I have one but can’t get it to work properly. They are quite expensive but will have a look.

EDIT: by the way, I took the qrisk test. I got 9.6. I will quote this to her.

 

[Donnadoobie]

Thanks for your replies to my cholesterol post. I think I struggle to balance sugar and cholesterol needs, although I believe that the diet should be similar anyway.

Comments about the fact that I should eat less carbs, from a statins Facebook group, made me think that I am doing some thing wrong, so thought I would put this here to see what people thought. Obviously, when on holiday, so a few weeks of the year, some of this goes out the window but not all, carbs are still limited but I do occasionally have a treat. This is what I eat on a weekly basis. This is definitely what I ate leading up to my blood test with the following supplements

Plant sterols, Berberine, Lecithin, co enzyme q10, fish oil, psyllium.

What the hell did I do wrong? Or am I just one of the unlucky genetically challenged minority. Struggle to get my glucose in the green area ( Amber now), or HDL and triglycerides anywhere near acceptable.

Feel like such a failure.

Typical day.

Coffee with almond milk and MCT oil

Mid morning. Portion of almonds

Lunch. Mackerel with tomatoes/ chicken salad with olive oil/ full fat Greek yogurt with berries, seeds ( pumpkin, sunflower, chia) cocoa nibs and walnuts. Or similar

Evening meal. Some examples. Stuffed aubergine and salad. Cauliflower cheese, salmon and salad, shepherds pie with celariac mash. Lamb meatballs with cauliflower rice, pork,loin chops with peppers and salad, roast chicken and salad. Prawns in soft cheese sauce with courgetti, steak with mushroom sauce and salad.

2 squares of 90% chocolate and a few nuts as a snack

Decaf coffee and water to drink. Coffee sometimes with almond milk and sometimes whole milk.

Alcohol for celebrations or holidays. Most weeks or even months with none at all.

Where am I going wrong?

I have looked into the carnivore diet but can’t get my head around it and makes me feel a bit sick to be honest. Love meat but love salads a veg equally.

 

[pixie1]

its a pain in the derierre. Are you checking your blood sugars 2hrs after you have eaten? if not, it maybe a good idea to do so, even with seemingly innocent foods. Are your meatballs homemade? if not, check out the ingredients. mushroom sauce, is it pre made? cauliflower cheese, is the sauce home made or is it frozen? check out the ingredients.
combination of chocolate and nuts together, may go over your tolerance level, keep an eye on the seeds and nuts, you maybe consuming more carbs than you think. or you may be snacking too much, because the main meals are not filling and feeling hungry soon after.

 

[Donnadoobie]

its a pain in the derierre. Are you checking your blood sugars 2hrs after you have eaten? if not, it maybe a good idea to do so, even with seemingly innocent foods. Are your meatballs homemade? if not, check out the ingredients. mushroom sauce, is it pre made? cauliflower cheese, is the sauce home made or is it frozen? check out the ingredients.
combination of chocolate and nuts together, may go over your tolerance level, keep an eye on the seeds and nuts, you maybe consuming more carbs than you think. or you may be snacking too much, because the main meals are not filling and feeling hungry soon after.

Thank you. I must admit to eating lots of nuts, so could be that. To be honest, my numbers never come down as easily as others and I find it demotivating at times. Even when I did the 800 BSD my a1c only got to 40. Cholesterol did drop to 5.8.

My triglycerides never seem to go down low enough and I can’t understand why and HDL is never high enough. I feel like I might cave on statins as I can’t see away forward right now.

 

[KennyA]

Statins will reduce your cholesterol (and possibly do other things as well). The question is whether reducing your cholesterol is a good thing or not. I happen to think it makes little difference to me. You might want to take a look at the results of the HUNT2 study on over 52,000 people, particularly in relation to women.

Link to study:

Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospective data from the Norwegian HUNT 2 study - PubMed

Our study provides an updated epidemiological indication of possible errors in the CVD risk algorithms of many clinical guidelines. If our findings are generalizable, clinical and public health recommendations regarding the 'dangers' of cholesterol should be revised. This is especially true for...

pubmed.ncbi.nlm.nih.gov

Conclusion of study:

Our study provides an updated epidemiological indication of possible errors in the CVD risk algorithms of many clinical guidelines. If our findings are generalizable, clinical and public health recommendations regarding the 'dangers' of cholesterol should be revised. This is especially true for women, for whom moderately elevated cholesterol (by current standards) may prove to be not only harmless but even beneficial.

 

[Oldvatr]

Statins will reduce your cholesterol (and possibly do other things as well). The question is whether reducing your cholesterol is a good thing or not. I happen to think it makes little difference to me. You might want to take a look at the results of the HUNT2 study on over 52,000 people, particularly in relation to women.

Link to study:

Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospective data from the Norwegian HUNT 2 study - PubMed

Our study provides an updated epidemiological indication of possible errors in the CVD risk algorithms of many clinical guidelines. If our findings are generalizable, clinical and public health recommendations regarding the 'dangers' of cholesterol should be revised. This is especially true for...

pubmed.ncbi.nlm.nih.gov

Conclusion of study:

Our study provides an updated epidemiological indication of possible errors in the CVD risk algorithms of many clinical guidelines. If our findings are generalizable, clinical and public health recommendations regarding the 'dangers' of cholesterol should be revised. This is especially true for women, for whom moderately elevated cholesterol (by current standards) may prove to be not only harmless but even beneficial.

It is difficult to understand what they mean by cholesterol. The following article may help

Biochemistry, Cholesterol - StatPearls - NCBI Bookshelf

This shows cholesterol is a specific molecule structure that our body builds and which is used throughtout the body. It is not what the doctor is discussing in the surgery. What he is worrried about is bubbles made of cholesterol that transport fats and amino acids in a waterproof form to stop them mixing with the water in the blood.

There are now 4 different classes of 'cholesterol'. VLDL, HDL, LDL and sdLDL. Triglycerides are fat lipids attached in three's to a glycerol stem, and is the form that is stored in the liver and adipose tissue. It too is not easily transported in water.

The blood test measures total cholesterol, HDL and trigs. then LDL is estimated using the Friedland Formula where LDL = TC - HDL - (TG/5), It is known to be inaccurate, and in the US they use a different formula.

Not sure what TG is a measure of. Its called Trigs, but it is measiured by clotting the blood sample, then stripping out the fats and leaving just the glycerol which is then analysed. So it is not clear what it is composed of (i,e, it seems to be the residue of all the glycerol in the blood sample, so includes VLDL and sdLDL residues too. I always understood it to be a measure of the residue, and thus is including other stuff apart from the usual culprits.

Now recent research has discovered sdLDL which is small dense LDL and this is damaged LDL that is not removed by HDL since it is no longer useful LDL. It is in effect a waste product. Now I can believe that high levels of sdLDL in the blood would also affect the TG glycerol result, and would be a potential marker of stress and inflammation in the body, So sdLDL may be the real Bad Boy of cholesterol and why high TG levels are bad for us. That makes sense to me.

I have always been surprised that the TG value is generally much less than the other markers in the blood test. If it was the glycerol from ths LDL etc then it should be quite dense. But if it is only measuring the glycerol in the serum i.e. no longer connected to the active lipids locked in the clotted sample, then it becomes a useful marker. So I ask what is the blood test actually measuring? The results (often less than 1mmol/l) neither support total glycerol or lipid glycerol from active 'cholesterol' It must be the residue glycerol and hence associated with the sdLDL. But I admit I am confused. To call this parameter Trigs is confusing since all 'cholesterol' is stuffed full of trigs.