Hypertension as a risk for type 2?

[lindisfel]

I suspect I have not had very high insulin resistance. My triglycerides have always been low, before and after diagnosis. My blood pressure has always been normal (except when on a particular cancer treatment but even then it wasn't outrageous). My fasting levels were rarely above 6 and dropped to low to mid 5's quite quickly. The only metabolic syndrome I had was being overweight especially round the middle, but my liver functions have always been good with the ALT in the teens and 20's, similarly the Gamma GT. I guess I am a black swan!

At least you are part of the British wildlife scene! . D.

 

[SimonCrox]

I'm a great fan of Kendrick and what he says re. cholesterol etc but admit I haven't actually heard that one, I'm sure he's right though. It was Kendrick who taught me to question just about everything the nannying NHS dishes out.
[Cue a big argument with my newly qualified junior dr granddaughter who slammed out of the room when I said recently that statins are offered according to what number on the Qrisk you had and that the risk had been lowered from 20% to 10% overnight with no explanation. "Why would they do that Granny": I didn't get the chance to mention Big Pharma before she'd gone!!
However I did comply with the hypertension thing though, I think I allowed myself to be scared by threats of Dementia, stroke,heart attack, etc dished out by the HCA when first I had the MOT.
I waited 3 months before going on meds and seeing another GP who was not so dismissive as the first. In the meantime I got my weight better controlled [BMI was 23], raised my exercise level by buying another dog to walk, cutting out salt etc.There was a lot of white coat syndrome I'm sure, but it was only after the second dr said that she would be jumping up and down and insisting on meds if I was her mother that I thought perhaps I should take notice. I've never been able to come off the things unfortunately but on the other hand I've never increased them either.

Interesting point about the drop in intervention threshold for statins, and it all relates to cost.

Most statin treatments in standard doses drop the chance of heart attack or heart attack/stroke by 25%. If one looks at a population who are going to have a lot of heart attacks etc, then dropping the events by 25% stops a lot of events, but if one has a population with a lower risk of heart attacks etc, then there are fewer events avoided, cos there are fewer events in the first place.

The government etc is really interested in preventing non-fatal heart attacks and strokes cos they cost to be looked after both medically and socially, but one suspects that the authorities are not too bothered about the citizens dropping dead cos that saves on care costs and pensions. But life is a two way street, and I guess most of us would not be too bothered if some politicians dropped dead. OK - I know that they want to get one Quality Adjusted Life year for whatever amount, generally £17,000-£20,000.)

When guidance was first issued, it was a 30% chance of avoiding a heart attack (ie stroke not considered) over the next 10 years, and the statin was simvastatin 40mg which cost £56 per month. So statin treatment was expensive and one wanted to avoid a lot of heart attacks for the money, so it was only used in high risk patients to avoid a lot of heart attacks.

Later the statins became cheaper eg atorvastatin 10-20 mg was £28 per month, so more people were offered a statin by decreasing the threshold for treatment to 20% 10yr risk of heart attack or stroke, ie more people at lower risk were treated, so there were fewer events to avoid but it could be afforded cos statins much cheaper.

And finally statins went generic so the treatment dose is now about £2.50 per month, and so the treatment was offered to even more people by dropping the treatment threshold to 10% risk heart attack or stroke over next 10 years.

Apparently, at 8% risk of heart attack or stroke over next 10 years, risk and benefits of statin are equal (I think that I read that in some guideline), so the threshold should not go any lower.

People at the lower risk eg 10% act in one of several ways when I used to see them; some go along the no way would I ever take a statin; some go along the line of trying the statin cos if side effects, can stop, but if have heart attack and cannot replace the damaged heart muscle; and some do whatever the doctor says – I found these last folk the most difficult!

The grand-daughter getting in a tizz over it is a different problem, although she clearly cares. Patients are allowed to refuse treatment if they are fully informed, so it is more challenging to make sure that they are fully informed, but more interesting. She needs to look at it from a different point of view; if the patient takes the proposed treatment and either gets side effects or it does not work, then the doctor looks bad, but if the patient does not take the treatment, there will be no come back on the doctor. The NHS is a very stressful place to work, and one needs to be able to cope with this. Most of my colleagues expected everything to work perfectly, but I didn’t; so when things occasionally did not work, my colleagues were very annoyed, but conversely, when anything worked (which was quite often), I was pleasantly surprised!

Best wishes

 

[Gardengnome]

Interesting point about the drop in intervention threshold for statins, and it all relates to cost.

Most statin treatments in standard doses drop the chance of heart attack or heart attack/stroke by 25%. If one looks at a population who are going to have a lot of heart attacks etc, then dropping the events by 25% stops a lot of events, but if one has a population with a lower risk of heart attacks etc, then there are fewer events avoided, cos there are fewer events in the first place.

The government etc is really interested in preventing non-fatal heart attacks and strokes cos they cost to be looked after both medically and socially, but one suspects that the authorities are not too bothered about the citizens dropping dead cos that saves on care costs and pensions. But life is a two way street, and I guess most of us would not be too bothered if some politicians dropped dead. OK - I know that they want to get one Quality Adjusted Life year for whatever amount, generally £17,000-£20,000.)

When guidance was first issued, it was a 30% chance of avoiding a heart attack (ie stroke not considered) over the next 10 years, and the statin was simvastatin 40mg which cost £56 per month. So statin treatment was expensive and one wanted to avoid a lot of heart attacks for the money, so it was only used in high risk patients to avoid a lot of heart attacks.

Later the statins became cheaper eg atorvastatin 10-20 mg was £28 per month, so more people were offered a statin by decreasing the threshold for treatment to 20% 10yr risk of heart attack or stroke, ie more people at lower risk were treated, so there were fewer events to avoid but it could be afforded cos statins much cheaper.

And finally statins went generic so the treatment dose is now about £2.50 per month, and so the treatment was offered to even more people by dropping the treatment threshold to 10% risk heart attack or stroke over next 10 years.

Apparently, at 8% risk of heart attack or stroke over next 10 years, risk and benefits of statin are equal (I think that I read that in some guideline), so the threshold should not go any lower.

People at the lower risk eg 10% act in one of several ways when I used to see them; some go along the no way would I ever take a statin; some go along the line of trying the statin cos if side effects, can stop, but if have heart attack and cannot replace the damaged heart muscle; and some do whatever the doctor says – I found these last folk the most difficult!

The grand-daughter getting in a tizz over it is a different problem, although she clearly cares. Patients are allowed to refuse treatment if they are fully informed, so it is more challenging to make sure that they are fully informed, but more interesting. She needs to look at it from a different point of view; if the patient takes the proposed treatment and either gets side effects or it does not work, then the doctor looks bad, but if the patient does not take the treatment, there will be no come back on the doctor. The NHS is a very stressful place to work, and one needs to be able to cope with this. Most of my colleagues expected everything to work perfectly, but I didn’t; so when things occasionally did not work, my colleagues were very annoyed, but conversely, when anything worked (which was quite often), I was pleasantly surprised!

Best wishes

Thank you for your reply. There was a time [a long time ago!] when I would have gone along with everything a doctor said, bowing to their superior knowledge, but now I tend to query just about everything and do my own research where I can. This started when I had an NHS MOT and the HCA found I had hypertension. She almost fell off her chair in her excitement and looked at me pityingly remarking "Well, you are 70", as though I should be shunted off into a care home. I snarled back that I was 29 thank you very much! That remark made 6 years ago has never left me and I felt patronised and trapped by what she probably thought was an innocuous remark. I was cross then and still feel cross when I think back; there is nothing we oldies hate more than being patronised!
So when I was offered a statin I asked my GP if she would take one given my state of health [good] and she said NO. Fine with me, but I'm sure lots of people wouldn't have queried it. And what you have said about the risk percentage dropping confirms my belief that it is all about the money. Big pharma must think it's Christmas all the year round the way these things are shelled out, it's their bread and butter.
With arthritis in one knee I like to walk and garden as I always have done, believing that exercising is a way of keeping the joint flexible and me fit. So far it has worked and I would be worried if I took a statin that side effects might aggravate it, so I won't risk it and it is recorded on my medical notes, my GP hasn't tried to alter my mind.

 

[lindisfel]

Malcolm Kendrick's discussion on what causes heart disease has been interesting but seems to be a universal catch all.
He does say for those with heart disease and have unstable plaques, statins stabilise those plaques by calcifying them, as does warfarin.

So you have to make you own decision on the issue regarding statins etc, low carbers die before they should of strokes with very good HDL and low trigs.
D.