Statins

Bluetit1802

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The problems with this are that triglycerides are constantly varying, so a single measurement at a particular time of day is useless; and that triglycerides are often not included in blood test results.
For comparative purposes, TC/HDL is a better indicator of triglyceride levels, a result < 3.5 being good. Ref Prof Sikaris.

I understand where you are coming from, but in general, if we have fasted long enough before the test, the trigs are likely to be more stable. I also appreciate not all surgeries include the triglyceride test, but if the total, HDL and LDL have been included, then it is easy to work the trigs out. The trigs are the baddies so it makes sense to include them and take notice of them.
 

Red59

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I had my first officials "diabetes consultation" with the DN today. (For some reason it took two years to get to this point, after moving from the USA to UK two years ago. I suspect this is because my HbA1c has never been found to be high by the NHS: by the time I moved here it was under control using diet and exercise.)

Anyway she congratulated me on keeping good control of my A1c (37, as measured two weeks ago) but said the test also showed my cholesterol is high. Serum cholesterol was 6.5, serum HDL was 1.8, and the ratio is 3.6. She consulted the duty GP and gave me a prescription for statins.

At this point I gently pushed back, saying that I would much prefer to try diet and lifestyle changes first. My argument was that if I start taking the statins immediately, I will never know whether non-drug alternatives could do the trick on their own.

The nurse said that the recommendation is for cholesterol to be 5 or below, and for anyone who has been diagnosed with diabetes, 4 or below. She said that because my cholesterol is high, I am at higher risk of a cardio-vascular event.

I then asked her to check what my cholesterol was, the last time it had been checked. This was 15 months ago (at the time of my NHS "MoT") and at that time the numbers were almost exactly the same as they are now. At the time, the nurse casually mentioned that the numbers were high but took no further action.

Today I told the diabetes nurse it looks like I have been living with high cholesterol for at least 15 months, so I don't personally have a problem with taking a few extra weeks during which I can try to use diet-only to bring the number down. At this point she actually agreed with me and gave me three months to get the number down without drugs. We will re-assess at the end of April. (She said I could keep the prescription because it is valid for 6 months!)

So: What is the best way to bring the number down? Also (playing devil's advocate) how much does it really matter?
Hi Grateful. Your story sounds very similar to mine. I reversed my diabetes in 2017 with the Newcastle and then Keto diet. My cholesterol numbers have been all over the map in the last 2 years. I have researched and have found that the top 2 selling drugs in North America (I am Canadian) are #1 Lantus Insulin and #2 statins so I my statin prescription from my doctor sits unfilled. I have read Dave Feldman's Cholesterol Code and recommend it https://cholesterolcode.com/. Also, I always do the Framingham Risk Score when I get my numbers. I am keeping an eye on it and have found that if I fast longer than 12 hours prior to the test my cholesterol, Total LDL numbers will be higher. There is no doubt for patients who have had a previous cardiac event or family history of cholesterol/cardiac issues that statins work but I don't believe they are effective for everyone. I am not a medical person just trying to figure this all out like everyone else. I wish you all the best Grateful and will follow to see how you are doing.
 

ianf0ster

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There is no doubt for patients who have had a previous cardiac event or family history of cholesterol/cardiac issues that statins work but I don't believe they are effective for everyone.
Not sure about that, since a recent 10yr study showed that those in the higher LDL category lived longer than those in the lower LDL category in a study population of those with a prior Stroke, heart Attack or Heart failure.

So how are statins helping? Is it that those with the higher LDL were on Statins? So they aren't lowering the LDL but they are reducing deaths?
Or that higher LDL is protective? - In which case why take a Statin to negate that beneficial effect?
 

maltham 2

Member
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11
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I had my first officials "diabetes consultation" with the DN today. (For some reason it took two years to get to this point, after moving from the USA to UK two years ago. I suspect this is because my HbA1c has never been found to be high by the NHS: by the time I moved here it was under control using diet and exercise.)

Anyway she congratulated me on keeping good control of my A1c (37, as measured two weeks ago) but said the test also showed my cholesterol is high. Serum cholesterol was 6.5, serum HDL was 1.8, and the ratio is 3.6. She consulted the duty GP and gave me a prescription for statins.

At this point I gently pushed back, saying that I would much prefer to try diet and lifestyle changes first. My argument was that if I start taking the statins immediately, I will never know whether non-drug alternatives could do the trick on their own.

The nurse said that the recommendation is for cholesterol to be 5 or below, and for anyone who has been diagnosed with diabetes, 4 or below. She said that because my cholesterol is high, I am at higher risk of a cardio-vascular event.

I then asked her to check what my cholesterol was, the last time it had been checked. This was 15 months ago (at the time of my NHS "MoT") and at that time the numbers were almost exactly the same as they are now. At the time, the nurse casually mentioned that the numbers were high but took no further action.

Today I told the diabetes nurse it looks like I have been living with high cholesterol for at least 15 months, so I don't personally have a problem with taking a few extra weeks during which I can try to use diet-only to bring the number down. At this point she actually agreed with me and gave me three months to get the number down without drugs. We will re-assess at the end of April. (She said I could keep the prescription because it is valid for 6 months!)

So: What is the best way to bring the number down? Also (playing devil's advocate) how much does it really matter?


Looks like you are doing OK on HB1AC and weight. No worries there. Christmas was clearly fun :)

The cholestrol thing is interesting and if not already pointed out you have to consider the NICE guidelines given to medical staff: above a certain level of cholesterol they must recommend the patient in the direction of statins. Ratio not considered.

If they do not do that and there is a problem later they can be open to legal action. So the normal path is to recommend statins.

I leave it up to you and readers to make your own judgement on the efficacy of statins but it's worth noting that even the NHS thinks that they will benefit just 1% of the overall prescribed population based on a generic cross sample. If you are not overweight, eat well, don't smoke, exercise a bit and live life in moderation, without local pollution then the average benefit is even less significant.

Do the investigation to inform.
 

Mike d

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The cholestrol thing is interesting and if not already pointed out you have to consider the NICE guidelines given to medical staff: above a certain level of cholesterol they must recommend the patient in the direction of statins.

Evidence?
 

ianf0ster

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MollieB

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Recognise this problem. My cholesterol has always been in the 7.4-7.6 range ever since first test, at least 20+ years back. Didn't vary no matter what weight or level of fitness I was at, which has included at times very high levels of fitness and activity. Current GP reckoned I have possibly got naturally high level. Offered statins but always refused as not prepared to take something with at best 99% chance of having no benefit. But - this month blood test done at first DPN appointment shows cholesterol up to over 8. BP still low. Weight dropping on LC/HF. Statins back on hard sell offer. Still don't want to take them and have said to let me try diet etc first. I understand that fasting (which I'm doing) can raise cholesterol levels and I know that there are increasingly questions over statin efficacy. I'm digging my heels in.

I live in the US and find this discussion somewhat fascinating. When you say your cholesterol do you mean LDL or total? That is pretty high for a total but, if that is your LDL (and if I converted it correctly), that is REALLY high. The general recommendations for diabetics in the US is LDL cholesterol below 80 (or 2.1 if the converter is correct) for the general diabetic population and below 70 (or 1.8) if they have a history of cardiovascular disease. Diabetic patients are associated with an 18% greater risk of cardiovascular mortality (death) than the general population.

You sound like you could be someone who has familial hypercholesterolemia. (Genetic high cholesterol). It is a possibility to explore.
 

bulkbiker

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When you say your cholesterol do you mean LDL or total?
It will be total... full lipid panels are not always the norm here in the UK and fasting advice is rarely given so results can be skewed anyway.
 

Brunneria

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Not sure about that, since a recent 10yr study showed that those in the higher LDL category lived longer than those in the lower LDL category in a study population of those with a prior Stroke, heart Attack or Heart failure.

So how are statins helping? Is it that those with the higher LDL were on Statins? So they aren't lowering the LDL but they are reducing deaths?
Or that higher LDL is protective? - In which case why take a Statin to negate that beneficial effect?
But if you really like statins, then you need to take either Simvastatin or Atorvastatin, since they pass through the blood/brain barrier and so can do their good work in allegedly depriving your brain cells of nutrients - LOL !

Could you please supply some links and references for these statements.
Thank you.
 

Bluetit1802

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The general recommendations for diabetics in the US is LDL cholesterol below 80 (or 2.1 if the converter is correct) for the general diabetic population and below 70 (or 1.8) if they have a history of cardiovascular disease.

In the UK the general recommendations are LDL ( serum lipids) up to 3mmol/l . I think it maybe a little lower for those with diabetes. The more recent NHS recommendations are to pay less attention to the LDL and to look at the Total cholesterol/HDL ratio, which should be under 5 and the non-HDL cholesterol level, which should be under 4 (3.4 for diabetics).
 

bulkbiker

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In the UK the general recommendations are LDL ( serum lipids) up to 3mmol/l . I think it maybe a little lower for those with diabetes. The more recent NHS recommendations are to pay less attention to the LDL and to look at the Total cholesterol/HDL ratio, which should be under 5 and the non-HDL cholesterol level, which should be under 4 (3.4 for diabetics).

Just had my GP "chat" ...."your cholesterol is over 5, your QRisk score is 19"...
Asked her remove the T2 diabetes.. oh yes your QRisk is 10.6..
Then "no I wasn't going to recommend a statin" she said... hmmm maybe I should have let her dig the hole first before jumping in...
A missed opportunity although she did admit I was "quite well informed" .. might have got back onto 6 monthly HbA1c and full lipid panel though.. no CAC scan worse luck..
 

Bluetit1802

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Asked her remove the T2 diabetes.. oh yes your QRisk is 10.6..

Yes, mine drops substantially if I remove diabetes, by almost a half. However, my nurse won't remove it on the one she does that goes on my medical records, although she understands my arguments. It may be surgery protocol not to do it, I don't know. I don't care. I still have 6 monthly blood tests for the lot.
 

ianf0ster

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Thanks, but I was rather hoping that @ianf0ster would supply his own references for his own claims and statements. :)

Perhaps I have a tendency to assume that other active members have seen the same information that I have, since although I spend several hours per day on studying Diabetes and CHD (and Colon Cancer) related subjects, for the most part I only see things that are widely linked or Tweeted.

Dose it make my statements less valid if I don't see a request for references before another member supplies it ?

Edited to add link to Statins crossing blood/brain barrier, evidence of cognitive impairment etc.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5830056/

For anecdontal evidence just ask @Resurgam
 
Last edited:

Santa_Fe

Newbie
Messages
4
Type of diabetes
Type 2
I had my first officials "diabetes consultation" with the DN today. (For some reason it took two years to get to this point, after moving from the USA to UK two years ago. I suspect this is because my HbA1c has never been found to be high by the NHS: by the time I moved here it was under control using diet and exercise.)

Anyway she congratulated me on keeping good control of my A1c (37, as measured two weeks ago) but said the test also showed my cholesterol is high. Serum cholesterol was 6.5, serum HDL was 1.8, and the ratio is 3.6. She consulted the duty GP and gave me a prescription for statins.

At this point I gently pushed back, saying that I would much prefer to try diet and lifestyle changes first. My argument was that if I start taking the statins immediately, I will never know whether non-drug alternatives could do the trick on their own.

The nurse said that the recommendation is for cholesterol to be 5 or below, and for anyone who has been diagnosed with diabetes, 4 or below. She said that because my cholesterol is high, I am at higher risk of a cardio-vascular event.

I then asked her to check what my cholesterol was, the last time it had been checked. This was 15 months ago (at the time of my NHS "MoT") and at that time the numbers were almost exactly the same as they are now. At the time, the nurse casually mentioned that the numbers were high but took no further action.

Today I told the diabetes nurse it looks like I have been living with high cholesterol for at least 15 months, so I don't personally have a problem with taking a few extra weeks during which I can try to use diet-only to bring the number down. At this point she actually agreed with me and gave me three months to get the number down without drugs. We will re-assess at the end of April. (She said I could keep the prescription because it is valid for 6 months!)

So: What is the best way to bring the number down? Also (playing devil's advocate) how much does it really matter?

I was once on statins and my cholestrol levels didn't change, up or down, so I came off them. My reading was only 4.2 but the attitude was "well you're diabetic so you must take statins".

According to the physiologists while there are good control methods within the human body for thirst, respiration rate, blood pressure and all sorts of other things there is no control loop for cholesterol levels. This begs the question of does the level matter? Some people say probably not. Cholesterol is seen as a problem because it deposits as plaque on the inside of blood vessels and eventually will block them, the question that is rarely if ever asked is, why does it do that? The medical profession appear unable to answer that question and big pharma won't ask it because they make too much money selling statins. One final word, I have seen reports that statins can have some serious side effects so if you can avoid them, I would.