LDL cholesterol in diabetics and statins

[Antje77]

But I tend to find it so difficult to discuss with healthcare specialists without wanting to come across as knowing better than they do.

You can just explain that you would like to know the exact science behind it. Getting a lifelong medication prescribed is not a small thing.
So it's not necessarily because you're a know-it-all, or because you don't trust them, you just want to know more.

 

[Grant_Vicat]

Debates on statins on this forum really drive me to despair, there are the same handful of medically unqualified members who repeatedly come on, advise people that there doctors are only prescribing statins because they earn money out of it, and/or your cholesterol numbers aren’t that bad, and/or cholesterol numbers don’t matter, and/or statins are bad for your general health and/or diabetes.

So far as earning money is concerned, a recent debate on here nobody was able to say how much money an individual dr got for prescribing a statin to a patient, what we were able to establish was that there was a pot of money, that was divided between all surgeries depending on how they performed on 60 health measures, one of which was statins .... I can’t see any dr handing out statins just because their practice may get a few pence because they do ..

As to whether statins are good or bad for you, yes those who are anti statin in the same vein as those who are anti vaxers or anti diabetes meds will be able to point to some doctors who say statins, covid vaccines and diabetes meds are bad ... personally I would rather accept the opinion of the majority of health professionals when it comes to statins, rather than some anonymous member of this forum with no claim to have any medical qualifications, just an ability to use google ...

If you are going to base your health decision on the multiple posts on this forum, ignore the same handful of members who contribute to every one to tell how statins are bad and then see what you are left with, but it probably makes more sense to base your decision on the medical expertise of your doctors, rather than anonymous, medically unqualified, members of any Internet forum.

In essence I think you have a very valid point and therefore my post above would be seemingly flippant and unhelpful. From personal experience I was routinely put on statins when I was 40. I took these for nearly 13 years before muscular problems caused me to be put on a different type. This caused me to come out in a major all embracing body rash and 3 days in hospital, where the top dermatologist told me that it had been caused by statins. Therefore I was taken off them completely. Two years later I had a double transplant and the nephrology team were going to prescribe statins. When I informed them that the dermatologist had given explicit instructions not to prescribe them, there was apparent consternation. I have not had any since 2011 and in February I had the best blood chemistry results in my lifetime. Of course I am not advocating that nobody benefitsfrom them, anymore than a patient's allergy to certain types of insulin means those types should be banned. I am truly pleased to see from your post below that they are of vital benefit to you. Keep well!

 

[Oldvatr]

For the benefit of full disclosure, I take a statin, I have done for 17 years, both my parents had high cholesterol, my grandfather died of heart failure in his 40s, my father had a quadruple heart bypass in his 40s, my mother had narrowing of the arteries early in life.

As a result I was advised to have my cholesterol tested when I turned 40, from memory it was 9, diet got it to 7, at that time they wanted it to be 6, I am now at 4. I am unaware of any side effects, 16 years after I started taking it and many stones later I was diagnosed as type 2, I don’t suppose that has much to do with the statins but I guess someone quoting stats will use me as an example of statin users becoming diabetic.

Your username and your posting style gives the impression you are a doctor or an HCP. If you are, then you should know that plaque buildup does not happen overnight, it takes years and years from childhood onwards to build up. You should also know that statins do not remove or reduce plaque once it is in place. So at best it may prevent future buildup.

There are many scientific studies carried out that get posted on this forum that support the POV that you disdainfully put down. These studies were not funded or performed by the manufacturers themselves, so stand a good chance of being based on sound science which is independant. The NHS uses NICE and SACN to advise, and they used only studies that the statin manufacturers provided in their application for licence, and these have been shown to have weaknesses, especially in their use of the Hazard Ratio statistical method that exaggerates small differences. It is possible the NHS has been misled.

PS I am anti-statin because i tried most of them and they made me very ill. My medical records now state that I am allergic to statins. I too have had a heart bypass, and my problem stems from being a heavy smoker and drinker most of my life. That I can believe.

In the old days, plaque buildup used to be called calcification, or hardening of the arteries, because a major component of the residue is calcium This element has no connection with cholesterol. Also the plaque buildup is mainly in the arteries, not the veins. but cholesterol is present in both. Also the cholesterol theory ignores the elephants in the room, which are Chylomicrons, and VLDL which are supertankers of lipids also transported in a similar bubble in the blood.

PS are you medically qualified? Just curious......

 

[dancer]

I was on statins for several years. The family joked about my poor memory while I was on them. In my 50s there were a couple of occasions where my memory problem was more serious. I had read about the possibility of statins causing memory problems, so stopped taking them. My GP wasn't very pleased and said there was only anecdotal evidence that statins can cause memory loss, but I refused to try a different statin. Only months later, I read that the EU had told drug companies to include memory loss as a possible side effect of statins.

A few years later, my consultant told me that a couple of studies had shown that the use of statins in Type 1s made no difference to the incidence of heart problems or strokes.

After my brother died of a massive heart attack, my consultant suggested that I try a different statin. I agreed but only lasted 10 days before I stopped using it, due to a feeling of slow thought processes and finally the most horrendous headache I have ever experienced. I feel fine and my cholesterol is usually 4.7. Ok I don't know what my blood vessels are like, but my memory isn't as bad as when on statins and my thought processes are fine. That is much better than worrying I had dementia!

 

[michelle88]

My cholesterol levels decreased after eating low carb - I had been told to take Atorvastatin but it was frightening to realise that my memory had been affected. I lost the car in the supermarket car park, wandered around using the key to locate it, and then realised that I'd done the Christmas shop already and left the stuff in the car.
I could no longer sing from memory, and had forgotten so many things - I still can't remember how to play guitar, but quite a lot has come back over the years.
It was after only 5 weeks taking the tablets that I binned them.

My mother has been on statins for a few years now. She's 74 and I've noticed her increasing forgetfulness. I don't know whether due to age or statins, but it's definitely disconcerting!

 

[bulkbiker]

I would rather accept the opinion of the majority of health professionals when it comes to statins, rather than some anonymous member of this forum with no claim to have any medical qualifications, just an ability to use google ...

And that is your choice.

Some of us prefer to listen to and read what other medical experts say rather than a GP who has little to no specific training in the field of cardiology. I think that Dr Aseem Malhotra, a word renowned cardiologist, may be slightly better informed that Dr Generalist at my surgery. But that's just me..

Google is great in that it can introduce you to concepts that you had never considered before.. Like the doctor being human as well as wrong!

I made a choice to inform myself about T2 diabetes and found this forum. By following the advice of

of medically unqualified members

I put my T2 into remission along with a host of other issues that my GP would have been prescribing for.
In what way is that wrong?

 

[Oldvatr]

[QUOTE="bulkbiker, post: 2511060, member: 219467

Edit to add.. in the 40 years that stains have been prescribed have heart attack deaths gone up or down compared to the previous 40 years? Maybe google has the answer..

Not sure where that quoted text came from, but it seems to be out of context here. But I look back at the people I know who either had or succumbed to heart attack. Not one of them would be considered obese or even overwaight. They wer in general considered fit and healthy at the time I put myself into that category too since I have suffered this event in the past while my BMI has been at or below 21.

Thank you for your clarification about your username, It was confusing me.

 

[bulkbiker]

This may be found interesting

 

[Oldvatr]

This may be found interesting

View attachment 54426

I believe the study itself was done by Augsburg university in Bavaria,
https://medlineplus.gov/ency/patientinstructions/000702.htm
That graphic is not shown in this report, but the study does indeed measure cholesterol vs CVD event and mortality. I have not found an English copy of the report.
The abstract seems to infer that the results varied greatly between countries (called centres) and no concrete conclusions were made. The study appears to be ongoing.

The nearest I can get to a conclusion is in this report, which ends up saying the trends followed the clasic risk factors of BP and cholesterol.
https://pubmed.ncbi.nlm.nih.gov/10703799/

Note Monica is the follow on from Framingham which has been heavily criticised for its poor methodology and statistics. This second report mentions those same weaknesses in Monica too.

 

[Oldvatr]

This may be found interesting

View attachment 54426

This graphic is taken out of its context in Monica, and has an opinion attached to it by someone not involved in the study. I think the conclusion that is claimed may be misleadng.

The graph is representing individual data points but uses line graph to pertray. This gives an impression that these data points are connected, which they are not. A scattergram or bar chart would be more in keeping with the data. Nowadays, a Forrest plot would probably be used, so the Monica does seem to be using the same principles and tools of Framingham.

The data points are presented in isolation. The Monica study is at least 10 years in progress, so are these points an average of the 10 years, or just the end point. So we do not know how the data moved over the time scale. There must be data for the years for each country showing the trends for them, and this would be more indicative of whether choleserol and mortality are linked.

The graphic does not take into account the effects of country health policies. If we are looking for an association, the plot should be of cardiac events not fatalities, since medical support may also have changed over time, leading to possibly more events being successfully treated. Also the level of statin use may be relevant, as per the OP.

Lastly, what does the 'death data' comprise? Is it purely MI deaths, and is it deaths due to blockage, or is it due to other causes such as valve failure, timing issues, heart malfunction due to medication issues or overdose? Does the data include stroke deaths caused by incorrect heart operation? Again those are relevant to this discussion only if the irregularity is due to blockage to the heart Without seeing the study itself these questions are difficult to answer, so the conclusion drawn from the graphic is not supported.

 

[bulkbiker]

They seem to be coming thick and fast..

https://www.zoeharcombe.com/2022/05/a-new-look-at-statins-ldl-cholesterol-cvd/

 

[Mbaker]

My opinion is based on what are the numbers and what does that mean in general. So @michelle88 as the "non-experts" have said it is best to do you own research with both sides of the available evidence. I find it disturbing that one of the posters diminishes technical consideration points that are not personal opinions, but points made by persons at least as qualified as the statin advocates.

The points from this non-expert that you might want to research for yourself in relation to statins:

1. Numbers needed to treat
   1. What is the efficacy of statins compared to placebo (absolute risk, not relative)
2. How many more days of life does a person have who
   1. has never had a heart attack or stroke then is on statins
   2. has had a heart attack or stroke and takes statins
3. What percentage of LDL is made within the body natuarlly
4. What hormonal functions is LDL part of
5. Is LDL part of the immune response
6. Has higher LDL been shown to be protective in post menopausal women
7. Is there any recent evidence of long lived populations with high LDL
8. Is LDL as a risk factor, more significant than
   1. Body fat
   2. High basal insulin
   3. High Trigs
   4. Low HDL
9. Is LDL at the scene of the crime to protect or to damage
10. Is the LDL is bad for mantra, science fact or an hypothesis
11. When studied do more people who have died of heart disease have
    1. Low or normal cholesterol
    2. High cholesterol

 

[Oldvatr]

They seem to be coming thick and fast..

https://www.zoeharcombe.com/2022/05/a-new-look-at-statins-ldl-cholesterol-cvd/

Two years ago I was given access to some of the data from the ASCOT trial by one of the trial organisers. I crunched the numbers and came up with the absolute risk ratios and noted that there was a 10:1 exaggeration when looking at the Statin Licence Application report for the same data set. So I agree with Zoe about the bias that Relative Risk (as it used to be called) or Hazard Ratio as it tends to be called now, The trouble is that the manufacturers have managed to persuade the SACN and NICE comittees to use HR as their gold standard. Note that when they use HR they do not mention the data at all. HR is the result, take it or leave it.

This paper is well researched and properly supported so I agree with it. it is also my experience, and has also been reported in other all cause mortality studies. The connection to the LDL-C study aspect is new, and welcome too. If my memory serves me well, I remember one meta study concluded that the Atorvaststatin trial showed that a man who has had a pre-existing CVE will have to take the statin at maximum dose for 10 years to gain one extra day of life, For women the same dose worked out as saving less than an hour. What is missing from this summary is the effect of taking max dose statin for 10 years compared to placebo.

 

[Goonergal]

So far as earning money is concerned, a recent debate on here nobody was able to say how much money an individual dr got for prescribing a statin to a patient, what we were able to establish was that there was a pot of money, that was divided between all surgeries depending on how they performed on 60 health measures, one of which was statins .... I can’t see any dr handing out statins just because their practice may get a few pence because they do ..

There is no easily quantifiable amount per prescription, but targets around statins and diabetes are included within the indicators of the Quality and Outcomes Framework (QOF) which according to the King’s Fund accounts for approximately 10% of GP surgery income. The exact payments are based upon a points based system measured against a series of indicators.

Quality and Outcomes Framework payments
The Quality and Outcomes Framework accounts for around 10 per cent of a practice’s income. The Quality and Outcomes Framework is a voluntary programme that practices can opt in to in order to receive payments based on good performance against a number of indicators. In 2018/19 more than 95 per cent of practices took part. The framework covers a range of clinical areas, for example, management of hypertension or asthma; prescribing safety; or ill health prevention activity. Each area has a range of indicators that equate to a number of Quality and Outcomes Framework points.

One such indicator in the Diabetes Mellitus section is as follows:

‘DM022. The percentage of patients with diabetes aged 40 years and over, with no history of cardiovascular disease and without moderate or severe frailty, who are currently treated with a statin (excluding patients with type 2 diabetes and a CVD risk score of <10% recorded in the preceding 3 years)’

So yes, there is a financial incentive to prescribe statins.

You might find a read of the full King’s Fund report (linked) eye opening.

To directly answer @michelle88 I’d want to see evidence from my doctor in relation to their claim, which I have not seen mentioned elsewhere.

 

[Oldvatr]

There is no easily quantifiable amount per prescription, but targets around statins and diabetes are included within the indicators of the Quality and Outcomes Framework (QOF) which according to the King’s Fund accounts for approximately 10% of GP surgery income. The exact payments are based upon a points based system measured against a series of indicators.

Quality and Outcomes Framework payments
The Quality and Outcomes Framework accounts for around 10 per cent of a practice’s income. The Quality and Outcomes Framework is a voluntary programme that practices can opt in to in order to receive payments based on good performance against a number of indicators. In 2018/19 more than 95 per cent of practices took part. The framework covers a range of clinical areas, for example, management of hypertension or asthma; prescribing safety; or ill health prevention activity. Each area has a range of indicators that equate to a number of Quality and Outcomes Framework points.

One such indicator in the Diabetes Mellitus section is as follows:

‘DM022. The percentage of patients with diabetes aged 40 years and over, with no history of cardiovascular disease and without moderate or severe frailty, who are currently treated with a statin (excluding patients with type 2 diabetes and a CVD risk score of <10% recorded in the preceding 3 years)’

So yes, there is a financial incentive to prescribe statins.

You might find a read of the full King’s Fund report (linked) eye opening.

To directly answer @michelle88 I’d want to see evidence from my doctor in relation to their claim, which I have not seen mentioned elsewhere.

This may explain the LDL protein connundrum
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4392164/

I think it is due to insulin resistance or lack of insulin interfering with the ability of lipids to move into storage in adipose tissue (which needs insulin to unlock the gate)

 

[BravoKilo]

For those struggling with various risk definitions (Relative, Absolute, oddsratios etc) Hazard Ratios etc , David Spiegelhalter has clear videos on the Winton Centre site in the RealRisk section aimed at journalists
https://realrisk.wintoncentre.uk/
where there is also a link to the !RealRisk tool that can be used to get from RR/HR/OR to Absolute Risk.

 

[ultradad]

Lots of good information and arguments. I am going to throw a Ken berry video into the ring

 

[Oldvatr]

For those struggling with various risk definitions (Relative, Absolute, oddsratios etc) Hazard Ratios etc , David Spiegelhalter has clear videos on the Winton Centre site in the RealRisk section aimed at journalists
https://realrisk.wintoncentre.uk/
where there is also a link to the !RealRisk tool that can be used to get from RR/HR/OR to Absolute Risk.

Watch out for the B1B stealth bomber of a scam in the background
https://www.cloudmark.com/en/blog/s...rsons-diabetes-cure-and-quantum-vision-system
I advise not clicking on the promo video that pops up at the end.. The RealRisk info is genuine and an interesting couple of videos.

 

[michelle88]

Thanks everyone for your input! There is a lot to consider, definitely. But still as of now there is no way I will take statins. It's just really irritating how health practitioners are relentless in pushing them.
So here are my lipid panel results from last week. My total cholesterol and LDL have decreased, but unfortunately so has my HDL, and my trigs have increased a bit.

Total cholesterol: 5.2
HDL: 1.88
LDL: 3.1
Cholesterol/HDL: 2.8
Trigs: 1.16

I noticed that the cut-off for total cholesterol was 6.2 mmol/l in 2018 when I had my first lipid panel, now it's down to 5.0, and for LDL it was 4.1, now it's down to 3.1!

 

[bulkbiker]

My mother has been on statins for a few years now. She's 74 and I've noticed her increasing forgetfulness. I don't know whether due to age or statins, but it's definitely disconcerting!

My mother was diagnosed with early onset dementia in her early 80's not long after she had been prescribed statins.
My dad took over everything and she sat in a chair most of the day (unfortunately he believed what the doctor had told him).

When he died we stopped almost all her medication (including the statins she'd been on for years) and after a few weeks my mother returned. Happy, laughing and, for her age, relatively mobile.