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Cholesterol levels

nirishdaisy

Well-Known Member
Messages
91
Type of diabetes
Type 2
Treatment type
Non-insulin injectable medication (incretin mimetics)
Hi,

Can anyone tell me (in layman's terms) what the cholesterol levels should be for a type 2 diabetic. My doctor for the last few years says levels are of no importance as long as you are on one statin. My levels are higher than they have ever been and all he tells me is to lose weight. I would if I could. I have spinal stenosis and struggle to walk much let alone anything else. I low carb - not very low carb. My HbA1C is 44 - he's not happy with that either (wants it at least 50). My last GP was a good diabetic doctor and my levels were always kept under good control. I'm a mess right now. My husband has just been diagnosed with Parkinson's disease and I look after him. I just didn't need the phone call I had from the GP!! Be gentle with me please!!
 
I don't think there's a simple answer to this. Your body makes most of the cholesterol it needs - around 80% of it by most estimates. Cholesterol or saturated fat in the diet does not seem to affect overall levels. Ultimately it's a choice for you. I made my choice but what I believe to be good for me is not necessarily good for others.

My own total cholesterol levels haven't ever changed much and have have gone from being described as "good" in the late 1980s to "too high" over 30 years, although they are where they always were. I have never taken a statin although have been under pressure to do that in the past - I'm now at an age where that pressure is a thing of the past.

The situation is complicated by the current NHS guidelines recommending statins and rewarding target groups being prescribed them. As that is "official policy" doctors will always tend to follow current guidelines. Statins clearly lower cholesterol - the question being asked is whether cholesterol actually needs to be lowered for most of us.

There is also increasing scientific evidence from some very large studies showing that what is currently described as "high" cholesterol does not adversely affect mortality. A couple of recent studies showed that people living into their 90s all had "high" cholesterol.


I'd suggest having a look at some recent research attached below:

https://www.sciencedirect.com/scien...tm_medium=referral&utm_campaign=the-arrow-188


Journal of the American College of Cardiology:
•Several foods relatively rich in SFAs, such as whole-fat dairy, dark chocolate, and unprocessed meat, are not associated with increased CVD or diabetes risk.
•There is no robust evidence that current population-wide arbitrary upper limits on saturated fat consumption in the United States will prevent CVD or reduce mortality.




Total cholesterol and all-cause mortality by sex and age: a prospective cohort study among 12.8 million adults - Scientific Reports

It is unclear whether associations between total cholesterol (TC) levels and all-cause mortality and the optimal TC ranges for lowest mortality vary by sex and age. 12,815,006 Korean adults underwent routine health examinations during 2001–2004, and were followed until 2013. During follow-up...

www.nature.com


No simple conclusion from this huge Korean study but - U-curve associations between TC levels and mortality were found in both men and women. The TC range associated with the lowest mortality was 210–249 mg/dL (5.4- 6.4mmol/l). When age was further considered, U-curve associations were observed regardless of sex or age, and the optimal TC range for survival was 210–249 mg/dL (5.4- 6.4mmol/l) for each age-sex group, except for men at 18–34 years (180–219 mg/dL or 4.6-5.6 mmol/l ) and for women at 18–34 years (160–199 mg/dL or 4.1-5.1 mmol/l) and at 35–44 years (180–219 mg/dL or 4.6-5.6 mmol/l)



Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73)

Objective To examine the traditional diet-heart hypothesis through recovery and analysis of previously unpublished data from the Minnesota Coronary Experiment (MCE) and to put findings in the context of existing diet-heart randomized controlled trials through a systematic review and...

www.bmj.com


Conclusion: Available evidence from randomized controlled trials shows that replacement of saturated fat in the diet with linoleic acid effectively lowers serum cholesterol but does not support the hypothesis that this translates to a lower risk of death from coronary heart disease or all causes. Findings from the Minnesota Coronary Experiment add to growing evidence that incomplete publication has contributed to overestimation of the benefits of replacing saturated fat with vegetable oils rich in linoleic acid.

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

Many clinical guidelines for cardiovascular disease (CVD) prevention contain risk estimation charts/calculators. These have shown a tendency to overestimate risk, which indicates that there might be theoretical flaws in the algorithms. Total cholesterol ...

www.ncbi.nlm.nih.gov


Conclusion: ".....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."




Conclusion: “… In the long-lived population examined, the cholesterol paradox was unlikely to be a reflection of reverse causality. Our results challenge the common view that longevity is invariably associated with low cholesterol levels. Furthermore, moderate hypercholesterolemia does not preclude the oldest adult from attaining advanced ages, contrary to common belief.”
 
Thank you for that KennyA. I'll take more time to read through again. I think I'll just ignore my cholesterol readings in future. For me, I need to pick the battles I fight. It's so confusing with evidence that you provide and the guidelines saying 2 different things. I'm done fighting for what both hubby and I need health wise. Took 4 years to get drs to take me seriously about hubby's Parkinsons. Had to go private for diagnosis - he's been on the urgent list here for over a year - 20000 on the urgent list!!
 
Thank you for that KennyA. I'll take more time to read through again. I think I'll just ignore my cholesterol readings in future. For me, I need to pick the battles I fight. It's so confusing with evidence that you provide and the guidelines saying 2 different things. I'm done fighting for what both hubby and I need health wise. Took 4 years to get drs to take me seriously about hubby's Parkinsons. Had to go private for diagnosis - he's been on the urgent list here for over a year - 20000 on the urgent list!!
@nirishdaisy I don’t avoid my cholesterol levels. Cholesterol levels are one of those areas in health care that is confusing, every person and his dog has an opinion. As far as Drs receiving kickbacks from statin uptake from their patients I personally couldn’t care less. I dare say it is true for most prescription drugs. The tests I take note of are my ApoB results and my Lipoprotein (a) figures. They are a far more accurate indicator of heart/stroke/dementia risk than the standard lipid panel.

I have a great Dr, I’m lucky. He is young and dynamic and I trust him and I trust his advice. Trust in your Dr is, in my opinion, is so important. I have in the past had Drs I don't trust. They are either disinterested or have not kept up with their medical knowledge. My Dr takes Cholesterol levels seriously.
 
Just to throw my 2penworth in. The "headline" total figure is a much use as a chocolate fireguard. the LDL/HDL/Trigs is more informative but again under much debate as it's not as straight forward as good and bad cholesterol. I have a family history of heart attacks and strokes caused by hypercholesterolemia, but straight statins don't work particularly well for me, as LDL/HDL ratios are out even though the total value is 4.4mmol, currently trying Ezetimibe to see if that makes a difference. I also had extreme muscle pain on simvastatin, so switched to atorvastatin
 
My HbA1C is 44 - he's not happy with that either (wants it at least 50)
Why on earth does he want your HbA1c to be higher? He should be happy you have got it in the pre diabetic range. Why would he want your HbA1c to raise it into the diabetic range? Sorry off topic, I am probably as confused as you are about cholesterol!
 
Why on earth does he want your HbA1c to be higher? He should be happy you have got it in the pre diabetic range. Why would he want your HbA1c to raise it into the diabetic range? Sorry off topic, I am probably as confused as you are about cholesterol!
Hi Rachox, I have no idea why he wants it higher but I'm not going back to higher levels. Worked too hard to keep my levels low.
 
Why on earth does he want your HbA1c to be higher? He should be happy you have got it in the pre diabetic range. Why would he want your HbA1c to raise it into the diabetic range? Sorry off topic, I am probably as confused as you are about cholesterol!
It is possibly a misinterpretation of the "levels to aim for" part of the QOF/NICE guidelines. The assumption is that the individual's HbA1c will be high, and therefore reducing it to 55 is an improvement. The guidelines also mention that if levels are lower, the patient should be encouraged to maintain the lower level. That might have been missed.

Alternatively there might be an issue around avoiding possible hypos where glucose-lowering medication is being taken.
 
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