Can we have the Statins conversation again?

[Margarettt]

My lovely diabetic nurse(she is pro low carb and really supportive) is calling at 9.30 tomorrow to confirm my diabetic treatment plan and go through ?markers? for whether or not I need statins. She seems keen for me to be on them but knows I'm reluctant. The thing is I have woken up this morning not really knowing why I am reluctant beyond reading posts on here about refusing them. Both my type2 parents are on Statins but neither have a history of heart attack or stroke. My non diabetic brother had a bypass a couple of years ago. My recent results (which I don't pretend to understand beyond 5 is some sort of magic number) are below
I'm 40 or 50 lbs overweight for my height but have lost 22lbs recently.

Total Cholesterol​

Current result: 6.5 mmol/L on 08/11/2023

HDL Cholesterol​

Current result: 1.50 mmol/L on 08/11/2023

LDL Cholesterol​

Current result: 4.5 mmol/L on 08/11/2023

Can you help me be a bit more informed when I take the call?
Thank you.

 

[JoKalsbeek]

My lovely diabetic nurse(she is pro low carb and really supportive) is calling at 9.30 tomorrow to confirm my diabetic treatment plan and go through ?markers? for whether or not I need statins. She seems keen for me to be on them but knows I'm reluctant. The thing is I have woken up this morning not really knowing why I am reluctant beyond reading posts on here about refusing them. Both my type2 parents are on Statins but neither have a history of heart attack or stroke. My non diabetic brother had a bypass a couple of years ago. My recent results (which I don't pretend to understand beyond 5 is some sort of magic number) are below
I'm 40 or 50 lbs overweight for my height but have lost 22lbs recently.

Total Cholesterol​

Current result: 6.5 mmol/L on 08/11/2023

HDL Cholesterol​

Current result: 1.50 mmol/L on 08/11/2023

LDL Cholesterol​

Current result: 4.5 mmol/L on 08/11/2023

Can you help me be a bit more informed when I take the call?
Thank you.

What you do with medication is entirely up to you. Things that happen to some when they take them, might not happen: side effects are a bit irate sometimes.

Statins can up your blood sugar levels, affect memory to the point of very real damage (our brains contain a large portion of cholesterol), cause joint pain and what have you... Could well be none of that will happen to you. Personally, I was on the only statin I can take due to my thyroid being wonky, and it made my rheumatism a thousand times worse. That was enough for me to call it quits, I was in agony. That's the thing... You don't have to stay on them if they don't agree with you. If you want to give them a go, do. If not, then don't. No-one can make you do anything, not the nurse, not us. How do you feel? That's the issue.

Hugs,
Jo

 

[KennyA]

This is a link to a very large Norwegian study on cholesterol.

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

Here's the conclusion:

Conclusion​

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.

Worth reading in full.

 

[catinahat]

I'm no expert on statins but I do know that the total cholesterol number is pretty meaningless when it comes to assessing our risk of heart problems.
A far more useful measure is the cholesterol ratios, a quick Google and you can find calculators to work out your ratios.
Your LDL/HDL ratio comes out at 3
If I remember rightly above 5 is bad, below 5 is good, below 2 is excellent.
My take on statins is that cholesterol is vital, it's so important that our bodies will not leave it to chance and rely on diet to get what we need, we make our own cholesterol.
Our bodies make enough for their needs, if we eat less, our bodies will make more.
Who am I to decide that my body and the whole of evolution has got it wrong.
Cholesterol is what our bodies use to repair themselves, blaming cholesterol is like blaming firefighters for setting fire to your house, just because when you got there your street was full of fire engines.

 

[In Response]

My advice is not to focus entirely on cholesterol.
There is clear evidence that people with diabetes are more likely to experience CVD. Likewise, there has been some research correlating high cholesterol with CVD .. as @KennyA highlights, there are other studies which suggests the opposite. I interpret this as "we don't know for sure."
When statins were last offered to me, I pointed out that I did not have high cholesterol. However, my consultant explained that people with diabetes have more fluctuations in blood sugars and these fluctuations put a strain on our hearts. So, regardless of cholesterol, we may benefit from statins.

On the other hand, all medication had potential side effects. So we need to decide whether we want the protection statins provide whilst taking the risks with the potential side effects.

Personally, I chose not to take them and manage my health through exercise and minimising large BG fluctuations. My HBA1C is 40 and my TIR is 85% so I feel my risk of CVD is best managed without unnecessary drugs.

 

[MissMuffett]

@catinahat Love that analogy of the firefighters

i found this YouTube video really informative

 

[Lupf]

There is a long threat on "Cholesterol and statins" with over 500 messages

Cholesterol and Statins

There are always a lot of threads about Statins and Cholesterol and we all post our various favourite bits of current presentations about them but I thought it might be handy to have them all in one thread. I meant to put this together soon after the get together in Birmingham (sorry @Debandez)...

www.diabetes.co.uk

Please note that the originator of this thread is @bulkbiker, who was banned from the forum,
but this thread has lots of useful information and links.

About a year ago I posted the following post in this thread

Cholesterol and Statins

If memory serves me right someone quoted on another statin thread that the surgery ( not the individual doctor) gets £1245 a year if they get enough of their patients who the nhs think should be taking a statin to take one, given surgeries now regularly have thousands of patients ...... do we...

www.diabetes.co.uk

so if you are interested, please read it, and feel free to ask questions.

 

[Westley]

It's a complicated and divisive topic. I've been finding this channel's videos good, as he takes quite an open minded evidence based approach.

https://youtube.com/playlist?list=PLxyjOraXh0-ndvUEstSZJ2hPgXR2DqKwR

 

[ianf0ster]

I would just like to clarify about the Cholesterol and Statins thread (and Bulkbiker in particular).
All that remains in the forum of what was posted by Bulkbiker is considered by the Moderators and Admin to be within the Forum rules.

This means that all the information, etc. in that Cholesterol and Statins (posted by anybody) is either a personal experience or has a medical study to back it up.

Muscle pains and the threat of other side effects caused me to re-think statins for me, but it's a personal decision for everybody to make up their own mins whether any particular medication is right for them.
What I hear from Dave Feldman's Twitter seems hopeful that the Lean Mass Hyperresponder study will confound the current lipid hypothesis, at least in the context of Low Carb/Keto. Official results expected in a few weeks.

 

[AndBreathe]

@Margarettt - I'm guessing if your nurse is comfortable with a low carb lifestyle that she will be better than many, however what I will say is really don't be pressurised, either way in your appointment tomorrow. The statin thing isn't a short term thing, like an antibiotic. It tends to be a longer thing. It isn't all that usual to hear of folks coming off statins because their numbers have improved.

I don't know how old your brother is, but that he required a bypass would suggest he had challenges in the cardiac regions that needed attention.

I was fortunate enough to take part in some research, running out of Leicester, which involved an extremely involved and thorough cardiac MOT, so I had some better information to judge the longer term upon.

I don't know whether you have ever done your QRisk score, but I'd feel confident your nurse will have used or will use it before your appointment tomorrow, although ideally she would be putting up to date information into it. That includes height, weight, BP and your cholesterol numbers.

There are a few things not asked on the QRisk, like (known) duration of your diabetes, or how well managed you are.

It's not easy, but you can always take on board tomorrow's information (make notes) and think about it, and if you want to take statins, I'm sure that could be covered by a phone call, or e-consult if your surgery does that.

QRISK3

qrisk.org

 

[Margarettt]

Thanks all. I'm currently recuperating from a big surgery so napping my days away in a painkiller haze and slow to respond and not posting much but I really appreciate the support.
Nurse says her score puts me at 40 something percent risk and she really would like me to start statins. We talked it out and agreed that now (my BG numbers are all over the place post op) was not a great time to start a new med and as over the last three months I have significantly lowered my Hba1c, lost weight and brought my blood pressure down a bit my risk is constantly changing.
In the end we agreed to wait until after my next bloods/obs reevaluate the risk and have the conversation again. This means I don't even have to think about it for now.
Because she is lovely she said yes to my request to make that 4 months rather than 3 in the hope these crazy post op numbers will settle down.

 

[Paul_]

Thanks all. I'm currently recuperating from a big surgery so napping my days away in a painkiller haze and slow to respond and not posting much but I really appreciate the support.
Nurse says her score puts me at 40 something percent risk and she really would like me to start statins. We talked it out and agreed that now (my BG numbers are all over the place post op) was not a great time to start a new med and as over the last three months I have significantly lowered my Hba1c, lost weight and brought my blood pressure down a bit my risk is constantly changing.
In the end we agreed to wait until after my next bloods/obs reevaluate the risk and have the conversation again. This means I don't even have to think about it for now.
Because she is lovely she said yes to my request to make that 4 months rather than 3 in the hope these crazy post op numbers will settle down.

Hope your recovery goes smoothly!

I don't have a particularly meaningful or insightful opinion on statins, so I can't really help you unfortunately. My cholesterol isn't particularly high, however for NHS guidelines for diabetics, it's advised that I should be on a statin. At this point in time I'm not on one. Under previous guidelines, before they were updated, I'm within range on every count except that my HDL is still low (but improving).

My overall position on statins is very similar to yours - I don't know what to believe. Like you, I'm currently reviewing on a blood test to blood test basis. I've also changed a lot of health variables for the better in the past 4 months, so I'm not sure adding in additional medication with side effects that could impact my healthier lifestyle is the best at this point in time. That may change, I'm not anti-medication, but I want to see how cholesterol results are impacted at the very least before signing up to additional medication.

Basically, no help to you whatsoever, but just wanted to show you're not alone in your caution or approach.

 

[Omar51]

I'm no expert on statins but I do know that the total cholesterol number is pretty meaningless when it comes to assessing our risk of heart problems.
A far more useful measure is the cholesterol ratios, a quick Google and you can find calculators to work out your ratios.
Your LDL/HDL ratio comes out at 3
If I remember rightly above 5 is bad, below 5 is good, below 2 is excellent.
My take on statins is that cholesterol is vital, it's so important that our bodies will not leave it to chance and rely on diet to get what we need, we make our own cholesterol.
Our bodies make enough for their needs, if we eat less, our bodies will make more.
Who am I to decide that my body and the whole of evolution has got it wrong.
Cholesterol is what our bodies use to repair themselves, blaming cholesterol is like blaming firefighters for setting fire to your house, just because when you got there your street was full of fire engines.

I have no idea how cholesterol works. I am pre on record (treat myself T2, no meds)

7 weeks ago I got my Lipid Panel test results. My total was 294 mg/dL (very high) and LDL 195 mg/dL (very high). My PCP recommended 5 mg statin. I got scared of high numbers and started taking statin.

Did my homework and talked to my nutritionist. Changed my diet. Totally cut down saturated fats, slightly increased carbs. Used 5 mg statin for 6 days and decided to stop statin. Just received my recent lipid panel test results. My total is 129/mg/dL (normal) and LDL 59 mg/dL (normal)
Sorry for not converting to UK mmol/L.
Thanks
Omar

 

[saky]

I have no idea how cholesterol works. I am pre on record (treat myself T2, no meds)

7 weeks ago I got my Lipid Panel test results. My total was 294 mg/dL (very high) and LDL 195 mg/dL (very high). My PCP recommended 5 mg statin. I got scared of high numbers and started taking statin.

Did my homework and talked to my nutritionist. Changed my diet. Totally cut down saturated fats, slightly increased carbs. Used 5 mg statin for 6 days and decided to stop statin. Just received my recent lipid panel test results. My total is 129/mg/dL (normal) and LDL 59 mg/dL (normal)
Sorry for not converting to UK mmol/L.
Thanks
Omar

Is this reading(ldl - 59mg/dl) on 5mg statin? or after stopping statin?
How is your ldl 59mg/dl?
Even I gave up chicken, fish, cheese, cream, milk, egg yolk. I eat tofu, egg whites, almond milk/coconut milk. I think my ldl is still high. I take 5mg statin......
Will go for another test on 14th Dec, 2023

 

[Omar51]

Is this reading(ldl - 59mg/dl) on 5mg statin? or after stopping statin?
How is your ldl 59mg/dl?
Even I gave up chicken, fish, cheese, cream, milk, egg yolk. I eat tofu, egg whites, almond milk/coconut milk. I think my ldl is still high. I take 5mg statin......
Will go for another test on 14th Dec, 2023

I have taken 5 mg statin for 6 days and stopped. After stopping statin and after 7 weeks my LDL Calculated is 59 mg/dL.
I can post this test too, I am also going for another test in 2 weeks.

 

[Omar51]

I have taken 5 mg statin for 6 days and stopped. After stopping statin and after 7 weeks my LDL Calculated is 59 mg/dL.
I can post this test too, I am also going for another test in 2 weeks.

After stopping statin.

 

[saky]

After stopping statin.

Ohh. That's nice....
Don't what my reading will be.....
Am on a low fat diet these days and taking 5mg statin....

 

[Omar51]

Ohh. That's nice....
Don't what my reading will be.....
Am on a low fat diet these days and taking 5mg statin....

 

[Speedbird]

My lovely diabetic nurse(she is pro low carb and really supportive) is calling at 9.30 tomorrow to confirm my diabetic treatment plan and go through ?markers? for whether or not I need statins. She seems keen for me to be on them but knows I'm reluctant. The thing is I have woken up this morning not really knowing why I am reluctant beyond reading posts on here about refusing them. Both my type2 parents are on Statins but neither have a history of heart attack or stroke. My non diabetic brother had a bypass a couple of years ago. My recent results (which I don't pretend to understand beyond 5 is some sort of magic number) are below
I'm 40 or 50 lbs overweight for my height but have lost 22lbs recently.

Total Cholesterol​

Current result: 6.5 mmol/L on 08/11/2023

HDL Cholesterol​

Current result: 1.50 mmol/L on 08/11/2023

LDL Cholesterol​

Current result: 4.5 mmol/L on 08/11/2023

Can you help me be a bit more informed when I take the call?
Thank you.

You need a full lipids breakdown. What are the results of your triglyceride? (They should have been included)
Try this calculato. I hope it helps.

Cholesterol HDL/LDL/Triglycerides Ratios Calculator (SI Version in mmol/L)

 

[AndBreathe]

Hope your recovery goes smoothly!

I don't have a particularly meaningful or insightful opinion on statins, so I can't really help you unfortunately. My cholesterol isn't particularly high, however for NHS guidelines for diabetics, it's advised that I should be on a statin. At this point in time I'm not on one. Under previous guidelines, before they were updated, I'm within range on every count except that my HDL is still low (but improving).

My overall position on statins is very similar to yours - I don't know what to believe. Like you, I'm currently reviewing on a blood test to blood test basis. I've also changed a lot of health variables for the better in the past 4 months, so I'm not sure adding in additional medication with side effects that could impact my healthier lifestyle is the best at this point in time. That may change, I'm not anti-medication, but I want to see how cholesterol results are impacted at the very least before signing up to additional medication.

Basically, no help to you whatsoever, but just wanted to show you're not alone in your caution or approach.

Paul I don't know where you are, in UK, but the research study I participated in, is still recruiting. It provides a very thorough cardiac MOT, including stress MRI, CAC scan and gazillions more.