Cholesterol/statins with history of heart attack

[andbreath]

Hi All
Long time lurker, first time poster here! First of all, this forum and the people on it have been such a great help to me over the last year since my T2 diagnosis, thank you all so much.
I was diagnosed with T2 last year in hospital after suffering a heart attack. BG at the time was 29 and HBA1c was 109. Hospital consultant sent me home with Metformin, Atorvastatin, Ramipril, Bisoprolol and Aspirin.
Since then I have gone low carb (around 50g a day) and last HBA1c was 43, which I had done privately during lockdown. I feel I have my head round my diabetes and my low carb diet. I wanted to ask you lovely people your opinion about the Atorvastatin. I decided to come off it in February as I was feeling very foggy. I intended to speak to my GP, but then lockdown so that didn't happen. I have now been called in for my diabetes review, and while I am fairly confident HBA1c will be in pre diabetic levels, I know my cholesterol is higher than the GP would want. Private tests done in June are:
TOTAL CHOLESTEROL 5.23 mmol/L (0 – 5)

LDL CHOLESTEROL 2.67 mmol/L (< 3)

NON HDL CHOLESTEROL 3.16 mmol/L (< 4)

HDL CHOLESTEROL 2.07 mmol/L (> 1.3)

TOTAL CHOLESTEROL : HDL 2.53 ratio (< 4)

TRIGLYCERIDES 1.08 mmol/L (<1.7)
I feel that my heart attack was caused by my undiagnosed rampant diabetes, and now that is under control (and I have lost 4 stone) I am in a much healthier state. Am I just kidding myself that I don't need the statins? I know that there are arguments for and against, but for someone in my position who has had a previous heart attack is it necessarily keep my cholesterol lowered? I will discus this with my GP once the blood results come back, so I am really just looking for an opinion from you knowledgeable folks.

 

[Resurgam]

I had to stop taking Atorvastatin as it was causing me problems with memory - as well as aches and pains and depression too - I know it is all supposed to be in the mind - to which I would say 'exactly and I wish it would get out from there'.
Your Cholesterol isn't terribly high - and there isn't much to be gained from pushing it low with tablets if you are losing quality of life and going around in a daze.

 

[andbreath]

That is my feeling too @Resurgam. I felt I could't concentrate and that cleared after stopping the statins for about 3 weeks. Most of my brain is convinced that there is no need for me to lower my cholesterol anyway. There is just the tiny part fretting about a heart attack.

 

[bulkbiker]

The ratio that more recent science suggests is the one to watch is theTrig/HDL ratio.
Anything under 0.87 is considered excellent and yours is 0.52 so looks pretty good to me!

 

[andbreath]

Thanks @bulkbiker. That is really useful information.

 

[Oldvatr]

There are different statins you could try. I have tried them all and am now marked up in my med recodes as being allergic to statins. If LDL is the problem then there is another type of medication called Ezetemibe that uses a different mechanism to attack just the LDL. I find I can tolerate this med quite well. If you're looking for an easy way out of an argument with the Doc, this is an alternative treatment that could tick all the boxes. I note your trigs are higher than I would be comfortable with. Not sure how to deal with it, and if you find out, let me know since I have the same level myself. I believe it indicates the level of damaged LDL there is and is the spill out from busted LDL balloons The damage is purported to be due to carb molecules colliding with LDL but I am not sure how to give them driving lessons.

This is what WebMD says
https://www.medicinenet.com/triglyceride_test/article.htm

I note that Beta Blocker BP medication can cause this Bisoprolol and Atenolol in my case.

 

[carty]

I am no expert but I understand that for some people for example ladies over 50 a slightly higher total cholesterol level is not considered to be a problem .I had a cholesterol level of over 7 when I was diagnosed with diabetes type 2 but after lowering my carbs it came down to just over 5 I had been offered statins on diagnosis but I declined and now I don't get the statin offer anymore !
Carol

 

[andbreath]

'Busted LDL balloons', you do paint a picture @Oldvatr! I had a wee look at my previous (through the GP) test results which were four months into the statin taking regime, and the trigs at that point were 1.4, which the Doc seemed sanguine about. I do think it will be the LDL which will be the sticking point. At least now I am armed with some knowledge to base a proper discussion on.

 

[bulkbiker]

'Busted LDL balloons', you do paint a picture @Oldvatr! I had a wee look at my previous (through the GP) test results which were four months into the statin taking regime, and the trigs at that point were 1.4, which the Doc seemed sanguine about. I do think it will be the LDL which will be the sticking point. At least now I am armed with some knowledge to base a proper discussion on.

My last LDL was 5.99 . had the dreaded phone consult and told them no thanks.
I guess after your previous experience they'll be more wary but as always its down to you.
LDL is caluclated rather than measured and low carbers have a tendency to fool the calculation.
To delve deeper maybe have a read of www.cholesterolcode.com a mine of info.

 

[andbreath]

@carty, you have me pegged, a lady over 50 is what I am. And like you, I am not a fan of the 'cookie cutter' approach to prescribing and the tendency to hand out the statins with every T2 diagnosis. I didn't feel like I had enough understanding around the subject, or indeed the energy to marshal an argument at the time. I am in a much better position now, thanks to this forum.

 

[andbreath]

Thank you for that @bulkbiker, I will have a read through that site over the weekend. I am pretty adept at arguing my case, but there is so much conflicting information out there about cholesterol that I want to be confident that I have a good grasp on the science.

 

[oldgreymare]

@andbreath Congratulations on your weight loss and great HBAc1. Definitely hear you re concerns over knee jerk prescription of statins (I consistently refuse). Statins will lower LDL levels, but I decline because I am not convinced that preventive taking of them has a material benefit in terms of subsequent improved CVD mortality for older women. That said, I think the evidence may be different for individuals who already have a CVD history - so it's a tough call.

If you're up for some biochemistry reading, then PeterAttiaMD.com is pretty critical and in particular his podcasts with Thomas Dayspring.

https://peterattiamd.com/tomdayspring6/

Listening to these and also other resources, I've decided I will use the following metrics to discuss my CVD risk with my health team -
HBAc1 & time in range (from my Dexcom G6);
Lipo (a) test result : mine was low normal - as this is a genetic marker the test only needs doing once (Did you have this measured as part of your heart attack workup?);
Triglycerides - ideally below 0.7 mmol/L - pretty much mirrors my carb intake;
Apo B - a more relevant LDL CVD marker than the outdated derived LDL-C estimate which is still common. Unfortunately usually not available to GPs, but an endo can order (not that expensive, so NHS NICE just very slow to modernise?);
CT CAC screen - provides estimate of cardiac arterial plaques/damage. I'm self referring to get a baseline value. Annoying as only costs $50-100 in USA, I'll have to pay £350. But unless looking high risk this only needs repeating every 5 years. First results next week;
Also blood pressure, liver function and kidney function markers.

Hope this gives you some ideas of some info you may want to ask for/obtain in order to make your mind up on your approach to statins and for discussion with health team generally.

 

[Resurgam]

If my resolve flickers I have a little advice written in the back of my 'contacts' book - 'Rather a year being me than a decade staring at a care home garden'

 

[andbreath]

Thank you @oldgreymare, my homework for the weekend is mounting up. I am incredibly grateful to everyone for their insights and their further reading pointers. I am not sure if Lipo (a) was tested when I was in hospital, but there was a GRACE risk score buried in my discharge paperwork. Might that be something similar?

 

[oldgreymare]

Thank you @oldgreymare, my homework for the weekend is mounting up. I am incredibly grateful to everyone for their insights and their further reading pointers. I am not sure if Lipo (a) was tested when I was in hospital, but there was a GRACE risk score buried in my discharge paperwork. Might that be something similar?

The GRACE risk score doesn't appear to reference Lipid markers, so you may wish to follow up on asking for a Lipo (a) test - this will help in assessing how vulnerable you may be to harmful LDL effects and consequently help determine optimal Apo B /LDL targets for you - great that you are being so pro active re your health!

 

[KatyMarianne]

This has all been supremely helpful, thank you so much everyone. I’ve been given this weekend to think about whether I take statins and I’m having another conversation with my GP on Monday. I’m also on a very low carb diet and my HbA1c is always fabulous (use a pump to manage my type one diabetes)
I’ve also read that statins will lower the levels of coenzyme Q 10 which is vital to support heart health and have been recommended to take vitamin E to keep my blood “slippery “… This from Dr Christiana Northrop
She also says that oxidated cholesterol directly leads to heart disease therefore it’s vital to eat a diet rich in antioxidants
Still chuckling at the idea of giving carb molecules and LDL balloons driving lessons!

 

[andbreath]

Thanks @oldgreymare, I will find out if I had the Lipo (a) test and take it from there.

 

[andbreath]

My results have come back, and I'm getting a chance to see them online before I speak to the Doc. So HBA1c is 42, which was expected (but I still had a dance about!)

Total cholesterol 4.3
HDL 1.7
LDL 2.2
Trigs 0.8

BP this time was 114/74. This is medicated, but in the last 20 years I have never had a normal BP reading, so am taking the win on this.

No Lipo (a) test was done at the hospital, so I will bring it up with the Doc.

So, after thinking about things, I have decided that I am going to stay off the statins for the moment. Thanks everyone for sharing your insights.