Diabetes & Statins

[surferchappie]

Hello, i am a 35 year old type 1 diabetic who was diagnosed at 11 years old.
Hba1C's have been poor in the past but over the last 3 years have been much better, today's review saw a 42, best yet but would like to just dip into the 38/39 range for my next one so the hard work continues (self-funding of libre has allowed this - finger pricking is a waste of time and blood).

Anyway, i was prompted to consider statins - being inquisitive i asked why as my cholesterol/HDL is 3.9 and there is little to no history of heart disease in my family - i was told that i should have been offered statins to reduce the risk of HD after 10 years with type 1 diabetes and that just by being in this category my risk went up dramatically, so, i got my cogs turning and wondering 'why?' as i sat there quietly. I listened to the doctor but politely declined the statins due to the negative press they receive and figuring i will do some research on the topic first.

I have since found that reports from NICE in 2004 suggested no firm evidence base for benefits of the use of statins in type 1 diabetics and furthermore recommended the area as a target topic for in-depth research moving forwards.*
A revised report was published in 2014 that, on the back of no additional research having been carried out, strengthened the recommendation for statins to be taken by type 1 diabetics who have had the condition for +10 years, are over 40, or have other cardiovascular risk factors present.*

A little more digging and i found the tool used by doctors when recommending the use of statins - the QRISK2 calculator. So, i duly go and find a version and tap in my own details (cholesterol/HDL, age, sex, ethnicity, weight and height and diabetes [type]), sure enough it puts me at 3.4% risk of heart complications inside the next 10 years versus the expected healthy equivalent person being at 0.7%, likely the factor that results in me being offered statins - however - why? What is the additional risk element or cause of damage? Why are my figures so vastly different to Jo Blogs' figures? Sure enough i play with the figures and the only thing affecting the result (3.4% vs 0.7%) was the inclusion of type 1 diabetes.
Taking type 1 diabetes out of the equation puts my data back on track with Jo Blogs' score, suddenly i am not at risk of heart complications.
What irked me about this was the lack of diabetes-related data being entered into the QRISK2 calculator - surely diabetes as a standalone element is not sufficient enough to add risk regardless of how well it is/is not controlled? There are diabetics out there with c35mmol/mol Hba1Cs that have never ventured from that level of control - the calculator is too rigid in this regard and an Hba1C entry would help to feedback to doctors a better understanding of diabetes and the impact of good vs poor control on future complications like heart disease etc.

What are your experiences with this topic?
Have you been advised to take statins, if so, have you taken the advice /has it made any difference?

Thanks for reading my rant.

NB: type 1 score with my stats was 3.4%, if altered to type 2 it changed to 2.2%
* www[dot]practicaldiabetes.com[slash]article[slash]statins-people-type-1-diabetes-treatment-start

Screen shots of results from QRISK2:

No diabetes


Type 1


Type 2

 

[Deleted Account]

I have been asked about statins and was told everyone with diabetes, over 40 is recommended to take statins.
However, this is based on evidence from a sample of people who do not exercise.
There has been no study for someone with diabetes who is fit and active.
As I exercise a lot, my consultant hinted (I think she felt should could not directly advise as it was contrary to NICE recommendations) it may not be necessary for me.

 

[surferchappie]

I have been asked about statins and was told everyone with diabetes, over 40 is recommended to take statins.
However, this is based on evidence from a sample of people who do not exercise.
There has been no study for someone with diabetes who is fit and active.
As I exercise a lot, my consultant hinted (I think she felt should could not directly advise as it was contrary to NICE recommendations) it may not be necessary for me.

Hi helensaramay, thanks for your reply.
It seems the finer details are not being considered when doctors are being expected to repeat from a standardised sheet of regs - i too am very active (surfing, squash, running) and have a very clean low-carb diet, if i was to risk-assess myself for heart complications further down the line i'd probably put myself way below some of my non-diabetic friends and colleagues given their lackadaisical attitude towards what is good/bad for you on a nutritional and exercise front.

I wish my doctor today had recognised the oddity in the statins recommendation, instead it was pressed quite strongly, that being said my local NHS don't run a diabetes consultancy clinic and instead ask you to drop in with the GP once per year so the lack of a condition-specific approach may be somewhat to blame there.

 

[LooperCat]

I understand that it’s the ratios of the various components that are the indicators of CVD, rather than just totals. My total is quite high, but it’s mostly HDL. My trigs are very low, and my GP said there was no way he was going to “inflict” statins on me (his word). Even though I’m over 40 and have been T1 for over the ten years.

 

[DavidGrahamJones]

What are your experiences with this topic?
Have you been advised to take statins, if so, have you taken the advice /has it made any difference?

Some good questions.
As you can imagine, the topic is huge. There has been so much written about statins:

The Great Cholesterol Myth
What you must know about statin drugs and their natural alternatives
The great cholesterol con
The great cholesterol myth
The Truth About Statins: Risks and Alternatives to Cholesterol-Lowering Drugs
How statin drugs lower your cholesterol . . . and kill you one cell at a time
The statin damage crisis
Poisoned, recovery from statin side effects
Fat and cholesterol don't cause heart attacks

I have read some of these and consequently my experience of the topic is that I just got confused because my GP was saying one thing and what I read said something different and my personal experience matched what I was reading.

I would never have questioned the advice of my GP had it not been for the serious side effects of taking Rosiglitazone and the physical side effects of Simvastatin and Atorvastatin that my GP put down to something different every time I mentioned my leg muscle pain, brain fog and poor sleep (all side effects recognised by the NHS). I should mention that it doesn't affect everyone the same way, I know people who have no side effects whatsoever, none that they recognise anyway.

So, I was advised to take statins for 17 years, it did lower my total cholesterol and it also gave me a lot of leg muscle pain. I eventually discovered that it was the fact that statins prevent the uptake of CoQ10 that was causing two of the problems and had actully been documented by Merk Pharmaceutical in it's 1990 patent application to add CoQ10 to the statin "to prevent the imminent muscle pain" quoted almost word for word from the patent application.

I stopped taking them because after reducing my carb intake, also against my GP's advice, my total cholesterol dropped so much that I felt confident in throwing them away, along with Gliclazide and Januvia and avoiding "progressing" onto insulin. Mt total cholesterol is still only 3.9.

Perhaps your GP can explain this graph. Seems that Cardio Vascular events increase when total cholesterol is above 5.4 . . . . and below 5.4. Produced by the British Heart Foundation and the World Health Organisation, it's interesting.

 

[Daibell]

Hi. The NHS formula used to condemn us all to statins is quite ridiculous and shows the almost complete absence of good science behind a lot of NHS health advice. I do take a medium dose of statins at the insistence of my cardiologist after a heart event. I think he's misled by the health advice about cholesterol but who am I to argue against an 'expert'. I also take CoQ10 based on my own research and don't suffer the muscle pains many do with statins. My lipids results are excellent with the statins but I make sure my total doesn't go too low and may reduce the dose in future. At my last cardio review another cardio tried to get me to start BP pills again based on the latest USA 'knowledge' that has lowered the level at which BP pills are started - I refused the pills as my home tests show my BP to be fine.

 

[KK123]

I have just returned from my diabetes Consultant, I knew all my numbers and 'lifestyle' were spot on so I knew he would bring up my high cholesterol and he did. It is 8, with (roughly) 2.45 HDL, 0.6 trigs and the rest 5.2 ish LDL. He says he thinks it is FH (familial hypercholesterolemia) even though I do not have a family history of it (ie no family who died of heart disease under 60 and so on). He has referred me to the lipid clinic and said 'Statins', when I asked him what he thought about statins telling him I had read about adverse effects etc, he said 'The Daily Mail is killing people' (even though I hadn't mentioned the DM!!! He said the LDL was the main number and did not view the rest as particularly relevant. What can you do!! He was a lovely man who did listen but they are entrenched in their ways, I did mention my lower carb approach and he said 'it's working, keep doing what you are doing' and then out of the blue said 'go onto diabetes uk, they are full of good advice'. So on the one hand he is clearly a low carb fan but on the other he loves statins! Sigh.

 

[bulkbiker]

go onto diabetes uk, they are full of good advice

Diabetes UK is the "other" place ... they are a bit mealy mouthed about Low Carb or at least have been in the past.

 

[surferchappie]

Perhaps your GP can explain this graph. Seems that Cardio Vascular events increase when total cholesterol is above 5.4 . . . . and below 5.4. Produced by the British Heart Foundation and the World Health Organisation, it's interesting.

That data is fantastic!
I would enjoy seeing someone in the field attempt a rational explanation of the magical 5.3/5.4 figure and it's protective elements against the onset of any/all CVD.

Thanks for the feedback guys - I am going to stick to the research-based decisions on this one and continue to live an active lifestyle with carefully controlled diabetes, statin-free of course.

 

[porl69]

I thought I had better start reading this thread! T1D since 6 years old....Nearly 52 years old now and have been on statins for 8 years (roughly) had a VERY high cholesterol level. Have never questioned my GP's decision! I really don't do much exercise at all, am on my feet all day in work and walk around 6k steps per day.
Should I be taking these statins????
Edited - I am also stage 4CKD!!!

 

[Fido78]

 

[Tabbyjoolz]

I wouldn't touch statins with a sh*tty stick. My practice tried bullying me for ages about taking them - to the extent that they even filed two prescriptions for me to pick up from my designated pharmacy. After a very strongly worded email to the practice manager, the automatic statin prescriptions and the texts urging me to take them, stopped. My lovely pharmacist, well aware of people's distrust of statins - and my wrath (angry at the practice, not the pharmacist), has agreed to support me in my refusal.

It's the old doctor - the head of the practice - who is the trouble. I refuse to see him point blank and always see a more sympathetic doctor, who goes through my cholesterol, trigs etc; and says I am fine.

 

[Resurgam]

I had a terrible time taking a statin and Metformin - could not report side effects as I could not say which tablet did what, but I stopped taking them at the end of 2016. Most of the effects subsided fairly rapidly, but only in the last week has the ache in my lower left leg subsided and it feels normal again, both to the touch and from the inside.
If I am ever prompted to take statins again I will agree to it as long as the pusher can tell me why the deathrate in France dropped when there was a decline in taking statins. The predicted increase in deaths was in fact about the same number decrease.