Doctor and cholesterol confusion

[lucylocket61]

I am not sure my doctor is well informed about Diabetes and cholesterol

I saw her yesterday and she said my total cholesterol should be under 2 because I am now a Diabetic!!! It is currently 4.5 total choloesterol

My HDL is 3.5 and my LDL thingy is 1.8 and I am confused as to why it must be under 2 and why I now seem to need statins. I have googled but cant find out where she got this figure from.

On a good note, my bp is now 130/75 : )

 

[Dillinger]

Hi Lucy,

You may be interested in this:-

http://www.cholesterol-and-health.org.uk/statins-4.html

In particular this bit - "In both these groups — elderly men and women of all ages — there is not one shred of evidence that taking statins will add as much as a day to their lives."

If you Google women 'all cause mortality and statins' or 'women statins and life expectancy' you'll get lots of information on that. Statins don't do much for anyone (they reduce the absolute risk of CVD by about 4% http://www.ncbi.nlm.nih.gov/pubmed/21968126). That same study says around 50 people would have to take statins for 10 years to prevent 1 cardiovascular event. That's not preventing a death, just an 'event'.

So, it's not true to say they don't do anything; they do, just not much and as a woman they won't delay your (hopefully far distant) funeral by 1 day.

Best

Dillinger

 

[Daibell]

Hi. I'm afraid saying you need to keep your cholesterol below 2 because you are diabetic is nonsense and not based on any evidence; challenge it. The generally held view is to try to keep below 5 and although diabetics have a higher change of blocked capillaries due to higher sugar levels, if you keep your sugar levels at a sensible level then you are, in general, no different from a non-diabetic.

 

[phoenix]

Your doctor is using the same criteria as mine over here in France
The BBC article on cholesterol says

The National Institute for Health and Clinical Excellence (NICE) and Department of Health cholesterol guidelines, which is the policy doctors follow, are:

Total cholesterol - less than 5.0mmol/l
LDL cholesterol - less than 3.0mmol/l
However, the Joint British Societies (a group of the main UK expert societies involved in cardiovascular disease) recommend different cholesterol limits for people who have, or are at risk of, coronary heart disease:

Total cholesterol - less than 4.0mmol/l
LDL cholesterol - less than 2.0mmol/l
These guidelines match the more stringent recommendations used in Europe.

NICE is currently reviewing its national policy guideliness

http://www.bbc.co.uk/health/physical_health/conditions/cholesterol1.shtml

Statins are controversial on these forums so you will have to look at both sides and make a decision for yourself. Dillinger has given one. Here is the press release from a large study done in the UK. It's on the website of the study itself so you can follow up the actual study if you want to. The Background question and answers on the press materials tab is also informative.
http://www.ctsu.ox.ac.uk/~hps/diabetes_ ... ease.shtml
As to the risk for women. It is true that many women up to the menopause have higher levels of HDL which is thought to be protective against heart disease. After menopause HDL can fall, also some women with diabetes seem to have quite low HDL levels. Unfortunately many docs don't seem to order a full cholesterol blood test. Without knowing your HDL level you're lacking important information.
It is no longer true to say that there is no evidence for the effect of statins in women (there didn't used to be as many trials were only on men) A recent meta analysis' (ie when the results of several trials were put together ) Meta-Analysis of Statin Effects in Women Versus Men' concluded that' Statin therapy is associated with significant decreases in cardiovascular events and in all-cause mortality in women and men. Statin therapy should be used in appropriate patients without regard to sex'

 

[lucylocket61]

thanks phoenix.Very interesting study and article.

The articles are from 2007 and 2003. Does anyone know if there any more up-to-date studies done? or articles about this?

My total cholesterol is 4.5
My LDL is 1.8

so I am only just abut the total cholesterol target.

 

[Dillinger]

Thanks Phoenix,

Here is a link to an overview of that men/women statin study.

http://content.onlinejacc.org/cgi/conte ... t/59/6/572

Most places are reporting that as confirmation that statins are good for everybody but the following report raises interesting questions, in particular the fact that the relative risk for CVD events is only reduced by 10% - the absolute risk isn't provided; on the basis that relative risk is always a much larger number than absolute risk the real figure may only be very small.

http://www.theheart.org/article/1347045.do

Again, 'significant' does not mean 'a lot' it means 'not by chance'.

Best

Dillinger

 

[phoenix]

Hi Lucy, I've just realised that I read your post too quickly and thought you said she wanted your LDL under 2mmol/l which I now realise it is. I can see why you are confused.
It is under most guidelines I would have though, even for those with the additional risk of diabetes. (unless of cause you smoke which adds to the risk) Sorry if I have added to your confusion.

A more recent (but difficult read) is the latest cochrane report.
http://www.update-software.com/BCP/Wile ... 004816.pdf
It concludes:
In people at high risk of cardiovascular
events due to their risk factor profile (i.e. 20+% 10-year risk), it
is likely that the benefits of statins are greater than potential short
term harms although long-term effects (over decades) remain unknown. Caution should be taken in prescribing statins for primary prevention among people at low cardiovascular risk.

 

[noblehead]

Not heard of the figure 2 for total cholesterol but here is the recommended guidelines for people with diabetes:

HDL: 1mmol/l or above for men; 1.2mmol/l or above for women

LDL: below 2mmol/l

Triglycerides: equal to or below 1.7mmol/l

Total cholesterol: below 4mmol/l

 

[librarising]

I am not sure my doctor is well informed about Diabetes and cholesterol

Get him to have a word with Minitata'a doctor

viewtopic.php?f=18&t=28519 :

"he's taken more note of patients who are healthy but with fairly high cholesterol - he told me not to worry after he'd seen an 89 yr old woman, fit as a flea with a total cholesterol of 8.9%. I pointed him to read some of the online cholesterol sites and he's more confident now with people not taking their statins."

or see if he can take you on

My recent studies online say that doctors are far too concerned about cholesterol, and too ready to use statins to control it.
My doctor would get a refusal from me.

Geoff

 

[hanadr]

There's at least 1 study that says that women, especially post menopausal women should not have a total cholesterol below 4. Sorry I forgot the reference.
Hana
Ps mine is about 3.4 and they still want me to take statins too.
The really important thing is the HDL/total cholesteerol ratio. You can look the numbers up.

 

[Pac]

I am not sure my doctor is well informed about Diabetes and cholesterol

" ...My recent studies online say that doctors are far too concerned about cholesterol, and too ready to use statins to control it.
My doctor would get a refusal from me."

Geoff

Ah, but dont they receive extra payment for treating 'high' cholesterol patients?