That's pretty much correct. In the US the LDLc is calculated: Total Chol-HDLc-(TG/5). And as they said although LDLc doesn't need fasting the TGs sometimes do and it's calculated using the TG. When the TG is really high (I see them over 2000mg/dl) the LDLc can be a negative number, so our labs directly calculate it instead of using the formula. People with lipoprotein lipase deficiency get really high TGs but their LDLc usually isn't too bad. They can develop pancreatitis. But the TG's have to get really really high to get that.If they have given you a total and a non-HDL total, someone, somewhere must have calculated or measured your LDL and triglycerides as they form part of both these totals. The Total cholesterol is the total of the HDL, the LDL and 46% of the trigs (in the UK). The non-HDL is the total minus the HDL.
My surgery always orders a full lipid panel (Total, HDL, LDL, Triglycerides) and from that they work out ratios.
Just a note on cholesterol tests. Even though you may be told it isn't necessary to fast, it actually IS necessary to fast. This is because if you have recently eaten, and especially if that food was fatty in some way, the triglycerides will be raised - they will be swimming about in your blood stream doing their job and will be increased in number. I always fast despite not being told to, and make sure I get a morning appointment.
Do you have print outs of your test results or on-line access? If not, maybe you could enquire about obtaining these.
All I know is when I see a 56 year old guy with Type 2DM, A1C=9, LDLc=125mg/dl, with hypertension who's overweight I can't click the Lipitor 40mg/d menu item quick enough on our EMR pharmacy program!If you use the search box at the top you will find many dozens of threads on the subject of statins, including lots of research links and videos. You are not alone in distrusting NICE and Big Pharma.
By the way, the QRisk score will go up every birthday! This is it, if you want to have a play. https://qrisk.org/three/
So the guy I saw this afternoon is 58, had his first heart attack at age 49, a coronary bypass age 54 after 3 stents, and has 3 stents since then. He's about ready for a defibrillator next. Type2 DM, with low HDL, slightly high TGs, LDLc so-so. Doesn't want a statin. His chances of seeing 60 are: slim and none. I see those dudes all the time. And yes I take a statin. And no I haven't read your "guidelines". Statins are all cheap now too.@TheBigNewt Have you looked into it yourself, or just trusted the guidelines that are mostly written by people in the pay of "Big Pharma"? (Or would thinking for yourself cost you your job and hence health insurance coverage, if so I fully understand why you would prescribe them.)
All I know is when I see a 56 year old guy with Type 2DM, A1C=9, LDLc=125mg/dl, with hypertension who's overweight I can't click the Lipitor 40mg/d menu item quick enough on our EMR pharmacy program!
No coronary disease? No statin. The high HDL is important. I don't look at the ratio much, just the numbers. Most people I see have coronary disease. Different animal then. Statins for all.What would you do with a T2D 66year old female with a latest HbA1c of 6.4, absolutely normal lipids, high HDL, perfect trigs and perfect ratios, no hypertension and no pre-hypertension, BMI of 25?
Edited to make it clear - this was me back in 2014 when my GP called me in specifically to push statins on me. No other reason.
No coronary disease? No statin. The high HDL is important. I don't look at the ratio much, just the numbers. Most people I see have coronary disease. Different animal then. Statins for all.
No coronary disease? No statin. The high HDL is important. I don't look at the ratio much, just the numbers. Most people I see have coronary disease. Different animal then. Statins for all.
Lowering TGs in Type 2 diabetics is of questionable (or no) benefit, at least using drugs. That's been the subject of a randomized trial. It's LDLc that mainly determines risk of atherosclerotic coronary events. And proving "primary prevention" by using statins hasn't been done in controlled trials hardly at all, the main one was using simvastatin years ago, it persons with high LDL. I'm talking about secondary prevention, and the case for using statins in persons with established coronary disease is so strong that further randomized trials would likely be unethical for persons assigned to the "control group". Side effects of statins unquestionably occur, mainly "muscle aches" which is pretty vague and entirely reversible. Documented significant liver enzyme increases occur in about 1 in 1,000 persons and is reversible. True serious muscle breakdown or "myositis" is bandied about as a feared side effect but in fact is extremely rare, I've yet to see a case myself.I reduced my TG from 21 mmol/L to 1.5 mmol/L by “low carb” and am convinced this reduced risk a lot more than any satin can, yet my GP pushed satins, and did not tell me about “low carb”……. (And how can I trust any doctor who still thinks "low fat" diets are a good opion for people with Type diabetes?)
Actually the PCPs here at the Veteran's Admin. facility usually prescribe statin and ACEI (lisinopril, etc.) to Type 2 diabetics routinely. I only see heart patients though I don't treat diabetes. Lowering triglycerides is done using fibric acid derivatives such as fenofibrate or gemfibrozil, or high doses of a fish oil prep. Diet won't work for people who have lipoprotein lipase deficiency, their TGs can be in the thousands. For the regular diabetics statins do just fine. They mainly need LDLc lowering."secondary prevention" is mostly done by consultants in the UK, yet we all get "primary prevention" forced on us by our GP unless great resistance is shown.....
If only our GPs had the same views on statins as you do.
------------As I understand it, the only way to lower TGs in Type 2 diabetics with diet is by removing the fat from the liver, and hence reduce insulin resistance. Am I missing something in my understanding?
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