Metabolic sydrome: Is this the same as prediabetes ?

[TheBigNewt]

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.

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.

 

[TheBigNewt]

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/

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!

 

[ringi]

@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.)

 

[TheBigNewt]

@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.)

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.

 

[Bluetit1802]

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!

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.

 

[TheBigNewt]

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.

 

[Bluetit1802]

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.

Absolutely no coronary disease, no hereditary CVD issues, and no other illnesses. My GP was very concerned that I would not take statins and nagged and nagged me about it. (Because my Q-risk score was above 10%) It is the Q-risk score that our doctors use to determine statin use as recommended by NICE. https://qrisk.org/three/

 

[ringi]

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.

This is a lot more defendable then the NHS, part of a NHS GP's pay depends on them "offering" satins to enough people.

Too many NHS GPs also claim that satins never have any side effects. (It does help that the main study excluded anyone from the dataset who dropped out within 3 weeks of the start of the study, and clearly people who got side effects were more likely to drop out.) NHS GPs have also been brainwashed based on “relative risk reduction”, and don’t think about how small that “absolute risk” is for lots of people. That assumes we can trust the studies that were funded by the satin makers, where they have refused to release the complete datasets for any independent person to look at.

(As I understand it, the NICE committee that recommends how the NHS uses satins is mostly staff by the leading researchers, who of course, all depend on keeping the drug companies happy otherwise their department loses a lot of funding….)

I question if it worth charging the “course of death” and the day on my death certificate without changing the month and year…..

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?)

 

[TheBigNewt]

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?)

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.

 

[ringi]

"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.

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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?

 

[TheBigNewt]

"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?

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.