Plant stanols, sterols, Diabetes & CVD - NICE's advice

miahara said:

I've just been looking on the NICE site to see what current advice is about the treatment of diabetes and also of CVD. Much to my surprise I found this advice regarding stanols and sterols.

Plant stanols and sterols


1.2.17 Do not advise any of the following to take plant stanols or sterols for the prevention of CVD:

• people who are being treated for primary prevention
• people who are being treated for secondary prevention (c'est moi)
• people with CKD
• people with type 1 diabetes
• people with type 2 diabetes. [new 2014] (c'est moi)

I almost laughed as one of things the DSN said on the afternoon course I went on in December 2015 was to use the 'cholesterol lowering' products. She was clearly a year out of date with her knowledge. Guess I'll stop tomorrow

Dave

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Yes, statins are prescribed for the prevention of CVD.

1.3.26 Offer atorvastatin 20 mg for the primary prevention of CVD to people with type 2 diabetes who have a 10% or greater 10‑year risk of developing CVD. Estimate the level of risk using the QRISK2 assessment tool

douglas99 said:

Yes, statins are prescribed for the prevention of CVD.

1.3.26 Offer atorvastatin 20 mg for the primary prevention of CVD to people with type 2 diabetes who have a 10% or greater 10‑year risk of developing CVD. Estimate the level of risk using the QRISK2 assessment tool

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I think he may be talking about cholesterol lowering food products, not statins.

Bluetit1802 said:

I think he may be talking about cholesterol lowering food products, not statins.

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Yes, they have been superseded for the prevention of CVD, hence the update in the guidelines.
It doesn't address the issue of whether they're better as a lifestyle choice or not, in fact they probably fit after primary or secondary prevention, but that's not the point of the guideline.

miahara said:

Yes indeed, I'm focussing on cholesterol lowering products. I take statins for CVD and am also T2 so fall into two of the contra-indicated groups in the NICE advice. I posted this because there's probably a few others who fall into the same category.

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Is there actually a contra indication, ie they are harmful to any of that group?

douglas99 said:

Is there actually a contra indication, ie they are harmful to any of that group?

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If they actually work, then I would say yes. Statins lower cholesterol substantially. Anything else on top could lower it to dangerous levels. That is my assumption. No evidence.

miahara said:

NICE obviously seems to think so, but I've no idea about the medical evidence behind that view. And., yes I do know that NICE's advice isn't always at the leading edge of current research, particularly regarding diet for D.

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If you read the guideline, it doesn't suggest plant stanols or sterols are harmful.
It suggests they solely shouldn't be used for the prevention of CVD, simply that statins should be used.

Which makes sense.

I was just wondering why you were 'surprised' NICE were recommending statins, rather than plant stanols or sterols for the prevention of CVD?

The Patient website has this to say:-

Dark Horse said:

The Patient website has this to say:-

"NICE recommends that patients should not routinely be advised to take plant sterols and stanols for the primary prevention of cardiovascular disease. This is based on the grounds that there are as yet no randomised controlled trials examining the effect of these substances on primary and secondary prevention with respect to cardiovascular outcomes. This recommendation may be subject to revision once the necessary data become available."
http://patient.info/doctor/cholesterol-lowering-sterols-and-stanols​

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Yes, NICE will (probably) always be recommending Statins as the primary prevention, as per above.

douglas99 said:

Yes, NICE will (probably) always be recommending Statins as the primary prevention, as per above.

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Probably .... until there is evidence for something better. Sorry, I should have used bold for part of the quote I was emphasising. I've done it now. Basically, Patient is saying that there is insufficient evidence to decide whether using stanols and sterols is useful in preventing CHD.

Please do not take my ramblings too seriously, I don't have an axe to grind, except I was in a lot of pain taking statins, I think Sir Rory Collins reckons I was the only one. LOL

In the beginning we were told it was cholesterol that caused CVD although the arteriosclerosis was the route cause, something that we all get to varying degrees as we get older. So along come statins to reduce cholesterol, not prevent arteriosclerosis.
They're very good at reducing cholesterol and back in 1997 when I was following what would be considered to be a normal diet although even then I didn't eat cake, biscuits, chocolate etc because I didn't really like them, I'm more savoury than sweet. My total cholesterol was 7 and even as a newly diagnosed type II the endocrinologist was OK with that but being diabetic automatically prescribed statins.

Here we now are in 2017 and I've been off statins for 3 years, I eat much less carbs than all those years ago, eat more fat in the form of more cheese and more proper yoghurt, preferably the stuff with no added sugar and my total cholesterol last month was 4. I eat very little in the way of plant sterols, things like Flora that my wife prefers, because I don't eat the bread to spread them on. I don't touch the little tiny drinks either, they're OK, just have enough to be consuming anyway.

So, although the afore mentioned products are not used by me, they're in the fridge and I wasn't aware that they might claim to prevent CVD. Just checked, they only say that they reduce cholesterol and I think they do. HID started to use them when her cholesterol started to rise and she hasn't been asked to take statins yet.

Basically, I don't think a doctor would advise something that the product doesn't claim anyway.

Back to statins, do they now prevent CVD or do they still just lower cholesterol? Even the part cholesterol plays in CVD is questionable especially when looking at the data collected by the World Health Organisation who I don't believe have any motives apart from collecting the data.

I'd post the graphs but photobucket is now such a bag of lwhdrncg that I need to find another host for pictures I want to post on forums. Any suggestion, although totally off topic, gratefully received.

Addenbrookes has a huge poster promoting one of the stanol margarines-and then above it "we do not endorse this product"....
Made me wonder why on earth the company pay for this huge poster.