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Statins, advised to start 20 mg Atorvastatin

Discussion in 'Non-Diabetic Medication' started by GuidingSenses, Apr 23, 2020.

  1. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Guru

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    They do take account of whether the diabetes is T1 or T2, but nothing else.

    The postcode seems to be based on the likely deprivation etc within that postcode as far as I can work out. My postcode comes out quite good, but not so some of the inner cities/large towns.

    The smoking thing gives a slightly better result than the diabetes does. So they think it is better to smoke than have diabetes.
     
  2. HSSS

    HSSS Type 2 · Well-Known Member

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    Yes you’re right re type, I’ve amended my comments.

    Depravation would likely be the reason for postcode but it very easy to be much worse or better off than the street behind you.

    My point was how blunt a tool it is is some respects and the amount of assumptions and stereotypes it relies on.
     
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  3. Dark Horse

    Dark Horse · Well-Known Member

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    There's a discussion of the rationale behind QRISK2 here:- https://qrisk.org/2017/BMJ-QRISK2.pdf It says, 'A risk prediction algorithm that does not include deprivation ... is likely to result in the inequitable definition of risk for affluent and deprived communities. Primary prevention programmes that do not take these variables into account risk exacerbating rather than reducing existing health inequalities'.

    If people think that their diabetes is so well-controlled that it's unlikely to affect their risk of heart disease, they could always re-run the calculator with 'no diabetes' selected for comparison. As the above article says, 'These estimates, like any predictive score, are an aid but not a replacement for judgment in individual clinical circumstances.'
     
  4. Jim Lahey

    Jim Lahey I reversed my Type 2 · Well-Known Member

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    Would it not be more sensible to actually test for heart disease rather than trying to predict it based on a hunch?
     
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  5. HSSS

    HSSS Type 2 · Well-Known Member

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    Interesting. In which case what is the relevance of postcode I wonder? (Haven’t read the article yet). And I don’t suppose a dr will run it without the diabetes label when trying to determine whether or not to prescribe statins to a diagnosed person
     
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  6. Dark Horse

    Dark Horse · Well-Known Member

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    The postcode will indicate if you live in a deprived area or an affluent area. You can run the QRISK calculator yourself and discuss the results with your GP. if/when the subject of statins is raised.
     
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  7. Dark Horse

    Dark Horse · Well-Known Member

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    In this case, we're talking about primary prevention - the idea is to prevent heart disease in people who don't yet have it.
     
  8. bulkbiker

    bulkbiker Type 2 · Oracle

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    Any recent trials that show that they may be effective in achieving this?
     
  9. HSSS

    HSSS Type 2 · Well-Known Member

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    So exactly my point. They are using postcode to suggest (assumed) depravation or otherwise that your link denied
     
  10. Jim Lahey

    Jim Lahey I reversed my Type 2 · Well-Known Member

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    Sure. I understand that. But it's a very poor predictor of anything at all, so its value in preventing heart disease is highly questionable. Maybe we should start prescribing Metformin to everyone over the age of thirty in order to prevent diabetes in those who don't yet have it :shifty:
     
  11. Dark Horse

    Dark Horse · Well-Known Member

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    I think that the link was quite clear that it was using postcode as a proxy for deprivation.The article says, 'The only item in QRISK2 that is not already routinely collected and recorded electronically is the Townsend deprivation score, which is linked to an individual postcode. This score has already been integrated into the EMIS clinical system and linked to the records of over 32 million patients. The mapping of postcode to deprivation score will also be made available, together with the supporting reference tables and algorithm itself.' It also says that the variables used in the calculator include, 'Townsend deprivation score12 (output area level 2001 census data evaluated as a continuous variable)'.

    There is information about the Townsend deprivation score here:- http://www.restore.ac.uk/geo-refer/36229dtuks00y19810000.php
     
  12. Dark Horse

    Dark Horse · Well-Known Member

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    I think the aim of risk calculators is to avoid exactly the sort of thing you suggest. Blanket targets for prescription such as 'everyone with diabetes' or 'everyone over the age of 40' would result in offering medication to people who don't need it - it would be much better to identify those people who are at higher risk. The QRISK calculator is under constant process of revision to improve accuracy and an updated calculator is released every year.
     
  13. GuidingSenses

    GuidingSenses · Well-Known Member

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    Wow Thankyou everyone- this has proven to be an extensive topic! I think the main thing I am getting from your replies are that 5.3 cholesterol isn’t that high. My cholesterol test was done at the same time as blood sugar hba1c when they first diagnosed me 1.5 LADA as hba1c was 14 mmol up from 7 five months previous so if my hba1c was this high would that also affect my cholesterol score?
    I would like to not go on them and now armed with insulin and low carb (5 weeks in) I feel I would want to wait until I’m tested again?
     
  14. Mike d

    Mike d Type 2 · Expert

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    There is NO direct arithmetical link between the cholesterol and the HBA1C where they move in tandem.

    Stick to your LCHF is my advice :)
     
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  15. KK123

    KK123 Type 1 · Well-Known Member

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    Yes, of course you could run it without putting in diabetes but what would be the point? You would still get a 'risk' assessment based on age and the other factors and no account taken of you as an individual. I have done that and my risk is around 5% but add in diabetes and it whips up to 15%. so 'it's statins for you no matter how you manage your diabetes' which was my original concern, (I don't take them by the way and to cut a long story short, I did undergo specific tests regarding cholesterol and found out my levels were NOTHING to do with lifestyle, the ratios were excellent but the LDL was more than the average persons!). I know that it is impossible for NICE to make that decision up front on a calculator BUT I do expect Drs & Consultants to start making their decisions based on the person in front of them instead of the 'average person' as the last bit of your para says of course. The fact is once they see 'diabetes' then it's conversation over. x
     
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    #35 KK123, Apr 29, 2020 at 3:26 PM
    Last edited: Apr 29, 2020
  16. KK123

    KK123 Type 1 · Well-Known Member

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    Everyone is different but personally I have NO intention of taking a powerful drug for something I don't have when there is NO evidence to say I will get it other than 'you might because of diabetes' and when my ratios are perfect. , I understand that those with existing heart conditions etc may do so but for the rest of us, it's prescribed on little more than a whim.
     
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  17. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Guru

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    I have been coded as diabetes in remission on my medical records by the GP. Yet it is still ticked on my Q-Risk score. However, it doesn't matter, because of my age, which on its own takes me to 13% without diabetes or any of the other health conditions boxes ticked but with an excellent BMI and ideal cholesterol and blood pressure. In other words, perfect health. I can't win. I cannot help my age!
     
  18. KK123

    KK123 Type 1 · Well-Known Member

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    Yep, which of course means EVERYONE over 60 (or whatever the age is) will be prescribed statins, so that is arbitrary, again taking no account of an individual's health. x
     
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