Statins - Do I or Don't I?

Pinkorchid said:

but maybe I will in the future who knows only time will tell.

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Yes that was exactly my point. People who claim that they have never had any trouble must surely include a few who will later. We still don't know the extent of the problems with statins.

Lesleywo said:

My cholesterol has always been elevated (mainly LDL) but my HDL has always been good, as well as triglycerides. I have just had a load of blood tests and my total cholesterol was 7.4, LDL 4.9, HDL 1.4 and trigs 2.7(!) I have attributed this rise to doing LCHF for some time and the increase in saturated fat.


Any thoughts?

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Well personally I have way more faith in the British Heart Foundation than I do in any dubious blogs or internet diet gurus who say that cholesterol doesnt matter but then I would as I also dont believe that sat fat is harmless either.

What I do know is that my cholesterol is fine so I have nothing to worry about but if like yours it was 7.4 I would take a statin, better to be safe than rely on the internet gurus I always say, but of course the choice is yours.

Squire Fulwood said:

Yes that was exactly my point. People who claim that they have never had any trouble must surely include a few who will later. We still don't know the extent of the problems with statins.

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Exactly You simply cannot attribute what (perceived) benefits they might bring against the potential negatives. Each to their own I guess

Mike

Love Dr Kendrick's latest post about the new US Dietary Guidelines - they've backed down on cholesterol, saturated fat, salt and admitted that too much sugar is harmful - FINALLY!

http://drmalcolmkendrick.org/2015/05/20/sorry-seems-to-be-the-hardest-word/

Lesleywo said:

So, the doc is wanting me on Crestor as he reckons I have a 1 in 5 chance of having a heart attack over the next 5 years (thanks for that cheery news .. not).
Any thoughts?

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Some few years ago my GP at the time said I had the lowest probability of CVD he had ever seen (according to the standard probability calculations). When I brought this up a couple of years ago with my current GP she said; 'ah, we changed how we assess that; as a diabetic you automatically get put into the 20% risk group'.

That's not science that's dogma. If my results show I'm low risk but I happen to have diabetes which is associated with higher numbers of heart disease in a population how should that affect my personal risk? Well, not at all. But according to the risk assessment I went from very low risk to uncomfortably high of risk over night.

The well established point about statins and women is that they wont' increase your life expectancy by a single day.

Read some of the posts by this British GP - Dr Malcolm Kendrick and see if what he says resonates.

http://drmalcolmkendrick.org/

I wish he were my GP!

Best

Dillinger

My TC has now gone over 5 mmol/L (while my HbA1c has dropped from 6.0 to 5.7 in 17 days), so I'm fully expecting my new GP to propose statins.

My questions would be around:

1. What are the benefits for women over 50/past the menopause, who have never had any kind of cardiac event?
As I understand it, for men around 1 in 100 or fewer have any benefit. As I understand it, the results are even lower for women.

2. Reported side effects.
(And many are unreported, or at least unrecorded by those that record the reporting, so take this as a minimum, not maximum).

1 - 2

Then 3. Is this stuff likely to make my existing conditions (which I'm managing) worse? Will all my endeavours to date be thrown to the four winds?

What you don't want to do is end up with side effects and/or impact on existing condition management when there is no chance of any reduction in risk.

Interesting straw poll in a lecture in SA by Tim Noakes, where he asked the audience about statins benefits and what they would be prepared to tolerate. The audience consensus was around 40-50-60 PER CENT needing to benefit.
And we know statin benefits are way way lower than that.

I'll try to track it down.

It's right at the end, in the Q&A, at around 1 hour 32m

Unsure what my cholestral reading is as am never told just that it is fine...... am on statins and undecided whether to stay on them but will ask the doc when i see him again

Just listened to today's Malcolm Kendrick interview with Jimmy Moore and sitting here gobsmacked by one of the pieces of information he discussed about possible side effects of statins. He said his wife works in the field of idiopathic pulmonary fibrosis (a disease I was diagnosed with in 2009) - he said if you understand anything about the metabolic pathways, it's understandable that the incidence of this disease has increased along with statin prescription. Never occurred to me that the two could be related, but now I have to wonder.

The frustrating thing is that I had my annual review on Monday - I wish the interview had been played last week so I could been forearmed to discuss the possibility with the doctor.

Makes me even more glad that I only took the bloody things for less than a year. Gawd only knows what state my lungs would be in now if I'd continued taking Crestor. As it is, I'm very lucky that there's been no progression of the disease since I was diagnosed.

I was unsure whether to take statins, eventually I decided I would not because of the heart disease risk but because high cholesterol can cause maculopathy and as I already have retinopathy with hard exudates (cholesterol which has escaped a retinal blood vessel and lying on the retina) I thought anything which can prefent that is worth it. If you don't have any retinopathy this may not be a consideration but worth bearing in mind if you do even background.

I don't know about other people but my experience with my GP was that doctors do not just go on cholesterol levels to advise statins
There are other things they take into consideration like any heart problems in the family, your lifestyle how active your are, smoking or ex smoker, alcohol consumption and obviously any other medical conditions you have to assess your heart attack and stroke risk over the next 10 years

In my experience, and the experience of several people I know with non-diabetic health conditions, the doctor pumps a few numbers into QRisk (or a very similar tool) and gets a percentage out, and then transfers that number to your medical records. That's the assessment of risk process.

From the NICE guideline (2014):
"Offer atorvastatin 20 mg for the primary prevention of CVD to people who have a 10% or greater 10‑year risk of developing CVD. Estimate the level of risk using the QRISK2 assessment tool."

Diabetes (T2) seriously bumps up your QRisk score (mine goes up by 233% if I toggle that on/off).
(And QRisk has in BG measurement component TC, but not Trigs.)

If your TC is over 5 (OMG! ), and your QRisk is upwards of 9% or so, I would imagine many UK GPs would push for statins.

While my new GP was pretty stunned by my managing to drop BG by 3 points in less than 3 weeks (though LCHF), she was also very 'but, but, but' and pointing at the TC figure repeatedly as being some kind of a no-no. Despite the fact that I do a lot of exercise, have excellent trig (0.6), have high HDL etc etc. She didn't know (a) there are different kinds of LDL and (b) other kinds of lipoproteins are not measured e.g. IDL, and (c) that LDL is an estimated figure. GP's knowledge on these topics can be quite rudimentary, and if it is, I'd imagine they will toe the line on NICE in its most basic interpretation, to the letter. Anything else takes time/application, and involves risk for them.

CheeseJunkie said:

. . . . the doctor pumps a few numbers into QRisk (or a very similar tool) and gets a percentage out, and then transfers that number to your medical records. That's the assessment of risk process.

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Standard NICE guidelines, http://www.nice.org.uk/guidance/cg87/resources/guidance-type-2-diabetes-pdf goes a long way to explain GPs behaviour. They can't go wrong if they follow the guidelines. Only we can, especially when it come down to dietary advice which might be fine for some, just not for me or most diabetics I know.

Wow - the NICE guidelines on statins sound like they have been written by Pfizer.

Look at this; "Tell people that there is no evidence that omega‑3 fatty acid compounds help to prevent CVD" and it is telling the GPs not to prescribe them.

Then if you have the time look at this; http://circ.ahajournals.org/content/106/21/2747.full

Which includes the following;

"RCTs (randomised controlled trials) have demonstrated that omega-3 fatty acid supplements can reduce cardiac events (eg, death, nonfatal MI, nonfatal stroke) and decrease progression of atherosclerosis in coronary patients. However, additional studies are needed to confirm and further define the health benefits of omega-3 fatty acid supplements for both primary and secondary prevention."

That's what NICE considers 'no evidence'.

Also, here's their view on coenzyme Q10 - "Do not offer coenzyme Q10 or vitamin D to increase adherence to statin treatment."

What do statins do to coenzyme Q10? Well according to The Lancet they 'inevitably lower the plasma and cellular concentrations of ... coenzyme Q10"

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(03)12877-2/abstract

What does deficiency in coenzyme Q10 do?

Well, according to the Mayo Clinic there is strong scientific evidence that:

"Symptoms of deficiency include heart failure, high blood pressure, and chest pain. Depending on the cause of deficiency, supplementing with CoQ10 or increasing dietary intake may be effective."

http://www.mayoclinic.org/drugs-supplements/coenzyme-q10/evidence/hrb-20059019

So, you know apart from lots of evidence that fish oils are good for you there is 'no evidence' and whilst we know that statins will reduce a coenzyme which we know can lead to heart failure you must not supplement your deficiency in that coenzyme.

This is almost sinister in how back to front this all is...

Best

Dillinger

My Lipitor experience in a nutshell.

Nov. 2014
Chol: 258 - 6.65
HDL: 39 - 1.00
LDL: 190 - 4.92
No sign of Diabetes
Put on 40mg Lipitor per day

Feb. 2015
Chol: 176 - 4.55
HDL: 45 - 1.17
LDL: 108 - 2.80
Diagnosed Type 2 by the end of the month.

At this point I told my Dr. that I wanted to reduce the statin by 1/2, (to 20mg). He was fine with that idea although he stopped short of acknowledging that Lipitor played ANY role in my diabetes diagnosis. I want to stress here that I firmly believe that I was well on my way to Type 2 anyway. Everything about my lifestyle for the past year was taking me straight there. However, I also firmly believe that the statin accelerated the process. I don't know how or why... I just believe it.

3 days ago, (May 18, 2015)
Chol: 151 - 3.91
HDL: 38 - 0.97
LDL 94 - 2.43

My own conclusions: The Lipitor initially accomplished improving my cholesterol levels. A lot. It also very well might have pushed me over the edge on my Type 2 diagnosis. However, my numbers were even better after reducing the dosage AND beginning a vigorous diet and exercise regime.

At the moment I am still on 20mg per day. I fully intend to be down to 10mg by my next Dr. visit. I am not as dead set against statins as some here. But I certainly would prefer to be off of the drug. The way I see it, I want to remove any medical reason for the doctor to want me on Lipitor... then I don't have to worry about whether I'm making the right decision about giving it up. I'm taking my time but I'm not having any real obvious issues at the moment.

Note: I know a lot of this is a repeat of my past posts. But I'm new at this and don't really have much to say except my own limited experiences.

I had to translate the numbers from Yankee... the Brit numbers are approximate.