Statins

[Thomas the Tank]

I had my first officials "diabetes consultation" with the DN today. (For some reason it took two years to get to this point, after moving from the USA to UK two years ago. I suspect this is because my HbA1c has never been found to be high by the NHS: by the time I moved here it was under control using diet and exercise.)

Anyway she congratulated me on keeping good control of my A1c (37, as measured two weeks ago) but said the test also showed my cholesterol is high. Serum cholesterol was 6.5, serum HDL was 1.8, and the ratio is 3.6. She consulted the duty GP and gave me a prescription for statins.

So: What is the best way to bring the number down? Also (playing devil's advocate) how much does it really matter?

In my opinion the best way to get the number down is to rub out the old result and write a lower figure in. That's how much the results are worth. I can 'play' my cholesterol levels like a bagpipe- if I want them higher I stress myself, get angry or rant on about
Big Pharma. If I want them lower I relax and meditate but unlike Bg levels it really doesn't matter what the numbers are.

 

[KennyA]

I live in the US and find this discussion somewhat fascinating. When you say your cholesterol do you mean LDL or total? That is pretty high for a total but, if that is your LDL (and if I converted it correctly), that is REALLY high. The general recommendations for diabetics in the US is LDL cholesterol below 80 (or 2.1 if the converter is correct) for the general diabetic population and below 70 (or 1.8) if they have a history of cardiovascular disease. Diabetic patients are associated with an 18% greater risk of cardiovascular mortality (death) than the general population.

You sound like you could be someone who has familial hypercholesterolemia. (Genetic high cholesterol). It is a possibility to explore.

I mean LDL. It's above the 'recommended' level (I don't know what converter you're using) but then the recommended level has very little science behind it. Yes, the advice I've had from the medics is that I have genetically high cholesterol. As three of four of my grandparents lived well into their 90s I'm not too worried. If I had what the fourth had I'd be dead already. And I am being urged to take statins, which I will not do. I see no demonstrable benefit.

 

[Member496333]

In my opinion the best way to get the number down is to rub out the old result and write a lower figure in. That's how much the results are worth. I can 'play' my cholesterol levels like a bagpipe- if I want them higher I stress myself, get angry or rant on about
Big Pharma. If I want them lower I relax and meditate but unlike Bg levels it really doesn't matter what the numbers are.

Bravo. Cholesterol schmesterol. I understand why others are concerned, but personally I couldn't give a hoot. I'm more concerned with preventing actual heart disease than treating virtually meaningless numbers.

 

[Resurgam]

Whilst taking Atorvastatin for only a few weeks I lost all my songs, and have had to relearn them, I was wandering around in a daze.
I did all the Christmas shopping twice - left the first lot in the car and found it again a couple of das later.
I do wonder how many people are in care homes being carefully medicated to keep them senile.

 

[MollieB]

e Total cholesterol/HDL ratio

That is extremely interesting...There is very little attention paid to it. In fact, our lab doesn't even report it. I always thought US and UK to be on about the same wave length with their medical "opinions" {doesn't matter where the studies are done, we are the same species } but this is very different. Depending on how they do you LDL cholesterol measurement, fasting is key. (Fasting is also key to getting a true triglyceride reading). In the US, the standard LDL lab test is derived from calculating it by subtracting HDL and triglycerides from Total cholesterol. Since triglycerides are sensitive to fasting, if you are not fasting, the LDL levels are not going to be accurate. LDL also can now be measured "Directly" (not calculating it). Since it doesn't rely on the other numbers to calculate the reading, a direct LDL doesn't have to be fasting. We also have another test called an NMR, which measures LDL particle number. This is important because huge studies have shown the LDL particle number to be the best indicator for cardiovascular events. Diabetics, in particular, can have normal LDL levels and still have elevated Particle Numbers.

 

[Bluetit1802]

That is extremely interesting...There is very little attention paid to it. In fact, our lab doesn't even report it. I always thought US and UK to be on about the same wave length with their medical "opinions" {doesn't matter where the studies are done, we are the same species } but this is very different. Depending on how they do you LDL cholesterol measurement, fasting is key. (Fasting is also key to getting a true triglyceride reading). In the US, the standard LDL lab test is derived from calculating it by subtracting HDL and triglycerides from Total cholesterol. Since triglycerides are sensitive to fasting, if you are not fasting, the LDL levels are not going to be accurate. LDL also can now be measured "Directly" (not calculating it). Since it doesn't rely on the other numbers to calculate the reading, a direct LDL doesn't have to be fasting. We also have another test called an NMR, which measures LDL particle number. This is important because huge studies have shown the LDL particle number to be the best indicator for cardiovascular events. Diabetics, in particular, can have normal LDL levels and still have elevated Particle Numbers.

Yes, the test for LDL particles is available, but the NHS doesn't routinely do these. In fact, I doubt they do it at all. They are available privately. Apparently, the particles will be mainly the good small fluffy ones if the triglycerides are low and HDL high. This is why some experts say it is the ratio between HDL and Trigs (HDL/Trigs) that is the important ratio for CVD risk - which should be as low as possible. I learnt this on the forum, and when I began to explain to my nurse it turned out she already knew! She had been on a course.

In England the LDL is also calculated, not measured.

 

[bulkbiker]

(HDL/Trigs) that is the important ratio for CVD risk - which should be as low as possible.

Other way round
Trigs/HDL Daf..

 

[Thomas the Tank]

That is extremely interesting...There is very little attention paid to it. In fact, our lab doesn't even report it. I always thought US and UK to be on about the same wave length with their medical "opinions" {doesn't matter where the studies are done, we are the same species } but this is very different. Depending on how they do you LDL cholesterol measurement, fasting is key. (Fasting is also key to getting a true triglyceride reading). In the US, the standard LDL lab test is derived from calculating it by subtracting HDL and triglycerides from Total cholesterol. Since triglycerides are sensitive to fasting, if you are not fasting, the LDL levels are not going to be accurate. LDL also can now be measured "Directly" (not calculating it). Since it doesn't rely on the other numbers to calculate the reading, a direct LDL doesn't have to be fasting. We also have another test called an NMR, which measures LDL particle number. This is important because huge studies have shown the LDL particle number to be the best indicator for cardiovascular events. Diabetics, in particular, can have normal LDL levels and still have elevated Particle Numbers.

This would be important as 'in my opinion' almost all of the studies have reported false, inaccurate or biased results. the other studies not giving any of the required results are hidden. Of course there is also the slight problem that even if LDL particle numbers are best indicators for cardiovascular events it does not mean it has anything what so ever to do with the cause.

 

[Walking Girl]

That is extremely interesting...There is very little attention paid to it. In fact, our lab doesn't even report it. I always thought US and UK to be on about the same wave length with their medical "opinions" {doesn't matter where the studies are done, we are the same species } but this is very different. Depending on how they do you LDL cholesterol measurement, fasting is key. (Fasting is also key to getting a true triglyceride reading). In the US, the standard LDL lab test is derived from calculating it by subtracting HDL and triglycerides from Total cholesterol. Since triglycerides are sensitive to fasting, if you are not fasting, the LDL levels are not going to be accurate. LDL also can now be measured "Directly" (not calculating it). Since it doesn't rely on the other numbers to calculate the reading, a direct LDL doesn't have to be fasting. We also have another test called an NMR, which measures LDL particle number. This is important because huge studies have shown the LDL particle number to be the best indicator for cardiovascular events. Diabetics, in particular, can have normal LDL levels and still have elevated Particle Numbers.

Your doctors office uses a different lab than mine does then. I’m in the U.S., very good company paid insurance. Ratio of Total/HDL is the first line on my lab report (Lab Corp). For the record, my last test was 2.2.

My doc has never agreed to run a particle number. I would have to pay directly with Walk In Labs or such.

 

[Walking Girl]

So: What is the best way to bring the number down? Also (playing devil's advocate) how much does it really matter?

Well, the majority of what I have read says a high soluble fiber, low saturated and trans fat diet, with exercise.

all I know is that with my plant based whole foods diet my lipid profile stays right around 3.4 total, 1.5 HDL, 1.36 cLDL and .82 triglycerides.

I’ll leave the arguments about whether that matters to others. I’m happy where I am.

 

[Bluetit1802]

Other way round
Trigs/HDL Daf..

You are quite right, Des. I apologise and blame my age. Thanks for correcting me.

 

[Tophat1900]

I did do an experiment and ate 150g of peanut butter per day for about a year, lowered the total from 5.2 to 3.9 over a year, all ratios remained from memory good and trigs below 1.0

 

[Grateful]

Thanks again for the info everyone. I am persisting with my diet/lifestyle changes, but am dubious as to whether they will budge the cholesterol needle (and I don't think I care if they don't; my cholesterol ratio has been good or excellent for the past 13 years, it's only the total that has been exceeding the supposed norm).

--Muesli for breakfast (to increase the fibre), despite the extra carb load. No more bacon and eggs, which was my standard low-carb breakfast.
--Tuna instead of chicken with my lunchtime salad. Plus an avocado every lunchtime (fibre, again).
--Reduction in meat suppers. I do the cooking 50 percent of evenings and am trying to do some tasty vegetarian meals. We already eat quite a lot of fish, so no scope to increase fish.
--The biggest lifestyle change is I stopped drinking beer 10 days ago and will continue that (boring) regime until the next blood test at the end of April (admittedly this has no connection with lowering cholesterol). Am drinking moderate amounts of red wine (two glasses) with supper, instead.
--Am trying to make sure that I get out for a one-hour walk every day. The weather, and work pressures, sometimes interfere.

As to whether I will stick with the above regime after the forthcoming end-April blood test, I honestly don't know, at this point. Obviously it will depend in part on what the numbers show (and whether I care), but it will also depend on whether I have found the diet/lifestyle changes to be beneficial in any other way.

 

[britishpub]

I received a letter yesterday from my GP, saying that she has just noticed that my QRISK score is above 10 and therefore I should start on a Statin.

She has received my response.

 

[bulkbiker]

but am dubious as to whether they will budge the cholesterol needle (and I don't think I care if they don't; my cholesterol ratio has been good or excellent for the past 13 years, it's only the total that has been exceeding the supposed norm).

So why make all the changes to what you eat if you really don't care.. ?
Especially adding carbs in for breakfast (probably the worst time of the day to have them).

 

[Hotpepper20000]

Thanks again for the info everyone. I am persisting with my diet/lifestyle changes, but am dubious as to whether they will budge the cholesterol needle (and I don't think I care if they don't; my cholesterol ratio has been good or excellent for the past 13 years, it's only the total that has been exceeding the supposed norm).

--Muesli for breakfast (to increase the fibre), despite the extra carb load. No more bacon and eggs, which was my standard low-carb breakfast.
--Tuna instead of chicken with my lunchtime salad. Plus an avocado every lunchtime (fibre, again).
--Reduction in meat suppers. I do the cooking 50 percent of evenings and am trying to do some tasty vegetarian meals. We already eat quite a lot of fish, so no scope to increase fish.
--The biggest lifestyle change is I stopped drinking beer 10 days ago and will continue that (boring) regime until the next blood test at the end of April (admittedly this has no connection with lowering cholesterol). Am drinking moderate amounts of red wine (two glasses) with supper, instead.
--Am trying to make sure that I get out for a one-hour walk every day. The weather, and work pressures, sometimes interfere.

As to whether I will stick with the above regime after the forthcoming end-April blood test, I honestly don't know, at this point. Obviously it will depend in part on what the numbers show (and whether I care), but it will also depend on whether I have found the diet/lifestyle changes to be beneficial in any other way.

If I remember correctly you are not an advocate for using a BG meter.
I would highly recommend that you start testing before and after you meals.
With all those extra carbs I wouldn’t be surprised if your A1C increases.
This would worry me more the the cholesterol numbers.

 

[Member496333]

If I were switching to Muesli for breakfast I would keep a glucometer in a hip holster and wear a grenade belt full of test-strip pots.

Proceed with extreme caution

 

[Bluetit1802]

Thanks again for the info everyone. I am persisting with my diet/lifestyle changes, but am dubious as to whether they will budge the cholesterol needle (and I don't think I care if they don't; my cholesterol ratio has been good or excellent for the past 13 years, it's only the total that has been exceeding the supposed norm).

--Muesli for breakfast (to increase the fibre), despite the extra carb load. No more bacon and eggs, which was my standard low-carb breakfast.
--Tuna instead of chicken with my lunchtime salad. Plus an avocado every lunchtime (fibre, again).
--Reduction in meat suppers. I do the cooking 50 percent of evenings and am trying to do some tasty vegetarian meals. We already eat quite a lot of fish, so no scope to increase fish.
--The biggest lifestyle change is I stopped drinking beer 10 days ago and will continue that (boring) regime until the next blood test at the end of April (admittedly this has no connection with lowering cholesterol). Am drinking moderate amounts of red wine (two glasses) with supper, instead.
--Am trying to make sure that I get out for a one-hour walk every day. The weather, and work pressures, sometimes interfere.

As to whether I will stick with the above regime after the forthcoming end-April blood test, I honestly don't know, at this point. Obviously it will depend in part on what the numbers show (and whether I care), but it will also depend on whether I have found the diet/lifestyle changes to be beneficial in any other way.

If you are trying to lower your total cholesterol by changing your diet, in my opinion you are changing too much all at once. A structured elimination change would give better results. By April when your next test is due, should your cholesterol be improved, how the dickens will you know what caused it? One thing for sure that will not help is the muesli. Carbs are known scientifically to lower the HDL, which is bad news. Your total may drop but your good stuff may decrease. Be careful.

 

[MollieB]

Your doctors office uses a different lab than mine does then. I’m in the U.S., very good company paid insurance. Ratio of Total/HDL is the first line on my lab report (Lab Corp). For the record, my last test was 2.2.

My doc has never agreed to run a particle number. I would have to pay directly with Walk In Labs or such.

We use LabCorp too. Diabetics have a greater chance of having a discordant LDL level and LDL particle number and the studies have shown that the LDL particle number is a better indicator for cardiovascular disease. Labcorp runs the NMR.

 

[FSnow]

Ask for a referral to a cardiologist. Then request a scan of plaque build up in your arteries etc. I understand the results of this scan can determine if you need to be on statins .
https://www.health.harvard.edu/heart-health/should-you-consider-a-coronary-artery-calcium-scan-