Statins

Resurgam said:

Yes. I was diagnosed late 2016 and I did the Christmas supermarket shop twice.
I called at my daughter's house on the way back from the first shop and forgot it was in the car. Two days later I went out again, wandered around the car park looking for the car, then opened it up and found all the things still in the back. It was a nasty shock. I went home and threw out the tablets, but for some years I was realising how bad it had been.

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That is horrific! I had an experience, similar but with an anti depressant. I found myself sitting on the window ledge of the upstairs window legs out the window. Could not for the life of me remember how or why I was there! That was after 3 days. GP advised that the symptoms would ease, I explained I could not risk it as I had 3 children to think of and I did not want them to be orphans! Never took anything like it again. I cannot seem to tolerate medication of any sort.

Edit by mod for language.

35yearsofType1 said:

Hi Alan,

I’m 38 and type 1 (diagnosed at 15 months old) my consultant at my last appointment said they same thing - even though all of my results were good - HDL, LDL, Triglycerides and the ratio between them was good. The conversation went along the lines of that although my cholesterol is good as diabetes is a metabolic disorder my risk of heart disease is high so to reduce this risk anyone who is 40 or over should take statins. I said at the time I wasn’t 40 and would like to have the same conversation again when I have turned 40!

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and when you are 40 I reckon you'll feel exactly the same. For me, unless there is a good and justifiable reason to take them (maybe for a heart problem or having had a stroke etc, and with tangible factors) then I refuse to take a strong medication on a 'just in case' basis.

Having just had a telephone (hospital) diabetes Consultant appointment, at the end of a very positive 'well done, you are the greatest' conversation (and modest too), at the very end she said 'Oh, your cholesterol...statins?.....', I just said 'No thanks, I choose not to take them' and she said 'yes, that's fine'. It makes me wonder if they are becoming more amenable to individual choice though maybe that's optimistic. Having said that, if I thought that I needed statins, ie for existing heart conditions or imminent evidence of strokes or furred arteries and so on, then I would consider them. It's not that I think they are the devil in ALL cases, it's that I do not subscribe to the theory of 'here you are just in case'. My levels are HDL, 2.5, trigs 0.5 and LDL around 4. Other than diabetes I thankfully have no other issues. It makes me smile when they say 'What medication are you on' and I say insulin. It's always followed by, 'Is that it, nothing else, are you sure'.

I take statins and have had no problems whatsoever with them. I write this as you may be getting a slanted view with so many posts about the side effects.

However, one problem I found was it counted against me for travel insurance as it was immediately taken as a sign of increased risk of vascular diseases beyond the diabetes alone (totally unfair). This may have changed and may not be a significant concern for you but I thought I'd mention it.

sunspots said:

one problem I found was it counted against me for travel insurance

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Yes, that's true. I think the same insurance issue arises whether you take them or not though, the question is asked 'Do you or have you been advised to take statins', the last bit forces you into saying yes, so you are still viewed (insurance wise) as an increased risk. For me though, regarding statins, it's not the side effects I'm worried about as all medication may cause those, it's the question of whether they are needed or not. I am more than willing to risk any side effects so long as the medication is justified and not prescribed on a 'You are the same as every other person with diabetes and we are putting you all on statins regardless of any differences in the rest of your health'. I sometimes wonder whether they do this as a catch all because it would be too expensive to actually do the artery/heart health tests in every individual, similar to the absence of antibody or C Peptide tests for diagnosis in the majority of those with diabetes.

KK123 said:

Yes, that's true. I think the same insurance issue arises whether you take them or not though, the question is asked 'Do you or have you been advised to take statins', the last bit forces you into saying yes, so you are still viewed (insurance wise) as an increased risk. For me though, regarding statins, it's not the side effects I'm worried about as all medication may cause those, it's the question of whether they are needed or not. I am more than willing to risk any side effects so long as the medication is justified and not prescribed on a 'You are the same as every other person with diabetes and we are putting you all on statins regardless of any differences in the rest of your health'. I sometimes wonder whether they do this as a catch all because it would be too expensive to actually do the artery/heart health tests in every individual, similar to the absence of antibody or C Peptide tests for diagnosis in the majority of those with diabetes.

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I must admit I consider them useful as anything that may decrease vascular problems when we already have diabetes is a plus. The damage done by diabetes is at such a minute level, and so pervasive, that I'd rather take something that may only probably help than pass up that opportunity. It is worth bearing in mind with all suggested medications that the NHS would rather not be giving anything that costs them money and yet may not be needed. If the NHS recommends a medication there will be good reasoning and research backing it up.

This is a very good article from NICE which explains the risks and benfits of taking/not taking statins in an easy-to-understand way. https://indepth.nice.org.uk/are-statins-the-best-choice-for-me/index.html The article is very clear that it is a personal choice and what may be right for one person my not be for another.

Note that they say:-

The article does strongly recommend statins if you already have CVD.

CallMeAlan said:

Hi all. Received a letter from my GP surgery a few days ago which said that new guidelines suggest that all diabetics take a statin to reduce their cholesterol, regardless of their actual cholesterol level. She has presribed Atorvastatin, 20 mg, one to be taken at night.

I have no idea what my cholesterol level is - it wasn't tested at my last blood test, when my HbA1C was 40.

Are there any views on this please?

Alan.

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Thanks for asking the question Alan.
And thanks to all those who answered, some of those answers provided some really useful information for me as I've been thinking about the pros and cons of statins myself.

I've just been put on them by my GP. My LDL is a little over 4.5 mmol. my HDL is 2 mmol. Total cholesterol is 7, my Total/HDL ratio is 3.5:1. That ratio is considered pretty good. But the levels of my total cholesterol and my LDL are considered very high.

I eat healthy foods, no sugar, no non-starchy veg, low carb, foods with healthy fats.
E.g. yesterday my calories were: 17% from carbs, 38% from fat and 45% from protein.

I work out regularly. My BP is bang on normal, and my resting heart rate is currently 56 BPM, it goes down as low as 53 when I've been really pushing the cardio. My HBA1c has been coming down consistently and I am very close to being out of diabetic ranges. Fingers crossed for the next blood test 3 months from now!

The statins have given me one noticeable side effect: a small rise in my FBGs.
In a few weeks I'll have a test to see if they are having any negative side effects on my liver (but 2 weeks in and I'm not getting any abdominal pains or signs of jaundice).
So far, no negative effects wrt memory or muscle pains.

On the positive side of things:

• Physically very fit, strong, healthy and active, great BP and Resting HR
• Diet very good.
• HDL levels considered good
• Total Cholesterol to HDL ratio considered good
• No negative side effects from taking statins so far aside from slight raising of FBG levels

On the negative, or risk side of things:

• Diagnosed T2 diabetic last year which increases my risk of cardio vascular disease
  
• My family history increases my risk of cardiovascular disease
  
• LDL levels considered bad irrespective of ratio to HDL increases my risk
• A strong history heart disease on my father's side of the family which increases my risk of cardiovascular disease
• Changing diet and lifestyle did not bring down my cholesterol scores
• No idea how long I have been insulin resistant and/or had unhealthily high BG levels (looking back at some of what I know now are early indicators or IR and high, BG I could have had these issues for 10 years or so)

So now it is about risk management. It is hard to know if statins are going to help you. Some people will see no positive effect from them, because really they were not really at risk in the first place. Some will see a great positive effect because they were at risk. We know that post heart attack survival rates are affected massively by taking statins:
https://my.clevelandclinic.org/health/articles/17506-statin-medications--heart-disease#:~:text=The trial showed that compared,of dying from any cause.
This is looking at people we know post event were definitely at risk.
From the paper above:
"The trial showed that compared to patients taking the placebo, patients taking a statin had a 54% lower chance of heart attack, 48% lower chance of stroke, 46% lower chance of needing angioplasty or coronary artery bypass surgery, and a 20% lower chance of dying from any cause."

Are statins going to help me? Very hard to say for sure. But on balance looking at:

1. the risks from my measured cholesterol levels
2. the risks from my own health history
3. the risks from my family history
4. the potential mitigations to the above risks from my diet and lifestyle
5. the potential mitigations to the above risks from taking statins
6. the lack of negative side effects for me from the statins

I am going to take the statins and see how things go both in terms of changes to my cholesterol numbers and any side effects. If I have any bad side effects or see no benefits happening from the statins, then I will stop taking them. But I will keep sticking to my healthier diet and lifestyle.

Sadly we don't get to know everything before we make all our decisions.

Apologies for the long post.
But @CallMeAlan, I would suggest not having a knee jerk response to taking statins based solely on the side effects some people have had, many many more have no such side effects. My heart felt sympathies to those who have had bad side effects. But it is absolutely not true to say that statins are useless for everyone as a lot of Youtube influencers seem fond of saying these days. I would be suspicious of such extreme views. T2 diabetes is a risk factor to consider, family history is a big risk factor to consider, you own personal blood measures are a risk factor to consider. Make your choice based on those risks. Cardiologists seem to agree from their experience that a fit and active diabetic is more at risk than a sit on the couch not very fit non-diabetic, add family history and then it is even more so the case.

I have a background in physics and engineering as well medical sciences. I see a lot of similarities between what engineers do to look after physical assets at risk of failure and act to prevent those failure; and what the medical professionals do to look after assets like the heart and vascular systems. You may notice as an engineer when looking at your signals on a railway for example, that when certain characteristics or parameters of a signalling asset reaches certain measurable values or combinations thereof, an intervention of type X or Y is going to prevent failure and perhaps keep the asset functioning as well as a brand new one would with much reduced risk of failure or negative effects. You will continue to monitor it of course. But the intervention is deemed worthwhile. Though in reality for 10% of the assets you do this intervention for there may be no benefit. When dealing with physical assets the logic os cold and clear. But when you or I are the asset and the we are made aware of what is recommended and what the effects, side effects and risks may be it becomes a lot harder to make a decision. I thought long and hard about it before opting to try the statins offered.

Whatever choice you make, the best of luck mate. Just make your own choice based on your own factors. Keep looking at the measures and remember you can always change your mind either way.

For those who want to dig a bit deeper....

https://www.diabetes.co.uk/forum/threads/cholesterol-and-statins.156985/

A really useful video IMHO from a respected cardiologist on the subject of statins: