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Statins

I should have added - there are two targets in the DM section that are to do with statin prescription:

DM022. The percentage of patients with diabetes aged 40 years and over, with no history of cardiovascular disease and without moderate or severe frailty, who are currently treated with a statin (excluding patients with type 2 diabetes and a CVD risk score of <10% recorded in the preceding 3 years) --------- 4 points , thresholds 50/90%

and

DM023. The percentage of patients with diabetes and a history of cardiovascular disease (excluding haemorrhagic stroke) who are currently treated with a statin ---------2 points, thresholds 50/90%

A QoF point is worth £220.62 in 24/25. The targets are not about what happens to the patients, but simply that they've had a statin prescribed. I cannot get a CVD risk score of less than 10% simply because of my age, thanks to the way the CVD risk score is calculated, so I am not helping my practice achieve target DM022.

Edited to add Qof point value for 24/25
 
KennyA said:
It works through the Quality and Outcomes Framework (QoF) in the UK. Basically a certain (very large) number of targets are set - eg 90% of patients fitting a, b, and c criteria are to be on medications x, y and z, and the GP practice is paid for achieving the targets. Targets are set by negotiation between NHS England and the BMA with the Department of Health on the sidelines.

The amount is not that large per target, but given the number of targets it adds up. The chances of a single patient's choice affecting what the practice gets paid is miniscule, and most of the targets are set around a lower achievement at say 75%, and higher one at (eg) 95%. Achieving the higher one gets a bigger payment.

This system is opposed by the BMA who believe that it is unduly prescriptive and does not take account of individual cases, as well as breaching trust between patient and doctor. It obviously rewards doctor activity rather than patient outcome. And because it takes the public health approach - eg this will benefit 80% of people but to achieve that we'll make everyone do it - there are undoubtedly people for whom the target is inappropriate.

I've posted a link before, but here it is again for 24/25:


Diabetes mellitus at page 48: nine (if I've counted correctly) targets, and none of them is about remission, although they will get a payment if 35% of patients have an HbA1c of 58mmol/mol or less, with a bonus for 75%:

DM020. The percentage of patients with diabetes, on the register, without moderate or severe frailty in whom the last IFCC-HbA1c is 58 mmol/mol or less in the preceding 12 months
Click to expand...
Stunning !- thanks for this information
Shoran
 
Hi

I need help.

Pre diabetic since 2007, have not progressed to type 2, controlled through diet. I have also had high blood pressure for 38 years, I was 24 when diagnosed. Genetic, maternal side

Unfortunately, my low carb diet has raised my cholesterol and I have been fighting with cholesterol levels going up and down for years.

In sequence from 2015. Have only been tested annually for the last 3 years.

7.2, 5.8, 8.2, 5.6, 8.8. 6.8, 7.6. I have refused statins every time.

Yesterday was my annual blood test. A1C 39, Liver normal, kidneys normal. Lost weight and back into normal bmi. Cholesterol 6.6!! Not only is it high but my HDL never seems to be high enough and they didn’t test tryglycerides, which are probably too high as well, I just don’t seem to be able to get any of the numbers right.

I don’t want statins but I am running out of options. My Mum took them years ago, said they made her head feel funny and stopped taking them. Not long after that she developed Alzheimer’s.

I have been a member of a few anti statin groups on Facebook but I have left them both today, as I went on with the question of how to raise my HDL and basically got attacked about not lowering my A1C enough, telling me to cut carbs and processed food ( hey I did that years ago!!) and sneering at my choice of supplements.

I have tried plant sterols, citrus bergamot, I take Berberine for blood sugar and then Black seed oil for my blood pressure. BP on meds averages 111/68.

I have spent the day fighting back the tears, as I have failed again. I should have been so excited with my sugar result as I have tried to get it under 40 for so many years and I finally did it!

I have kept this to myself today. Have been very quiet and have not spoken to my husband about it. He keeps telling me what a great job I did with the test. Have swung back and forth all day about worrying about having a heart attack or stroke, with feeling awful and developing side effects on statins. I have also read that statins raise blood sugar! Great!

I have been taking propranolol for my BP since 1987. If you google this drug in relation to Tryglycerides and HDL, it says it raises trigs and lowers HDL.

I have a poor relationship with my GP, mostly because I don’t want to take statins. This makes me reluctant to go and ask for a change in my bp meds but feel this might help some of the results. The cholesterol I guess is hereditary, as I eat well, no rubbish just healthy home made food and low carb. My qrisk score was 14.7 ( although when I put my own figures in it came out at 9.72)

I am a fit, very active 62 year old. 65 kg 165 cm

Any advice? I feel like I am about to throw in the towel and just accept the statins. I have failed.
 
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You have NOT failed! Your BG readings are great - well done!

There is a lot of pressure on us to take statins, but if we understand that there is financial pressure on Drs. to prescribe them, and we check out the most modern research (early research didn't even include women!) you will find interesting information on which to base your decisions. GPs don't have that incentive, but we do.
 
Donnadoobie said:
Hi

I need help.

Pre diabetic since 2007, have not progressed to type 2, controlled through diet. I have also had high blood pressure for 38 years, I was 24 when diagnosed. Genetic, maternal side

Unfortunately, my low carb diet has raised my cholesterol and I have been fighting with cholesterol levels going up and down for years.

In sequence from 2015. Have only been tested annually for the last 3 years.

7.2, 5.8, 8.2, 5.6, 8.8. 6.8, 7.6. I have refused statins every time.

Yesterday was my annual blood test. A1C 39, Liver normal, kidneys normal. Lost weight and back into normal bmi. Cholesterol 6.6!! Not only is it high but my HDL never seems to be high enough and they didn’t test tryglycerides, which are probably too high as well, I just don’t seem to be able to get any of the numbers right.

I don’t want statins but I am running out of options. My Mum took them years ago, said they made her head feel funny and stopped taking them. Not long after that she developed Alzheimer’s.

I have been a member of a few anti statin groups on Facebook but I have left them both today, as I went on with the question of how to raise my HDL and basically got attacked about not lowering my A1C enough, telling me to cut carbs and processed food ( hey I did that years ago!!) and sneering at my choice of supplements.

I have tried plant sterols, citrus bergamot, I take Berberine for blood sugar and then Black seed oil for my blood pressure. BP on meds averages 111/68.

I have spent the day fighting back the tears, as I have failed again. I should have been so excited with my sugar result as I have tried to get it under 40 for so many years and I finally did it!

I have kept this to myself today. Have been very quiet and have not spoken to my husband about it. He keeps telling me what a great job I did with the test. Have swung back and forth all day about worrying about having a heart attack or stroke, with feeling awful and developing side effects on statins. I have also read that statins raise blood sugar! Great!

I have been taking propranolol for my BP since 1987. If you google this drug in relation to Tryglycerides and HDL, it says it raises trigs and lowers HDL.

I have a poor relationship with my GP, mostly because I don’t want to take statins. This makes me reluctant to go and ask for a change in my bp meds but feel this might help some of the results. The cholesterol I guess is hereditary, as I eat well, no rubbish just healthy home made food and low carb. My qrisk score was 14.7 ( although when I put my own figures in it came out at 9.72)

I am a fit, very active 62 year old. 65 kg 165 cm

Any advice? I feel like I am about to throw in the towel and just accept the statins. I have failed.
Click to expand...
I'm not seeing any failure at all here.

Your cholesterol figures vary because your body's production of cholesterol varies. Around 80% of your cholesterol is made in and by your body. Statins interfere with that production - they have no effect on the much smaller fraction of cholesterol from your food.

Qrisk is a rigged test, weighted to produce the results wanted. I can't ever get a score less than 10% because of my age. Even if all my other markers are perfect I'm always still "high risk". There is a public health position in the UK (for the moment) that advocates lower cholesterol, and therefore prescribing statins. There is equally a valid medical position that disputes the value of this.

In addition, your total cholesterol levels are calculated rather than measured directly, so there are built-in assumptions at work. You might find these recent bits of research to be an interesting read. In short, they find that the "risk" of high cholesterol appears to be over stated, and that mortality rises with low cholesterol (~under 5).

www.nature.com

Total cholesterol and all-cause mortality by sex and age: a prospective cohort study among 12.8 million adults - Scientific Reports

It is unclear whether associations between total cholesterol (TC) levels and all-cause mortality and the optimal TC ranges for lowest mortality vary by sex and age. 12,815,006 Korean adults underwent routine health examinations during 2001–2004, and were followed until 2013. During follow-up...
www.nature.com www.nature.com

A study based on nearly 13 million adults

Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospective data from the Norwegian HUNT 2 study - PMC

Many clinical guidelines for cardiovascular disease (CVD) prevention contain risk estimation charts/calculators. These have shown a tendency to overestimate risk, which indicates that there might be theoretical flaws in the algorithms. Total ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov

Conclusion
Our study provides an updated epidemiological indication of possible errors in the CVD risk algorithms of many clinical guidelines. If our findings are generalizable, clinical and public health recommendations regarding the ‘dangers’ of cholesterol should be revised. This is especially true for women, for whom moderately elevated cholesterol (by current standards) may prove to be not only harmless but even beneficial.

https://www.bmj.com/content/353/bmj.i1246 [this one is interesting because it revisits the original work from the Minnestoa Coronary Experiment on cholesterol reduction. In layman's terms, the original reseach's "incomplete" publication fiddled the figures]

Conclusions Available evidence from randomized controlled trials shows that replacement of saturated fat in the diet with linoleic acid effectively lowers serum cholesterol but does not support the hypothesis that this translates to a lower risk of death from coronary heart disease or all causes. Findings from the Minnesota Coronary Experiment add to growing evidence that incomplete publication has contributed to overestimation of the benefits of replacing saturated fat with vegetable oils rich in linoleic acid.

I don't find any of the groups on Facebook or reddit etc. to be worth it. Far too many people willing to tell you what to do and yell at you if you don't - we try to avoid that on this forum... not always successfully.
 
Statins affected my memory and ability to think straight - not in a small way.
I really can't justify risking my almost genius level IQ and wicked intellect in order to have more years spent staring out of the windows of a care home trying to work out how to escape and live feral in the New Forest.
 
I stopped taking Statins, as i could barely walk, and my wife was seriously worried that i was developing Alzheimers.
I can now walk reasonably well, circulation dependent. And usually get close to the 1% question, and even sometimes get it. This is after having 3 strokes, only 2 officially on record. I would rather live a few DAYS less with a good quality of life. Than a few DAYS more with what time i have seeming like an eternity. My Cholesterol level is currently what it was nearly 50 years ago, strangely it was absolutely fine then.
 
@Resurgam - fully 20% of the total cholesterol in your body is in your brain - and made there by brain cells - it forms the lining of the cells that literally carry your thoughts. Statins pass the blood/ brain boundary and disrupt production of cholesterol. I actually managed to get my GP to agree with this assessment - but did not get an answer to "and so why would I want to take a drug that did that?"

But - this is the link between statins and "brain fog" - etc.

@Donnadoobie - hang in there, I only see amazing success in what you're doing.

Also - Plant Sterols - they will reduce the measurable LDL molecules, but understand that what they do is present the liver with the option that it doesn't need to make as much - you can never eat as much food rich in Cholesterol compared to what you need (you need cholesterol for loads of things - like making the lining of your blood cells, or testosterone, to pick a couple) so if you take plant-sterol instead of chole-sterol, your liver will use it instead, but it's really plant-sterol, not human-sterol (I'm deliberately over-simplifying) and so the things your body makes from it just don't work so well - so, Plant sterols do actually do what they say - will reduce your LDL levels, but quite often that is totally irrelevant, (per everything said here) and only because it replaces the things you need with plant equivalents, which are better for plants than humans.
 
Thanks Kenny and Outlier. Your words and research evidence is very reassuring this morning.

It is mostly what I have already known and understood but had a crisis of confidence after a 6.6 TC

I will try to sort out my propranolol issue, as I am sure this is not helping me healthwise anyway.
Chris24Main said:
@Resurgam - fully 20% of the total cholesterol in your body is in your brain - and made there by brain cells - it forms the lining of the cells that literally carry your thoughts. Statins pass the blood/ brain boundary and disrupt production of cholesterol. I actually managed to get my GP to agree with this assessment - but did not get an answer to "and so why would I want to take a drug that did that?"

But - this is the link between statins and "brain fog" - etc.

@Donnadoobie - hang in there, I only see amazing success in what you're doing.

Also - Plant Sterols - they will reduce the measurable LDL molecules, but understand that what they do is present the liver with the option that it doesn't need to make as much - you can never eat as much food rich in Cholesterol compared to what you need (you need cholesterol for loads of things - like making the lining of your blood cells, or testosterone, to pick a couple) so if you take plant-sterol instead of chole-sterol, your liver will use it instead, but it's really plant-sterol, not human-sterol (I'm deliberately over-simplifying) and so the things your body makes from it just don't work so well - so, Plant sterols do actually do what they say - will reduce your LDL levels, but quite often that is totally irrelevant, (per everything said here) and only because it replaces the things you need with plant equivalents, which are better for plants than humans.
Click to expand...
Thanks for that Chris.

TBH only take the plant sterols in the run up to a blood test, as I am also of the belief that we need cholesterol in our bodies but I had never thought of it that way before.
 
Yesterday I met a friend that I hadn't seen for a while. She has been told to take statins despite the fact that her cholesterol readings are between 2 and 3. She has declined. But we can only guess at the GP's priorities........
 
After a lift in mood yesterday I am back down again.

The stress of the last few months and the build up to ‘the test’ has definitely taken it’s toll and I am again tearful.

I think what is bothering me is that I expected my total cholesterol to be high but put a lot of effort into raisin my HDL and wanted to see my triglycerides, which despite fasting and requesting a fasting test, they didn’t check them. They would probably have been too high anyway.

I feel that no matter what I do I can never get HDL up ( in fact it has dropped each test) and triglycerides are always raised. Is there any way to balance sugar with cholesterol? It feels impossible. They say, exercise, don’t eat carbs or processed food, take berberine, sleep well, eat olive oil and oily fish. I do all of these and nothing happens!

Propranolol, which I have taken for 38 years, from reading seems to lower HDL and raise triglycerides.

As I don’t have a good relationship with my GP I am nervous to ask to come off propranolol. I actually want to change my GP but there is only one In my surgery that I would want and I don’t think I can be with her, as I used to look after her children as a childminder. I might just message her for advice anyway.

Is there any way of being able to see a low carb anti statin gp in the U.K.?

I actually feel as if I am falling into a big hole and the more I think the deeper I go. My husband is losing patience with me too I think, although he always supports me whatever.
 
Hi @Donnadoobie We are all different, but in general as well as in my personal experience LCHF increases HDL and decreases Triglycerides in most people. Also, most T2 diabetics (though not me) are/were overweight and for them LCHF mostly either has no effect on LDL, or actually reduces it.

As I said I'm in a minority having been a TOFI (Thin Outside Fat inside), so in my case (and of other slim T2's that I know of) LCHF while having that good effect on HDL and Triglycerides does raise LDL, sometimes by quite a lot. These are sometimes called 'Lean Mass Hyper-responders' and there is a medical study taking place to see if there hugely raised LDL actually contributes to plaque in the arteries. The initial results show there is considerable doubt about this because at the start of the study those who had been lean and eating LCHF for over 1yr had the same or less artery plaque that those in the control group despite having much higher LDL. Some were tested as to the type of LDL in their bloodstream and it was found that the majority of it was of the 'light fluffy' LDL which is not thought to harm arteries.

I find this encouraging even though my LDL isn't quite high enough to qualify as a Lean Mass Hyper-responder, plus those in the study were athletic and hadn't had T2 diabetes (I'm not a fan of exercise and have been in remission for over 4yrs).

It is known that increasing total carbohydrates to around 100gms per day often reduces LDL for those eating LCHF with high LDL, but that option is not available to me since I need to stay below 40gms in order to keep my BG low and stay in remission. I choose to be in T2D rather than worry about my LDL, since uncontrolled diabetes is one of the biggest risks for heart disease. That is just a personal choice as in my opinion. there is no compelling data to convince on either side.
 
I am top end of normal BMI. I have exercised all my life and am fit enough to run a 5k, slowly, in around 40 minutes and generally do 10,000 plus steps a day. I eat a low carb diet and have done for around 8/9 years. My Blood Pressure since going low carb has dropped from an average of 138/85 to 111/68. Weight has dropped from 13 st 2lbs to 10st 7lb ( it went to 9st 6lb initially but has settled around 10.7 mark) A1C in 2015 was 49 is now 39

It just seems so unfair that everything I do seems to be wrong. I feel sugar control is the most important ( 39 for A1C on Monday) and I really wouldn’t worry about the LDL if the HDL and triglycerides were good but they are pants! 0.88 HDL last week and trigs were last taken 2 years ago and were 2.2.

I will keep going with low carb, push on to lose more weight, as that might do it but at 62 I don’t want to get too skinny as It it makes you look scrawny and saggy but hey health is the most important thing.

I am good at dusting myself off but always need these dark down days to push me onwards. First thing I will do is contact the gp, the one who I used to care for her children. She probably won’t be able to help me but might point me in the direction of somebody who can.

I have a holiday in Greece in 4 weeks. Will go and relax and enjoy a few treats I don’t normally allow myself.


Thanks for your reply
 
Had phone call from the pharmacist at my practice about my cholesterol figures -
Serum Cholesterol/HDL 3.3
Serum LDL cholesterol 4.8
Serum non high density lipoprotein 5.2
Serum Cholesterol 7.5
Serum trigs 0.8
Serum HDL cholesterol 2.3

She said that I should definitely be taking statins, She became quite irate when I refused to take them. She said that had recently been a new study but wouldn't give me any reference.


Levothyroxine -taking 50 micrograms every day, 25 micrograms every other day. T3 25mcg 1/2 tablet every day.

I am seeing the 'diabetic' nurse on Monday. That should be interesting.
 
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Donnadoobie said:
I am top end of normal BMI. I have exercised all my life and am fit enough to run a 5k, slowly, in around 40 minutes and generally do 10,000 plus steps a day. I eat a low carb diet and have done for around 8/9 years. My Blood Pressure since going low carb has dropped from an average of 138/85 to 111/68. Weight has dropped from 13 st 2lbs to 10st 7lb ( it went to 9st 6lb initially but has settled around 10.7 mark) A1C in 2015 was 49 is now 39

It just seems so unfair that everything I do seems to be wrong. I feel sugar control is the most important ( 39 for A1C on Monday) and I really wouldn’t worry about the LDL if the HDL and triglycerides were good but they are pants! 0.88 HDL last week and trigs were last taken 2 years ago and were 2.2.

I will keep going with low carb, push on to lose more weight, as that might do it but at 62 I don’t want to get too skinny as It it makes you look scrawny and saggy but hey health is the most important thing.

I am good at dusting myself off but always need these dark down days to push me onwards. First thing I will do is contact the gp, the one who I used to care for her children. She probably won’t be able to help me but might point me in the direction of somebody who can.

I have a holiday in Greece in 4 weeks. Will go and relax and enjoy a few treats I don’t normally allow myself.


Thanks for your reply
Click to expand...
@Donnadoobie - it is tough when you are under such pressure to bow to the advice on Statins.

For my next set of blood tests (which I'm about to go and arrange) - I need to draw up a chart. My last set; I was ecstatic with, but the note from my GP was "disappointing to see the cholesterol is still high" - but this is something of an ongoing argument that we have. On my last visit, I said to her:

"Look, the four critical risks for heart disease, the thing that we are all focussed on, particularly Diabetics, because statistically most diabetics die of heart disease, and I have this from several books written by heart surgeons and Cardiologists - they are: smoking, high blood glucose, high blood pressure, and elevated stress hormones - the only direct causes of heart disease are sickle-cell anaemia, and Lupus."

I had that written down beforehand (which is why I can quote verbatim - and also the thing about the brain). The point being that none of these direct risks involve my LDL level - all of that depends on a theory of plaque buildup which has never been proven, was not 100% agreed with when it was presented in the Fifties, and that I don't buy into"

We agreed on some of that, not all... but she did agree not to try to force the issue...

So, the chart I need to draw up, is the ratio of triglycerides to HDL - The problem with the serum lipid test we get is that it's both too complex and too simple. On the one hand - if you buy the "heart disease is a condition of too much damage and repair, not some kind of furring up thing that biologically cannot actually happen" - then you really don't need to worry about the level of LDL - it's all based on bad science that goes back generations (this is my opinion of course, and of many others that I respect, but definitely not the medical baseline) - or if you are still concerned (because lipid levels are complex and important) - then you really need to know what type of LDL molecules your liver is producing - are they nice and fluffy, or small and dense (and therefore likely to cause damage much like the blood cells do in sickle-cell) - this also being related to diet, but not in the way that the doctors will tell you. But the key thing is that the small, dense type of LDL molecules don't get measured in the serum lipid panel, but you can get a fairly accurate idea of the spread of the size of molecule by looking at the ratio of Triglyceride to HDL..

Hope that helps - or at least gives you some ..material to have a more helpful conversation with your support team..
 
How important is the cholesterel ratio and what are the “good” parameters please.
 
PenguinMum said:
How important is the cholesterel ratio and what are the “good” parameters please.
Click to expand...
Well, that's the big question. Some doctors say the ratio doesn't matter at all and that there is no such thing as good cholesterol.

In my opinion what matters it the ratio of 'light fluffy' LDL to total LDL, but in the UK the standard test doesn't even measure total LDL, it is just estimated using one of 2 formulae.

Numbers and ratios that are meaningful for us are:
HDL near or above 2.0
Triglycerides near or lower than 1.0

Some doctors say that if you have both of those then the majority of your LDL will probably be of the 'light flufy' supposedly harmless variety.
 
These are my figures and ratios . All in mmol/ls
TC - 6.5
HDL - 1.71
LDL - 4.54
Triglycerides - 0.54

My Total Cholesterol of 6.50 is High Risk
My LDL of 4.54 is High Risk
My HDL of 1.71 is Optimal
My Triglyceride level of 0.54 is Optimal

Yet my ratios are:
My TC/HDL ratio is 3.80 - Good
My HDL/LDL ratio is 0.377 - Good
My Triglycerides/HDL ratio is 0.316 - Ideal

I don’t drink alcohol, I don’t smoke, I’m very fit. I have a BMI of 19
I eat mainly chicken and fish, I have red meat may be once or twice a month.
I eat a lot of salads
I cook from scratch.
I do have a problem metabolizing fats, that said I do eat cheese, and I use olive oil for all my cooking and dressings.

If statins are suggested, I will turn them down, unless my Dr can give me a good reason for using them, but I doubt he will. I’m assuming my LDL’s are mainly the light and fluffy kind.
Edited for clarity.
 
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