Are these good or bad test results

[Gwynn]

Hi I got a set of cholesterol test results but I am not sure if thdy are bad or ok. Any experts out there to help me with this?

Total Cholesterol 5.9 (NHS guideline <5)
Triglycerides 1.0 (NHS guideline < 2.3)
HDL 1.78 (NHS guidelines > 1.0)
LDL 3.66 (NHS guidelines < 3.0)
'Ratio' 3.3 (NHS guidelines <6.0)
Non HDL 4.12 (NHS guidelines < 4.0)

So some seem ok, some well within, some out of bounds. But overall are they ok results?

 

[Deleted member 21371]

You will be bombarded with loads of answers claiming high cholesterol is good for you based on a discredited study even the authors withdrew.
I take the NHS figures as my target.
These are close enough to be excellent.
(Personally, I would try to trim the LDL a little bit, but that's me trying to trim the .66! saturated fat pushes my bad cholesterol through through the ceiling)
Brilliant result overall

 

[Gwynn]

Thank you. That helps me a lot.

 

[Burylancs]

Hi I got a set of cholesterol test results but I am not sure if thdy are bad or ok. Any experts out there to help me with this?

Total Cholesterol 5.9 (NHS guideline <5)
Triglycerides 1.0 (NHS guideline < 2.3)
HDL 1.78 (NHS guidelines > 1.0)
LDL 3.66 (NHS guidelines < 3.0)
'Ratio' 3.3 (NHS guidelines <6.0)
Non HDL 4.12 (NHS guidelines < 4.0)

So some seem ok, some well within, some out of bounds. But overall are they ok results?

Not too good for a diabetic. Those NHS targets are for ordinary people. Diabetic targets are tighter - Total Cholesterol under 4 and LDL ('bad' chol ) under 2. The tipping point for the acceleration of Cardio Vascular Disease ( one of the main complications we are battling) comes at Total Chol over 4 for Diabetics ( over 5 for non-Ds). LDL are the blighters that get into the linings of the arteries causing a progression of foam cells, fatty streaks, atheroma, plaques, heart attacks, strokes etc.
You can do the QRISK calculation which suggests if you are over 10 % risk of a heart attack you should take a statin. Of course once you put 'diabetic' in the calculator your risk zooms up because we manufacture large amounts of LDL when Our bgs are raised and 85% of diabetics die of cvd ( or did do before the advent of statins in the 1990s).

 

[silentsquirrel]

Gwynn, when i was diagnosed with Vascular Parkinsonism a year ago (tremor only symptom at the moment), the consultant neurologist/geriatrician advised that the best thing I could do was to keep Bgs, Bp and cholesterol levels as good as possible. She then looked at my previous cholesterol results in my notes, and said, with some surprise, that my cholesterol was actually quite good, with quite low trigs and quite high HDL (as you have). She did not even mention LDL or the high total (6.8, I think). The total is all my surgery nurse ever sighs about at reviews. (GP sensibly ignores cholesterol numbers, as I am statin intolerant.) I'm happy with the consultant opinion!

 

[Eddy Edson]

There are no experts here, and whether yr lipid profile is ok or not depends on your individual risk profile.

This is a tool UK practitioners are supposed to use as a guide for risk assessment: https://www.qrisk.org/three/index.php

 

[Sharron1]

There are no experts here, and whether yr lipid profile is ok or not depends on your individual risk profile.

This is a tool UK practitioners are supposed to use as a guide for risk assessment: https://www.qrisk.org/three/index.php

A question. Entering T2 will, I assume increase the risk but there is no consideration of how well managed (or not) the diabetes is. Surely that must have a bearing on a result? It seems to be a bit rough and ready.

 

[Eddy Edson]

A question. Entering T2 will, I assume increase the risk but there is no consideration of how well managed (or not) the diabetes is. Surely that must have a bearing on a result? It seems to be a bit rough and ready.

It does seem that way. But as I understand things (limited!), there is evidence that diabetes can have an impact on CV risk independently of how well BG is controlled.

 

[Gwynn]

Thank you all for you replies. Very helpful. I will have to wait for my next blood test (don't know when) to see if things are improving or not. They seemed a tiny bit better this last time from the original set at diagnosis.

 

[Sharron1]

What a b*****d that Diabetes is

 

[AndBreathe]

Hi I got a set of cholesterol test results but I am not sure if thdy are bad or ok. Any experts out there to help me with this?

Total Cholesterol 5.9 (NHS guideline <5)
Triglycerides 1.0 (NHS guideline < 2.3)
HDL 1.78 (NHS guidelines > 1.0)
LDL 3.66 (NHS guidelines < 3.0)
'Ratio' 3.3 (NHS guidelines <6.0)
Non HDL 4.12 (NHS guidelines < 4.0)

So some seem ok, some well within, some out of bounds. But overall are they ok results?

Gwynn, the attached image is my latest lipid profile, done in June, as part of a study into cardiac disease and T2. I took part as part of a small cohort whose T2 is in remission.



To be honest, when the results flashed up on the screen, my initial reaction was along the lines of "Here we go........"

Bottom line is the cardiologist saw no reason why I should be taking a statin (I don't and never have) as my ratios and triglycerides were good.

So, the message? Lipids seem to be a hot topic, but I'm content to take the messaging of a cardiologist undertaking research into T2, seeing LOTS of T2s.

To be absolutely clear, had I had an historic cardiac even or certain types of cardiac disease in play, the recommendation would be differed.

I'd have a look at the QRisk Scores, plus HughCalc: https://www.hughcalc.org/chol-si.php and https://cholesterolcode.com/report/

Good luck with it all. There's a lot to do, a lot of learning to take on board.

 

[everydayupsanddowns]

A question. Entering T2 will, I assume increase the risk but there is no consideration of how well managed (or not) the diabetes is. Surely that must have a bearing on a result? It seems to be a bit rough and ready.

It does seem that way. But as I understand things (limited!), there is evidence that diabetes can have an impact on CV risk independently of how well BG is controlled.

I’ve asked different clinicians about this in various conversations over the years (not necessarily about my own situation).

There is an understanding as @Eddy Edson says that having diabetes, by default, will raise your risk. It‘s an association that’s fairly well understood. Because no matter how well managed you aim to be (esp in the case of T1?) you will be having levels and variations in BG that a ‘nonny’ simply never would.

Various data (UKPDS and DCCT) do show a reduction in risk with better management, so aiming for stable and relatively in-range BGs is certainly worth it.

I have heard some fairly eminent clinicians say that tools like QRISK don’t really work for PWD for exactly the reasons that you suggest @Sharron1 - but they are what we have. Added to which the whole situation is a bit fuzzy anyway because of the data and the interpretation of risk elevation involved (2 identical HbA1c can come from very different glucose profiles and convey very different levels of risk… different types of LDL - some arguably not ‘bad’… trigs as a proxy for dense vLDL… ratios of various panel components… blah blah blah). But they didn’t just stick a finger in the air to develop the tool. There will certainly be a lot of data, research, and specialist knowledge underpinning it.

So I think while it may seem a bit ‘rough and ready’ it’s pretty decent rough and ready. A bit like a 2-3week weather forecast perhaps? Probably more or less right in general, but don’t rely on it being 100% precisely accurate for 2 weeks on Wednesday afternoon)

 

[Leadinglights]

Gwynn, the attached image is my latest lipid profile, done in June, as part of a study into cardiac disease and T2. I took part as part of a small cohort whose T2 is in remission.

View attachment 18721

To be honest, when the results flashed up on the screen, my initial reaction was along the lines of "Here we go........"

Bottom line is the cardiologist saw no reason why I should be taking a statin (I don't and never have) as my ratios and triglycerides were good.

So, the message? Lipids seem to be a hot topic, but I'm content to take the messaging of a cardiologist undertaking research into T2, seeing LOTS of T2s.

To be absolutely clear, had I had an historic cardiac even or certain types of cardiac disease in play, the recommendation would be differed.

I'd have a look at the QRisk Scores, plus HughCalc: https://www.hughcalc.org/chol-si.php and https://cholesterolcode.com/report/

Good luck with it all. There's a lot to do, a lot of learning to take on board.

Interesting that those results are from Fasting Blood sample as my blood tests are not fasting and never have been for years.

 

[Eddy Edson]

I’ve asked different clinicians about this in various conversations over the years (not necessarily about my own situation).

There is an understanding as @Eddy Edson says that having diabetes, by default, will raise your risk. It‘s an association that’s fairly well understood. Because no matter how well managed you aim to be (esp in the case of T1?) you will be having levels and variations in BG that a ‘nonny’ simply never would.

Various data (UKPDS and DCCT) do show a reduction in risk with better management, so aiming for stable and relatively in-range BGs is certainly worth it.

I have heard some fairly eminent clinicians say that tools like QRISK don’t really work for PWD for exactly the reasons that you suggest @Sharron1 - but they are what we have. Added to which the whole situation is a bit fuzzy anyway because of the data and the interpretation of risk elevation involved (2 identical HbA1c can come from very different glucose profiles and convey very different levels of risk… different types of LDL - some arguably not ‘bad’… trigs as a proxy for dense vLDL… ratios of various panel components… blah blah blah). But they didn’t just stick a finger in the air to develop the tool. There will certainly be a lot of data, research, and specialist knowledge underpinning it.

So I think while it may seem a bit ‘rough and ready’ it’s pretty decent rough and ready. A bit like a 2-3week weather forecast perhaps? Probably more or less right in general, but don’t rely on it being 100% precisely accurate for 2 weeks on Wednesday afternoon)

The risk increase from diabetes, as I understand it, isn't due solely to BG-related stuff, or anyway it may not be. A basic mechanism is endothelial dysfunction => atherosclerosis, and it seems that the dysfunction has multiple causes: eg as discussed here https://www.sciencedirect.com/science/article/pii/S0925443913002718

Mechanisms including altered glucose metabolism, impaired insulin signaling, low-grade inflammatory state, and increased reactive oxygen species generation ...

But this quickly goes beyond what I know anything about, and I don't really have any feel for how independent the drtivers would be from the metabolic syndrome markers (BMI, BP, lipids) which get picked up in things like QRISK3.

BTW, the NICE lipids surveillance committee recommended years ago that QRISK is in fact appropriate for T1D's but I don't know if that has made it into practice. I don't think it's ever not been recommended for T2D's.

 

[everydayupsanddowns]

BTW, the NICE lipids surveillance committee recommended years ago that QRISK is in fact appropriate for T1D's but I don't know if that has made it into practice.

Yes my consultant is certainly happy to use QRISK in the context of my T1D.

I think elevated/erratic BG is inflammatory isn’t it?

 

[Eddy Edson]

I think elevated/erratic BG is inflammatory isn’t it?

I don't know? Most things seem to be 🙂

 

[Burylancs]

Hi I got a set of cholesterol test results but I am not sure if thdy are bad or ok. Any experts out there to help me with this?

Total Cholesterol 5.9 (NHS guideline <5)
Triglycerides 1.0 (NHS guideline < 2.3)
HDL 1.78 (NHS guidelines > 1.0)
LDL 3.66 (NHS guidelines < 3.0)
'Ratio' 3.3 (NHS guidelines <6.0)
Non HDL 4.12 (NHS guidelines < 4.0)

So some seem ok, some well within, some out of bounds. But overall are they ok results?

Q

I’ve asked different clinicians about this in various conversations over the years (not necessarily about my own situation).

There is an understanding as @Eddy Edson says that having diabetes, by default, will raise your risk. It‘s an association that’s fairly well understood. Because no matter how well managed you aim to be (esp in the case of T1?) you will be having levels and variations in BG that a ‘nonny’ simply never would.

Various data (UKPDS and DCCT) do show a reduction in risk with better management, so aiming for stable and relatively in-range BGs is certainly worth it.

I have heard some fairly eminent clinicians say that tools like QRISK don’t really work for PWD for exactly the reasons that you suggest @Sharron1 - but they are what we have. Added to which the whole situation is a bit fuzzy anyway because of the data and the interpretation of risk elevation involved (2 identical HbA1c can come from very different glucose profiles and convey very different levels of risk… different types of LDL - some arguably not ‘bad’… trigs as a proxy for dense vLDL… ratios of various panel components… blah blah blah). But they didn’t just stick a finger in the air to develop the tool. There will certainly be a lot of data, research, and specialist knowledge underpinning it.

So I think while it may seem a bit ‘rough and ready’ it’s pretty decent rough and ready. A bit like a 2-3week weather forecast perhaps? Probably more or less right in general, but don’t rely on it being 100% precisely accurate for 2 weeks on Wednesday afternoon)

I’ve asked different clinicians about this in various conversations over the years (not necessarily about my own situation).

There is an understanding as @Eddy Edson says that having diabetes, by default, will raise your risk. It‘s an association that’s fairly well understood. Because no matter how well managed you aim to be (esp in the case of T1?) you will be having levels and variations in BG that a ‘nonny’ simply never would.

Various data (UKPDS and DCCT) do show a reduction in risk with better management, so aiming for stable and relatively in-range BGs is certainly worth it.

I have heard some fairly eminent clinicians say that tools like QRISK don’t really work for PWD for exactly the reasons that you suggest @Sharron1 - but they are what we have. Added to which the whole situation is a bit fuzzy anyway because of the data and the interpretation of risk elevation involved (2 identical HbA1c can come from very different glucose profiles and convey very different levels of risk… different types of LDL - some arguably not ‘bad’… trigs as a proxy for dense vLDL… ratios of various panel components… blah blah blah). But they didn’t just stick a finger in the air to develop the tool. There will certainly be a lot of data, research, and specialist knowledge underpinning it.

So I think while it may seem a bit ‘rough and ready’ it’s pretty decent rough and ready. A bit like a 2-3week weather forecast perhaps? Probably more or less right in general, but don’t rely on it being 100% precisely accurate for 2 weeks on Wednesday afternoon)

A few points …

1. The UKPDS studied 4 complications of Type 2 and found a 22% reduction in them through good control. But the UKPDS was cited by Ben Goldacre as an example of Bad Science because they aggregated the results then averaged them out. One complication, retinopathy, showed an 83% improvement from good control but in the other three,including cvd, good control had negligible effects, something like 2,2 and1%. Add em up, get 88, divide by 4 and hey presto good control gives a 22% reduction in the four complications. It came as a shock when I read Goldacre’s book because UKPDS was so cited and relied on. Bad news not just Bad Science. And recently ProfTaylor says in his work that his version of ‘remission’ does not guarantee that complications won’t occur.

2. There aren’t different types of LDL, the baloney about ‘big fluffy’ LDL is just that. Pattern A, B and C of LDL refer to the theoretical distribution of LDL about the average width of the pores in the arteries. Even an average distribution of LDL is atherogenic.

3. vLDL isn’t dense. The name itself ‘very low density’ tells you its not dense and comparatively large. In fact at an average of 112 nm it’s the second largest of the Lipids after Chylomicrons. Of course, as it gives up its cholesterol and APO-4 it shrinks in size with some becoming ‘vLDL-fragments’ which are atherogenic.

 

[AndBreathe]

Interesting that those results are from Fasting Blood sample as my blood tests are not fasting and never have been for years.

I make a point to have all my bloods done fasted, unless specified otherwise. That way I have a fairly robust comparison, with other factors, like circadian rhythms or activity coming into play.

That said, I recently had a raft of auto-immune bloods done mid morning.

 

[Deleted member 21371]

Interesting that those results are from Fasting Blood sample as my blood tests are not fasting and never have been for years.

Mine are always fasting.
I have a swathe of tests done, usually two or three pages worth, every six months or maybe a year as part of my review.
I control it by simply not eating beforehand, and only drinking water.

 

[everydayupsanddowns]

2. There aren’t different types of LDL, the baloney about ‘big fluffy’ LDL is just that. Pattern A, B and C of LDL refer to the theoretical distribution of LDL about the average width of the pores in the arteries. Even an average distribution of LDL is atherogenic.

3. vLDL isn’t dense. The name itself ‘very low density’ tells you its not dense and comparatively large. In fact at an average of 112 nm it’s the second largest of the Lipids after Chylomicrons. Of course, as it gives up its cholesterol and APO-4 it shrinks in size with some becoming ‘vLDL-fragments’ which are atherogenic.

Interesting points, thank you. And yes the vLDL thing has always bemused me. But there do seem to be references to ‘dense’ and ’gritty’ particles in the literature, as well as simply in the writings of known sceptics.

I am still open to the idea that there are different types of LDL, not all of which are trying to kill me. Some LDL does seem to have a positive role to play in bodily functions. But like many systems, it’s one which needs to be kept in balance IMO.

This meta analysis of 21 studies >30,000 participants did seem to find an association between what it calls sdLDL (small dense) and CVD risk.

Association of small, dense LDL-cholesterol concentration and lipoprotein particle characteristics with coronary heart disease: A systematic review and meta-analysis

Objectives The aim of this study was to systematically collate and appraise the available evidence regarding the associations between small, dense low-density lipoprotein (sdLDL) and incident coronary heart disease (CHD), focusing on cholesterol concentration (sdLDL-C) and sdLDL particle...

journals.plos.org