Cholesterol questions

[everydayupsanddowns]

And interesting that QRISK-3 (2018) only uses TC/HDL ratio given what @Burylancs and @travellor say about ratios having fallen out of fashion?

Maybe an update is a bit overdue?!

 

[EmmaL76]

Phew! Let’s hope your consultant was right! I’ve just been reading a long article linking to various studies round the world and the general conclusions seemed to be that good control reduced risks and that having kidney complications was often associated with CVD risk in Type 1s. It’s a pity there’s not a Type 1 Risk calculator where we can add HbA1C. It must have some effect surely?

I find it quite a stressful subject also. I had pre eclampsia twice so that worries me

 

[Inka]

I’m going to stop reading the scary studies now but it did say that an HbA1C below 53 reduced risk (by 30%). It also said ApoB was a better marker of risk for Type 1s and that the lipid profile wasn’t quite as useful for Type 1s as Type 2s.

@EmmaL76 Good control and good blood pressure seem to decrease risk a lot. I feel better reading the studies now so please don’t worry. You’re doing really well. xx

 

[EmmaL76]

I’m going to stop reading the scary studies now but it did say that an HbA1C below 53 reduced risk (by 30%). It also said ApoB was a better marker of risk for Type 1s and that the lipid profile wasn’t quite as useful for Type 1s as Type 2s.

@EmmaL76 Good control and good blood pressure seem to decrease risk a lot. I feel better reading the studies now so please don’t worry. You’re doing really well. xx

Yes I do that, read stuff then get this horrible feeling inside. In fact I’m sure dr google raises my QRISK way more than the creamy teas! Thanks inka and all x

 

[Drummer]

It was only on Twitter, but someone claiming to work in cardiology was fuming that well over half his cases had below average levels of cholesterol but it was something which could not be mentioned without serious damage to any future employment.

 

[Burylancs]

@Burylancs A bit off-topic and I’ve probably missed a post explaining this but why does having Type 1 diabetes increase heart risk so much? I did the calculator twice - once as Type 1, which I am, and again having removed Type 1 and leaving everything else the same. The difference was shocking.

I’d heard about metabolic syndrome and Type 2 risk but not so much on Type 1. That’s probably me not reading around on the topic, but any information or links would be appreciated regarding exactly why the risk is so increased.

Apologies for hijacking your thread a bit @EmmaL76 I was offered statins but refused them. My ratio was good, my HDL high and my triglycerides very low. I personally think it’s always easier to make decisions with the full facts, so I hope my question above helps.

Apparently at times of raised bgs LDL is over produced. All diabetics are at risk of that. I don't know the biochemistry involved in that.

 

[Deleted member 21371]

And interesting that QRISK-3 (2018) only uses TC/HDL ratio given what @Burylancs and @travellor say about ratios having fallen out of fashion?

Maybe an update is a bit overdue?!

It does appear to be.
Another downside of that particular method of assessing risk is there was a study referenced on here, that showed there was a cut off limit of around 2.3 on the effectiveness of HDL.
Past that ceiling it seems increasing HDL actually has minimum effect on risk, so the ratio, while good, negates the effect of HDL, but increases the risk from non HDL.

 

[Robin]

I've just bitten the bullet and started Statins again. I got pains in my arms when I took them before, (tried a couple of different ones, too) but the registrar at the hospital at my recent review suggested that there were more modern ones now that have fewer SEs, he suggested a very low dose, and one every other day, so that’s what I’ve started on. I can’t think that’ll make much difference, but assume he gets to tick a box somewhere.
As I understand it, all people with Type 1 who are over 40 OR had it for more than 10 years are advised statins, irrespective of cholesterol levels, which seems a bit daft to me for people with low levels to begin with. So because of the SEs I’d had, I declined them for for the last few years as my levels were in the 5s. Recently they crept up to the 6s though, and it was my LDL that had increased, so I said I was prepared to give them a go.

 

[Burylancs]

I've just bitten the bullet and started Statins again. I got pains in my arms when I took them before, (tried a couple of different ones, too) but the registrar at the hospital at my recent review suggested that there were more modern ones now that have fewer SEs, he suggested a very low dose, and one every other day, so that’s what I’ve started on. I can’t think that’ll make much difference, but assume he gets to tick a box somewhere.
As I understand it, all people with Type 1 who are over 40 OR had it for more than 10 years are advised statins, irrespective of cholesterol levels, which seems a bit daft to me for people with low levels to begin with. So because of the SEs I’d had, I declined them for for the last few years as my levels were in the 5s. Recently they crept up to the 6s though, and it was my LDL that had increased, so I said I was prepared to give them a go.

Interesting Article ...

Cardiovascular Risk in Type 1 Diabetes Mellitus

Type 1 diabetes mellitus (T1DM) is associated with premature cardiovascular disease (CVD), but the underlying mechanisms remain poorly understood. The American Diabetes Association and the European Association for the Study of Diabetes recently updated ...

www.ncbi.nlm.nih.gov

 

[rebrascora]

My cholesterol levels have been decreasing from 5.2 since I was diagnosed with D 3 years ago and the last result was 4.5 and ratios are good. Just had a blood test this week so will get that result next week. I eat a lot of fat including saturated fat so I will be interested to see if the decreasing trend continues. I was informed up until last December that I didn't need statins by my DN and consultant and I was happy with that. I now have a new DN who says I have a QRisk of 14% and I should start statins. The factors which cause that result are my age sex and my diabetes which is well managed. I am fitter and healthier and slimmer than I was pre diagnosis with diabetes and my cholesterol has decreased and yet she wants me to now start taking statins. To me it is just not logical and not looking at me as an individual. I strongly suspect that the QRisk is inflated by the many people who don't manage their diabetes well and I resent that my diabetes diagnosis which has lead to me improving my health and lifestyle inflates my risk. I have declined the offer of statins both on this basis but also ethically, I cannot take a statin to supposedly reduce my cholesterol when I follow a higher fat diet. It would be like me bingeing on sweets every day and going through gallons of insulin to deal with it.
It is one of the main points that I want to discuss with my consultant next week to get his input and see if his opinion has changed but I do resent the nurse even suggesting I take them as I work very hard on my diet and diabetes management and my cholesterol levels have been steadily decreasing and are not particularly high to start with.

Sorry to rant a bit on your thread Emma. Statins are such a hot topic for many people, it isn't surprising you are anxious about it. Personally I don't rate the Qrisk calculator but I think if you get a low score then there is even more reason not to be concerned since your diabetes is well under control.

 

[Robin]

Interesting Article ...https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6531592/

Oh good, my takeaway from that is that my good kidney function, normal/low blood pressure and good fitness levels will stand me in good stead, as will waiting til I was over 50 to develop Diabetes. (Not that I could have done anything about that. I also can’t do anything about my advancing age!)
The interesting thing is, that when I started researching the topic a few years ago, I came up against the stumbling block of 'we need to do more research' the whole time, and this article acknowledges that the relationship between Type 1 and CVD is still not fully understood.

 

[Inka]

Interesting Article ...https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6531592/

That’s the main one I read today. It was helpful and less scary than the others.

 

[Robin]

My cholesterol levels have been decreasing from 5.2 since I was diagnosed with D 3 years ago and the last result was 4.5 and ratios are good. Just had a blood test this week so will get that result next week. I eat a lot of fat including saturated fat so I will be interested to see if the decreasing trend continues

I read something recently, and unfortunately can’t remember where. It said that some people are super-responders to carbs, and find their cholesterol levels fall when they decrease carbs, but others find their cholesterol increases when they decrease carb. I had been reducing carbs to shed a couple of Christmas pounds when I had my latest cholesterol test, I wonder if I fall into category of someone who is better having a few more carbs and a bit less fat.
A sort of 'Jack Sprat could eat no fat, his wife could eat no lean' scenario!

 

[helli]

As I understand it, all people with Type 1 who are over 40 OR had it for more than 10 years are advised statins, irrespective of cholesterol levels, which seems a bit daft to me for people with low levels to begin with. So because of the SEs I’d had, I declined them for for the last few years as my levels were in the 5s. Recently they crept up to the 6s though, and it was my LDL that had increased, so I said I was prepared to give them a go.

Some years ago (probably when I passed my 40th birthday or 10 years since diagnosis), statins were discussed with me.
My consultant at the time (the only time I met her) explained this was based on some research done with overweight people with diabetes who did not exercise. At the time, there had been no studies of the value of statin for people with diabetes with a healthy BMI who exercised regularly. AS I am not keen on taking medication for the sake of it, I declined and have never been offered them since.
With your horse-riding, I would have thought you were pretty fit but understand you may want to know your recent rise on the head.

 

[trophywench]

Atorvastatin then changed to Sim cos it was cheaper.

I couldn't understand and still don't know, why the 'starter dose' of Ator was 10mg, but with Sim, it's 20mg. So I was on them between 1998 and the noughties and it wasn't until the second half of the noughties that the unwanted side effects became apparent. Lots of people on DSF had reported muscular effects and by then rhabdomyalysis was known about and publicised in the medical press and by bloggers like Malcolm Kenrick, Zoe Harcombe etc - but mine weren't muscular - mine were with my memory. I didn't grasp this at all except knowing I couldn't cope very well at work any more I seemed to have considerably slowed down in how much I could process each day so I was constantly behind with things. This came to a head when in the middle of a conversation sat next to my only sister on holiday talking to her when I was literally about to say, Well you know Gill blah blah and I said Well you know - and couldn't remember her name. So I had to leave a silence, a gap, and then say the blah blah. Then shortly after that back at work we'd have meetings and I'd take quick brief notes of what I had to do whilst participating - always the way, you make the comprehensible notes after the meeting - and then entirely forget we'd had the meeting, couldn't understand these jotted down notes or which client the might be about - so obviously didn't do whatever it was - and that just got worse and worse so I was having panic attacks so BG was like the big dipper - literally HI to LO on my meter multiple times a day (but my HBA1c looked OK, how blooming wrong can that be!) and I lost my job.

I remain terrified of statins - though I have since found out that there are some which do not 'cross the blood/brain barrier' - and would like to discuss them with a medic I trust, but can't at the moment think of who that person might be. Those I've formerly trusted have either retired or disappeared! (- this happens to you as you age .... there is now ONE man who still works at our Tesco, who has been there since it opened as we have, when they built it, where the gasworks used to be!)

You did ask, @EmmaL76 !

 

[EmmaL76]

Yes I did ask, and I’m more than happy for this thread to go wherever it takes us. Always a hot topic.

 

[Robin]

With your horse-riding, I would have thought you were pretty fit but understand you may want to know your recent rise on the head.

I think all the while my total cholesterol was rising slowly (as it does with age) and my ratios were good, I resisted them, but I think I had a mental 'cut off' point, where I thought if I reached that point I would consider them. Having drifted up through the fives, and then hit the low sixes, I was a bit alarmed to have shot up to 6.9 total cholesterol at my last test, caused by my LDL increasing, so thought I'd probably reached my self imposed cut off point.

 

[Leadinglights]

There are some statins which shouldn't be taken with some blood pressure medications so that may be why people are prescribed different ones. It does seem some people tolerate some but not others. Both muscle pain, memory loss and depression being a few of the side effects.
I suppose it is the same with any medication some people tolerate them well others not so.

 

[nonethewiser]

Ever since tested for cholesterol it's always been low, around 4 lowest being 3.6 & ratios always good according to consultant, that despite liking me cheese butter eggs & things, but do eat cholesterol busting foods.

Still was offered statins & after some careful reading around & seeking advice from consultant decided to take low dose, in total was on them about 4 months with no side effects whatsoever, only stopped taking them as forgot to take them for few nights & thought what the hell.

Was told that you can still have plague in arteries even with low cholesterol & when this plaque breaks away it leads to strokes & heart attacks, it's what tipped me over to start taking them in first place.

Another thing what was reassuring was knowing that statins is one of the most researched drugs in recent times & is considered safe by all leading authorities in cardiovascular health.

 

[harbottle]

I read something recently, and unfortunately can’t remember where. It said that some people are super-responders to carbs, and find their cholesterol levels fall when they decrease carbs, but others find their cholesterol increases when they decrease carb. I had been reducing carbs to shed a couple of Christmas pounds when I had my latest cholesterol test, I wonder if I fall into category of someone who is better having a few more carbs and a bit less fat.
A sort of 'Jack Sprat could eat no fat, his wife could eat no lean' scenario!

When I was diagnosed with T2 my LDL was a bit high, HDL low, and Trigs high. After 3 months of low carb, LDL has gone up, HDL has gone up to normal levels and Trigs down to normal levels. I don't eat much saturated fat and keep an eye on how much I do eat. Might had a small bit of cheese, mainly low far Babybel, or low fat Greek Yoghurt. The odd tablespoon of double cream in a meal. Not like my wife who has half a carton of double cream over fruit and has normal levels!