Deciphering Cholesterol figures?

[pjgtech]

Hi, so I got the results from my Latest HbA1c blood test, and happy with my latest result (41) bearing in mind I'm now not on medication, so only controlling via diet.
But my cholesterol has gone up (a bit) and I know I'll be having a telephone call soon to discus this with my HCP.
I know there is good cholesterol and there is bad cholesterol, but am a little confused about which is which and what is the really important figure to pick out, eg: Total cholesterol?
So trying to arm myself with info before the inevitable phone call, what do peeps think about these latest figures, see cholesterol numbers....


If it helps my last figures were:
Cholest Serum = was 5 (now 6,5)
Triglys = was 2.2 (now 2,45
HDL was 1.08 (now 1.4)
Cheers

 

[Bruce Stephens]

LDL is bad, HDL is good, triglycerides are much badder. (That's very much a summary, I suspect. I don't remember the details.)

 

[BobbleHat]

Cholesterol is a controversial topic. Cholesterol with diabetes even more so!

My sister is a practice nurse, and is the diabetes specialist for her GP (she is also T2 in remission herself). When I was first diagnosed with diabetes, my cholesterol was also raised and was stable but still raised at my last hba1c. (Total: 6.0/6.1). When itcwas applied to my QRisk score I was still less than 10% so not offered statins (which I was undecided about accepting anyway!)

It was my sister who said that to me that total cholesterol is less useful as a health marker than the ratio. And your ratio on that form is normal (mainly because your HDL 'good' cholesterol is above average).

My understanding is that high triglycerides are of particular note too, especially for us diabetics as they can damage our pancreas and are generally caused by high carb intake.

You've just lost quite a significant amount of weight on the pathway to remission too. Triglycerides are stored in adipose tissue so can be quite elevated after a period of weight loss. That could be an argument for a wait and see approach - see if they settle as your weight loss stabilises.

I'm not a medical expert (well I am but in pregnancy/babies, not in the field of diabetes/cholesterol other than by lived experience!!) but that's my take on your results based on my own reading/advice from my sister about cholesterol.

 

[pjgtech]

Thank you very much. That is very useful to know.
I was given statins about 18 months ago and it almost crippled me, had awful muscle pains and I reckon lost about 80% of my mobility (from someone that had fairly good normal mobility). They tried me on 3 different ones over six months but all were terrible (for me). It then took me 6 months(after stopping the statins) to get anything like normal again, so I am very, very, very reluctant to try statins again. Even now, well over a year later I am still not back to normal, with knee aches that I never had before taking statins.
So just trying to gather info as best I can, cheers.

 

[counsellorneil]

@pjgtech this will probably sound weird, but will share my experience. I’ve been on avorstatins for years at 40mg daily, but wanted to try and reduce the quantity. Thankfully I was not having any adverse reactions as some, including yourself, do. I started taking a teaspoon of Amla powder daily mixed in with matcha tea every morning and three months later my cholesterol levels dropped. I got approval to half my statin dose to 20mg and next bloood test showed a further reduction, though only by a very small amount. I’d read Dr Greger book how not to age where he sited studies regarding the benefits of amla and cholesterol levels reduction. May or may not work for you.

Amla (dried Indian gooseberry) vs. Lipitor for Lowering Cholesterol | NutritionFacts.org

Extracts of amla (Indian gooseberry) were pitted head-to-head against cholesterol-lowering statin drugs and the blood thinners aspirin and Plavix. Indian

nutritionfacts.org

 

[AndBreathe]

Thank you very much. That is very useful to know.
I was given statins about 18 months ago and it almost crippled me, had awful muscle pains and I reckon lost about 80% of my mobility (from someone that had fairly good normal mobility). They tried me on 3 different ones over six months but all were terrible (for me). It then took me 6 months(after stopping the statins) to get anything like normal again, so I am very, very, very reluctant to try statins again. Even now, well over a year later I am still not back to normal, with knee aches that I never had before taking statins.
So just trying to gather info as best I can, cheers.

Have you had any cardiac or circulation issues in the past, or now?

I's urge you to do quite a bit of research on lipids and come to your own conclusions. Cholesterol can be a polarising subject (I'm not a fan), but if, after your research, you are keen to reduce your cholesterol, there are alternatives to statins these days, so don't feel boxed into a corner. If necessary, you could ask for a referral to a lipids clinic.

My only comments would be that if you are losing, or have recently bee losing weight, that cab skew cholesterol numbers, as can fasting for a protracted period before your test. Your triglycerides are also a bit higher than desired. Are you eating lots of carbs at the moment?

Do any of your family members also have elevated cholesterol?

 

[harbottle]

LDL is bad, HDL is good, triglycerides are much badder. (That's very much a summary, I suspect. I don't remember the details.)

LDL is vital for the human body, it's certainly bad, but if it gets oxidised it becomes dangerous - the particles aren't removed properly and get stuck in artery walls. (Large LDL particles are fine, apparently.)
This happens with inflammation (Common in people with T2D).
Some research I believe shows that low markers of inflammation (Such as high trigs) and high LDL may not be a problem.
Low carb diets often lead to higher LDL, but there is apparently an argument that if other markers are OK, then in may not be an issue (However, I'm not sure there's a consensus on this)

High HDL is not necessarily good, as well.

 

[pjgtech]

Have you had any cardiac or circulation issues in the past, or now?

I's urge you to do quite a bit of research on lipids and come to your own conclusions. Cholesterol can be a polarising subject (I'm not a fan), but if, after your research, you are keen to reduce your cholesterol, there are alternatives to statins these days, so don't feel boxed into a corner. If necessary, you could ask for a referral to a lipids clinic.

My only comments would be that if you are losing, or have recently bee losing weight, that cab skew cholesterol numbers, as can fasting for a protracted period before your test. Your triglycerides are also a bit higher than desired. Are you eating lots of carbs at the moment?

Do any of your family members also have elevated cholesterol?

Hi, no never had any heart probs and no not eating lots of carbs, but yes have lost load of weight 15kg ish in last 6 months.
Cheers

 

[Loobyloo]

I had exactly the same happen on a low carb diet and weight loss. It was my HDL that rose. I have similar figures to you (triglycerides lower) and my GP commented ratio fine so hasn't recommended statins. I know some GPs only look at total cholesterol and not ratio and give statins to almost anyone over 50. Depends on the views of your GP it seems as i have seen some people well under 5 total cholestererol given statins.

 

[Burylancs]

Hi, so I got the results from my Latest HbA1c blood test, and happy with my latest result (41) bearing in mind I'm now not on medication, so only controlling via diet.
But my cholesterol has gone up (a bit) and I know I'll be having a telephone call soon to discus this with my HCP.
I know there is good cholesterol and there is bad cholesterol, but am a little confused about which is which and what is the really important figure to pick out, eg: Total cholesterol?
So trying to arm myself with info before the inevitable phone call, what do peeps think about these latest figures, see cholesterol numbers....
View attachment 34798

If it helps my last figures were:
Cholest Serum = was 5 (now 6,5)
Triglys = was 2.2 (now 2,45
HDL was 1.08 (now 1.4)
Cheers

Biermann's researches in the early 1990s found that the tipping point for an acceleration in cvd/cardio problems began at Total Chols over 5. But when he focussed on diabetes he found the same tipping point in diabetics came at chols over 4. Naturally the advice became Total Chols under 4 for diabetics and under 5 for non-diabetics. This was refined with various ratios which have since been largely abandoned. Now the emphasis is on absolute level of LDL and Total minus HDL. Your 5.1 for Total minus HDL looks bad from memory. Cholesterol is a particular worry for diabetics since they are already under the cosh for cvd. Statins have made a huge impression since their advent and have become a major contributor to the good control of the consequences of Diabetes. Some wags suggest statins have helped to make cancer the main killer in America because they have made such a huge dent in heart disease and heart attacks.

LDL represents cholesterol that's on its way into the body and HDL represents cholesterol that's on its way out of the body. HDL are essentially 'binmen/scavengers' removing excess cholesterol. A good balance is needed between them in the warfare going on in our arteries. And Statins are a straightforward way of reaching recommended target levels.

The latest news on statins in the newspapers is of research that suggests they are protective against the development of dementia.

 

[pjgtech]

Thanks for the info, but as I mentioned above I'm intolerant to statins, so if medication is required, it would have to be something else. (for me).

 

[everydayupsanddowns]

Have you ever been offered ezetimibe @pjgtech ? That’s a non-statin cholesterol-lowering medication that some on the forum use.

You might find this thread detailing latest NHS lipid management guidance helpful to put your levels and varying components into context?

Thread 'NHS England lipid management guidelines'

Nov 22, 2021

Up to date and summarised in a helpful chart:

https://www.england.nhs.uk/aac/publication/summary-of-national-guidance-for-lipid-management/

Some random things which catch my eye:

- It really brings things much more into line with Euro and US guidance than I had noticed for the UK previously.

- No "HDL ratio" stuff here: it's all non-HDL and LDL cholesterol.

- PAD is recognised as a condition which puts you in the secondary prevention category, in line with international guidance. Previously, I hadn't seen that explicitly stated in UK guidance. (It does say "symptomatic PAD"...

• Eddy Edson
• Replies: 14
• Forum: Links

• 

 

[Eddy Edson]

Have you ever been offered ezetimibe @pjgtech ? That’s a non-statin cholesterol-lowering medication that some on the forum use.

You might find this thread detailing latest NHS lipid management guidance helpful to put your levels and varying components into context?

Thread 'NHS England lipid management guidelines'

Nov 22, 2021

Up to date and summarised in a helpful chart:

https://www.england.nhs.uk/aac/publication/summary-of-national-guidance-for-lipid-management/

Some random things which catch my eye:

- It really brings things much more into line with Euro and US guidance than I had noticed for the UK previously.

- No "HDL ratio" stuff here: it's all non-HDL and LDL cholesterol.

- PAD is recognised as a condition which puts you in the secondary prevention category, in line with international guidance. Previously, I hadn't seen that explicitly stated in UK guidance. (It does say "symptomatic PAD"...

• Eddy Edson
• Replies: 14
• Forum: Links

• 

That guidance links to a statin-intolerance guidance summary: https://www.england.nhs.uk/aac/wp-content/uploads/sites/50/2020/04/statin-intolerance-pathway-v2.pdf

If statins at any dosage level are not tolerated:

- Consider ezetimibe, (NICE TA 385) therapy as per algorithm
- Consider ezetimibe combined with bempedoic acid (NICE TA 694) as per algorithm
- Consider inclisiran if eligible for treatment according to NICE TA 733
- Consider PCSK9i if eligible for treatment according to NICE TA 393, 394

I think that in most cases, ezetimibe by itself won't be enough to get the 40%+ reduction in non-HDL-C called for by the guidelines for primary care, so a combo with bempedoic acid (a recent addition) might be preferred. Inclisiran and PCSK9i are stronger but more expensive, so probably only for more severe/intractable cases, I imagine.

There seems to be a rising tide of opinion that first-line treatment should be statin + ezetimibe, allowing for a lower statin dose than if used by itself - reducing side effect risks - but with the same effectiveness. By the guidelines, I imagine your clinician would want to make sure you're not OK with a lower dose of a different sattin (eg rosuvastatin) as a first step, if that hasn't been done before.

FWIW, your most important numbers are the non-HDL-C and the LDL-C, both of which are way high IMO. My LDL-C at DX was 3.2 mmol/l, enough (combined with heavy smoking & diabetes) to give me full-on atherosclerosis - blocked femoral artery, moderate coronary stenosis - and on a fast track to a heart attack if I hadn't zapped it with high-intensity statin therapy and lifestyle changes. I'd jump on it.

 

[pjgtech]

Have you ever been offered ezetimibe @pjgtech ? That’s a non-statin cholesterol-lowering medication that some on the forum use.

No, not offered, when I reacted badly to the first three statins, they just took me off them completely.
My cholesterol went down a bit after the 12 week pathway to remission diet, (despite taking no statins at that time) but has come back up again, since I've been eating "normally" again, although I'm still on a low carb diet.