HbA1c and Cholesterol...

[Newtothis]

Have my diabetic review on Wednesday so phoned up for results prior, my kidney function check (bloods) came back ok; Hba1c remained at 5.7 (39ml) and my cholesterol has remained at 4.7. Therefore, going to consider statins....

Although above was only reviewed 3 months ago I think I'm kidding myself that I can reduce my cholesterol..

Has anyone had any unwelcome side-effects??

 

[AJLang]

Well done on your HBA1C. That's brilliant. I haven't had any problems with statins. I've stopped them twice to see if they are having any negative effects but I didn't feel any difference at all so I've kept taking them.

 

[Newtothis]

Well done on your HBA1C. That's brilliant. I haven't had any problems with statins. I've stopped them twice to see if they are having any negative effects but I didn't feel any difference at all so I've kept taking them.

Have taking the statins reduced your cholesterol? My problem is I'm a born worrier-I worry about everything. My brother who is Type 2 is also on statins and never had any problems... Not really sure what I'm worried about... xx

 

[everydayupsanddowns]

Caveat: At some point I am going to try to look into the whole statins thing for myself and pick through some of the current research. I have not done this. My current position is based on what I've read so far, and, to some extent coloured by the fact that my clinic are not 'on my case' to start taking them.

Here's where I am so far:
a) The whole cholesterol issue seems to promote more passionate opinion than any other on D forums
b) I am fairly deeply suspicious of any medication suggested as "absolutely everyone should be taking this, regardless of results, personal history and family background"
c) Many many thousands of people take statins without any apparent problems and side effects
d) People who have taken them and experienced severe joint and muscle pain and/or cognitive impairment which began after starting statins and cleared up soon after stopping them will not be persuaded to take them again
e) There is a statistical link between populations with high cholesterol and incidence of heart disease
f) The waters get muddy when you take someone who has high cholesterol and lower it with statins. If the patient already has heart disease statins seem to help, but statins don't seem to prevent a first heart attack from happening* - you just have a coronary with lower cholesterol
g) Women who may or are trying to conceive should not take statins because of the risk of congenital abnormalities in the developing foetus

Confusing eh?!

* [quote from Huffington Post article regarding Cochrane review deleted at the request of another forum member]

 

[Newtothis]

Caveat: At some point I am going to try to look into the whole statins thing for myself and pick through some of the current research. I have not done this. My current position is based on what I've read so far, and, to some extent coloured by the fact that my clinic are not 'on my case' to start taking them.

Here's where I am so far:
a) The whole cholesterol issue seems to promote more passionate opinion than any other on D forums
b) I am fairly deeply suspicious of any medication suggested as "absolutely everyone should be taking this, regardless of results, personal history and family background"
c) Many many thousands of people take statins without any apparent problems and side effects
d) People who have taken them and experienced severe joint and muscle pain and/or cognitive impairment which began after starting statins and cleared up soon after stopping them will not be persuaded to take them again
e) There is a statistical link between populations with high cholesterol and incidence of heart disease
f) The waters get muddy when you take someone who has high cholesterol and lower it with statins. If the patient already has heart disease statins seem to help, but statins don't seem to prevent a first heart attack from happening* - you just have a coronary with lower cholesterol
g) Women who may or are trying to conceive should not take statins because of the risk of congenital abnormalities in the developing foetus

Confusing eh?!

* Cochrane Group did a review of all the major statin studies by an international group of independent scientists. The review failed to show benefit in using statins to prevent heart attacks and death

Now I am depressed....

 

[trophywench]

What Mike said.

The Cochrane reviews (of anything they review) are excellent because they can be relied upon to sort the wood out from the trees - ie they don't take the headline and rely on that - they investigate the actual research that was done in every case and work out which bits the researchers may have chosen to ignore when they presented their conclusions. Cos sometimes you know (LOL) the researchers are so keen to prove something they kind of ignore all the things that prove the opposite. Not all of em, just sometimes. In which case, Cochrane don't take that bit of research as being reliable .....

And I did have cognitive problems meself.

They did lower my LDL cholesterol. Since I stopped em, they have gone back up and I'm being whinged at again, but I've stated I'd rather take the chance of having a heart attack than do that to my brain again. And I'm sticking to that.

Thousands of peeps worldwide take em with no ill effect whatsoever; I expect their LDL decreases otherwise they wouldn't still be on em.

But nobody knows if they are actually doing em any good in the long term, do they?

 

[Northerner]

Well done on your results Amanda! 🙂 Your cholesterol is similar to mine (4.5 last time). When I was on statins my total cholesterol reduced to 2.4 but, in addition to experiencing some side effects, my research indicated that the possible benefits to me in taking them were probably closely matched by the risks - or that they simply wouldn't make any difference at all as far as possible heart attacks go. Can't find it at the moment, but I remember seeing a site where it showed that out of a 100 people who were low risk of a heart attack who took statins it would make no difference to 97 of them. For those with a moderate risk, it would make no difference to 94 of them. Statistically, of course, if you extrapolate across large populations then you get thousands of people avoiding heart attacks (e.g. out of 100,000 people, 3,000 would be helped: out of 1m people, 30,000 would be helped etc.)

I took the decision not to take them because for me personally I'd rather not take what is a very powerful drug that may not do me any good but may do me harm. For others, however, the decision may not be as clear cut.

 

[Newtothis]

Its really difficult when medical professions tell you to lower your cholesterol but don't tell you how..... wish it was just easier.... think I'm going to discuss with my GP rather than my DSN xx 🙂

 

[mcdonagh47]

* Cochrane Group did a review of all the major statin studies by an international group of independent scientists. The review failed to show benefit in using statins to prevent heart attacks and death

Rubbish ! The recent Cochrane Review of Statins found the exact opposite of what you are claiming ... and the that review has been criticised for trying to draw negative conclusions from evidence that does not support them...

"All cause mortality. coronary heart disease and stroke events were reduced with the use of statins as was the need for revascularisations".

Let's read that again from the Abstract of the Cochrane Report ...
"All cause mortality. coronary heart disease and stroke events were reduced with the use of statins as was the need for revascularisations." OK ?

AND that review was only about people taking statins with no other risk factors apart from raised Cholesterol ...i.e. it was irrelevant to anyone with diabetes (all of us) which is an independent risk factor for heart disease.

Have a read of this balanced review of the Cochrane Report ...what they showed was 1 live per 1000 saved p.a., which runs out at 10,000 lives per year.
And if that is not a result ,what is ?

http://www.sciencebasedmedicine.org/index.php/statins-the-cochrane-review/

 

[everydayupsanddowns]

I think it would help your passionate defense of statins McD, if your tone was not so aggressive.

Caveat: At some point I am going to try to look into the whole statins thing for myself and pick through some of the current research. I have not done this. My current position is based on what I've read so far...

And as you are so fond of saying recently, let's read that again:

Caveat: At some point I am going to try to look into the whole statins thing for myself and pick through some of the current research. I have not done this. My current position is based on what I've read so far...

I have read in more than one location/blog/report that the effectiveness of statin therapy for people who have *not yet* had a heart attack is not as clear cut as for those who have already had a heart attack. Perhaps it was a mistake to quickly Google and come across that quote. Perhaps I should have picked the Cochrane report apart from source.

But I just grabbed the headline quote which more or less reflected my existing uncertainty. Which is perhaps ironic because that seems that most comment for and against statins comes from opinions which are already made up.

Me? I'm not sure. And I admit that if/when I am told to take them (the matter has never been pressed with me whenever it has been raised) I will take the time to consider both sides of the matter carefully. I'll be interested to pick your brains at that point as you are without doubt the most consistent and passionate statin advocate I have come across online.

Incidentally, I was interested to be told at a recent meeting at NICE, that the guideline for treatment of lipids and lipid modification, and the research into its effect on risk is currently being reviewed.

 

[mcdonagh47]

Caveat: At some point I am going to try to look into the whole statins thing for myself and pick through some of the current research. I have not done this. My current position is based on what I've read so far...

.

Your statement, "* Cochrane Group did a review of all the major statin studies by an international group of independent scientists. The review failed to show benefit in using statins to prevent heart attacks and death" is the exact opposite of what the recent Cochrane Report on statins found. Please edit it out of your post.

And no, I'm not a "passionate " defender of statins, its an important medical issue ( especially for diabetics) where twisting and misrepresentation, however well-meaning or ill-informed, of the evidence just won't do.

 

[everydayupsanddowns]

Duly edited from my original post.

 

[SimplesL]

Never read the cochrane report, but I did go onto statins (I only take a baby dose of 10mg) as when I was diagnosed 2 years ago my total cholesterol was in the normal range of 4.9 I think. But the HDL/LDL was rubbish so by taking the baby dose it now in the right proportion & the overall total is now 3.4. In fact I had the triglcerides checked in February & they were 0.89 so really pleased with my scores on the doors.

I had no effects in taking them & have a family history of heart disease as well as type 2, my grandmother died early with a heart attack after years of angina (from her 30's) & my dad had angina from his 40's, angioplasty in his 50's & a triple by-pass in his early 60's. He is now beginining to show signs again & is now under the care of the "heart doctors" as well as his type 2 & kidney failure earlier this year.

So for me a no brainer & anything to reduce the possible cholesterol (bad LDL) is a bonus. Having said that I would never agree to a higher dose; quite happy for a baby dose as long as it does the business.

 

[mcdonagh47]

Duly edited from my original post.

tx, you're a gent 😉

 

[cherrypie]

Have my diabetic review on Wednesday so phoned up for results prior, my kidney function check (bloods) came back ok; Hba1c remained at 5.7 (39ml) and my cholesterol has remained at 4.7. Therefore, going to consider statins....

Although above was only reviewed 3 months ago I think I'm kidding myself that I can reduce my cholesterol..

Has anyone had any unwelcome side-effects??

I would ask for a lipid profile and see if it is the LDL, HDL or triglycerides that are not within normal range before you decide. An overall cholesterol score does not give much information.

http://www.labtestsonline.org.uk/understanding/analytes/lipid/tab/glance

 

[everydayupsanddowns]

tx, you're a gent 😉

I have to say though, that having read the Chochrane abstract this morning, it does quite clearly state that there is a good deal of uncertainty over the use of statins in primary prevention of CHD ('primary' as in where people have not already had a heart attack).

Total cholesterol and LDL cholesterol were reduced in all trials but there was evidence of heterogeneity of effects*...

Authors' conclusions:
Reductions in all-cause mortality, major vascular events and revascularisations were found with no excess of cancers or muscle pain among people without evidence of cardiovascular disease treated with statins. Other potential adverse events were not reported and some trials included people with cardiovascular disease. Only limited evidence showed that primary prevention with statins may be cost effective and improve patient quality of life. Caution should be taken in prescribing statins for primary prevention among people at low cardiovascular risk.

*heterogeneity refers to the 'scatter' of findings in published data - if all studies show the same thing results are described as 'homogenous'

Now you could argue that *all* people with diabetes are inevitably at higher risk regardless of any other factors, and therefore the situation is clearer. But is that ever really going to be the case?

Most people with diabetes, certainly type 1 (given the relatively low numbers who achieve A1cs below the recommended 6.5%) live with persistently high BGs. Persistently high BGs contribute to artherlosclerosis/artery clogging (can't remember where I read that). Poorly controlled diabetes, with excess weight is likely to correlate with higher blood pressure. People with diabetes often have severely mangled cholesterol levels, and perhaps more significantly tend to have high levels of trigs and poor HDL:trigs ratios.

But...
If you, as an individual, have diabetes that is well controlled. If your BP is good. If you have no family history of heart problems. If your total Chol is only moderately raised (and with high HDL and few trigs). Then does your diabetes *still* put you into the high risk category?

That, to me, is the heart of the problem with trying to apply research findings to your own personal circumstances.

 

[Northerner]

But...
If you, as an individual, have diabetes that is well controlled. If your BP is good. If you have no family history of heart problems. If your total Chol is only moderately raised (and with high HDL and few trigs). Then does your diabetes *still* put you into the high risk category?

That, to me, is the heart of the problem with trying to apply research findings to your own personal circumstances.

Pretty much describes my situation Mike. My cardiologist put me in the low risk category (after numerous assessments after my diagnosis when they had suspected a mild heart attack but concluded that it was, in fact, myocardopathy (an inflammation of the heart muscle caused by the virus that also scuppered my pancreas). My chol is 'moderately raised' by current diabetic definitions at 4.5, but I have a good split of HDL to LDL.

Reminds me of the Flora Heart Age Calculator which, as soon as you admitted to being diabetic, reduced your lifespan expectations by between 5 and 20 years, regardless of your control or other factors that would reduce risk! So, according to that there doesn't really appear to be any point in trying...🙄

 

[DeusXM]

I would ask for a lipid profile and see if it is the LDL, HDL or triglycerides that are not within normal range before you decide. An overall cholesterol score does not give much information.

This is extremely important to bear in mind. I've had this conversation with my hospital clinic and they get so frustrated as the blood labs always just do the whole figure. Even they say it's largely useless giving a single figure.

As for the OP, 4.5 isn't high, over 5 is, so I don't really know why you're worrying about statins at all.

Finally...one thing that hasn't been raised here is the issue of diet to cholesterol. There does seem to be an underlying assumption that if you have diabetes, your cholesterol will go up, no matter what you do.

The problem is, the advice given to people with diabetes is likely to raise overall cholesterol levels.

People with diabetes are advised to eat less fat and more carbohydrate. The problem is, fat doesn't impact on cholesterol levels as much as carbs. A high carb diet is known to increase triglyceride levels, because trigs go up when serum insulin levels go up - which in turn raise overall cholesterol levels, particularly the 'bad' cholesterol.

In other words, the diet recommended to people with diabetes is probably the reason why people with diabetes seem to have higher cholesterol levels, rather than it being simply because they have diabetes.

I've also raised this point elsewhere but I think we need to be extremely sceptical about statins being recommended across the board for diabetes. The largest campaigner for diabetes treatment recommendations is Diabetes UK. Diabetes UK is sponsored by Pfizer, the world's largest statin manufacturer, and Diabetes UK explicitly states that its corporate partnerships are to help further the interest of its corporate sponsors, not people with diabetes.

Let me be clear; I am not accusing anyone of intentionally misleading or interfering with advice. I am saying we should be asking the question over whether the advice we are given is at risk of being influenced by those who are motivated by something other than our best interests.

 

[PattiEvans]

Without getting overly technical, the problem with diabetics is that high BGs cause inflammation in the arteries. The cholesterol (and let's not forget that it is a natural and extremely necessary substance, not a poison, which contributes towards the making of all your hormones and cells) then scurries along to try to "repair" the artery and can end up as a blockage as it tries to repair ever more inflammation.

A colleague's husband has recently had a heart attack and stents fitted. This gentleman had low cholesterol, but persistently high BGs. It strikes me that controlling BGs to reduce inflammation will do more good than taking chemicals.