High Cholesterol

[bulkbiker]

you've put two and a half stone back on on your diet.

So what?
My blood sugars are fine (last HbA1c 27 mmol/mol) I have still lost about 40kg and maintained that loss for 7 years.
You are the only person that appears to have a problem with my cholesterol levels.. I certainly don't so...


"

• Community Members: Please be respectful of other peoples' opinions about diabetes. Everyone manages their health differently. Please be mindful of this."

 

[everydayupsanddowns]

Its fairly obviously not "cholesterol" that is causative of CVD.

There is a well established association of increased heart disease risk with elevated blood lipids (commonly referred to as ‘cholesterol’).

As you have stated elsewhere the components LDL and HDL are more accurately lipoproteins, but they are so commonly referred to as cholesterol, that it is misleading to make such a broad statement without qualification.

Diabetes UK has reliable evidence-based information about cholesterol and lipids here:

Cholesterol and diabetes

Cholesterol is fat that is found in our blood. Sometimes it’s called lipids. When we hear this word, we think of it building up in our arteries and contributing to long-term health problems, but cholesterol isn’t just a bad guy. Healthy levels of cholesterol are vital for our cells to function...

www.diabetes.org.uk

 

[everydayupsanddowns]

You are the only person that appears to have a problem with my cholesterol levels

I have seen several members expressing concern about your cholesterol levels, including @rebrascora and @nonethewiser

The majority of evidence in the literature doesn’t support your position that an elevated cholesterol level is unimportant, though I understand why you have concluded that given the ‘all clear‘ you said you were given in tests.

But it is important to balance your individual decisions about your own risk and health, with the bulk of the evidence, which stresses the importance of lipid management to help reduce risk for others reading these threads.

”If you have high cholesterol levels, you should have a blood test to measure total cholesterol, HDL cholesterol and non-HDL cholesterol three months after starting statin treatment, with an aim of 40% reduction in non-HDL cholesterol. Ask your healthcare team what your individual targets are for your cholesterol levels. “​

 

[AndBreathe]

I have seen several members expressing concern about your cholesterol levels, including @rebrascora and @nonethewiser

The majority of evidence in the literature doesn’t support your position that an elevated cholesterol level is unimportant, though I understand why you have concluded that given the ‘all clear‘ you said you were given in tests.

But it is important to balance your individual decisions about your own risk and health, with the bulk of the evidence, which stresses the importance of lipid management to help reduce risk for others reading these threads.

”If you have high cholesterol levels, you should have a blood test to measure total cholesterol, HDL cholesterol and non-HDL cholesterol three months after starting statin treatment, with an aim of 40% reduction in non-HDL cholesterol. Ask your healthcare team what your individual targets are for your cholesterol levels. “​

The thing about cholesterol (and, for the avoidance of doubt, I am NOT referring to ANY member on this thread) is that huge weight seems to be given to Total Cholesterol, irrespective of the component breakdowns.

It is perfectly possible to have components individually considered "Ideal", but add to an inconveniently high total. Where then is the logic in suppressing those?

In my world, the bottom line is it is important to invite anyone asking to get themselves acquainted with lipids (or whatever), make their decision, own it and live with their decision.

In some instances there are opportunities for a "deep dive", but taking part in research, or whatever. We are supposed to receive personalised guidance for our health. It strikes me the stance of ">5 equals a stroke in waiting" does nobody any favours.

 

[bulkbiker]

association

You say it yourself, it is not proof of causation.

But it is important to balance your individual decisions about your own risk and health, with the bulk of the evidence

But when the "bulk of the evidence" dates from pre 2004 when standards were far lower and more recent studies have shown that this "association" is not proof of causation (and may not even be a valid association) then surely in the interests of scientific thought, this needs to be explained.

 

[Deleted member 21371]

The thing about cholesterol (and, for the avoidance of doubt, I am NOT referring to ANY member on this thread) is that huge weight seems to be given to Total Cholesterol, irrespective of the component breakdowns.

It is perfectly possible to have components individually considered "Ideal", but add to an inconveniently high total. Where then is the logic in suppressing those?

In my world, the bottom line is it is important to invite anyone asking to get themselves acquainted with lipids (or whatever), make their decision, own it and live with their decision.

In some instances there are opportunities for a "deep dive", but taking part in research, or whatever. We are supposed to receive personalised guidance for our health. It strikes me the stance of ">5 equals a stroke in waiting" does nobody any favours.

No one is talking about "total cholesterol" here, that's a misdirection.
We are all talking about bad cholesterol, LDL.

 

[bulkbiker]

No one is talking about "total cholesterol" here, that's a misdirection.

" Yes, I find saturated fats push my cholesterol up, and like most, have no side effects to statins."

?

 

[Deleted member 21371]

" Yes, I find saturated fats push my cholesterol up, and like most, have no side effects to statins."

?

Cholesterol and diabetes

Cholesterol is fat that is found in our blood. Sometimes it’s called lipids. When we hear this word, we think of it building up in our arteries and contributing to long-term health problems, but cholesterol isn’t just a bad guy. Healthy levels of cholesterol are vital for our cells to function...

www.diabetes.org.uk

 

[everydayupsanddowns]

It is perfectly possible to have components individually considered "Ideal", but add to an inconveniently high total. Where then is the logic in suppressing those?

In my world, the bottom line is it is important to invite anyone asking to get themselves acquainted with lipids (or whatever), make their decision, own it and live with their decision.

In some instances there are opportunities for a "deep dive", but taking part in research, or whatever. We are supposed to receive personalised guidance for our health. It strikes me the stance of ">5 equals a stroke in waiting" does nobody any favours.

The national guidance on general targets (total cholesterol of 4 or below for people with diabetes, with individual recommendation for HDL, calculated LDL and trigs) are based on a summary of all the available research to date.

And yes, ideally you would get individual targets from your Dr, but my experience is that I mostly get the general recommendations.

I also gather that the importance of ratios is felt to be less significant in the national (NHS England) lipid guidelines linked here

https://forum.diabetes.org.uk/boards/threads/nhs-england-lipid-management-guidelines.97005/

 

[bulkbiker]

The national guidance on general targets (total cholesterol of 4 or below for people with diabetes, with individual recommendation for HDL, calculated LDL and trigs) are based on a summary of all the available research to date.

So far as I am aware NICE have ditched the Total cholesterol level of 4 for diabetics and instead and use the QRisk3 calculator. For which LDL levels are not even included...

QRISK3

www.qrisk.org

Cholesterol/HDL ratio is used.. so much for those who claim that "total cholesterol" is the best indicator...

 

[everydayupsanddowns]

So far as I am aware NICE have ditched the Total cholesterol level of 4 for diabetics and instead and use the QRisk3 calculator. For which LDL levels are not even included...

Can you provide a link to NICE saying LDL is unimportant?

I hadn’t seen that the general rule of thumb of 4 (and below 2 for LDL) had been dropped, but was easily able to find this from October 2022

• Modification of the blood lipid profile can reduce CVD risk.
  • Total cholesterol is an important predictor of CVD events. However, non-high density lipoprotein cholesterol (non-HDL-C) — the difference between total and HDL-C is a powerful risk factor.
  • Non-HDL-C has replaced low-density lipoprotein cholesterol (LDL-C) as the primary target for reducing cardiovascular risk with lipid-modifying treatment.
  • A raised triglyceride level is a risk factor for CVD and is independent of total cholesterol.

Lipid modification - CVD prevention | Health topics A to Z | CKS | NICE

Cardiovascular disease (CVD) is an umbrella term for diseases that involve the heart, blood vessels, or both, caused by atherosclerosis

cks.nice.org.uk

Which explicitly states that if you look at everything in your lipid panel that isn’t HDL, that’s the best indicator of risk - so that’s mostly LDL.

and also

That elevated trigs are independently associated with increased risk, even if your total cholesterol (or TC/HDL if you like) looks good.

So a good ratio hasn’t been shown to be as important as the actual numbers themselves.

 

[bulkbiker]

Can you provide a link to NICE saying LDL is unimportant?

Not quite what I said... ?
I simply pointed out the in the QRisk3 calculator LDL isn't used at all to assess heart attack risk.

My personal view is that it is indeed unimportant and of course isn't even measured but "calculated" in almost all lipid panels.

 

[harbottle]

I simply pointed out the in the QRisk3 calculator LDL isn't used at all to assess heart attack risk.

It sort of is, as part of 'top number' of that ratio is LDL.
So having high LDL can affect that ratio.

 

[Deleted member 21371]

So far as I am aware NICE have ditched the Total cholesterol level of 4 for diabetics and instead and use the QRisk3 calculator. For which LDL levels are not even included...

QRISK3

www.qrisk.org

Cholesterol/HDL ratio is used.. so much for those who claim that "total cholesterol" is the best indicator...

You're still over 20% Eddie, but no probs, it's only a "calculated" risk.
Hope your blood pressure is good.

 

[AndBreathe]

QRisk for those in remission, irrespective of how long they have been in remission, or what their current A1c happens to be is a very blunt tool. I feel certain that the overall indicators for those whose foray into the diabetic arena is brief (undefinable, obviously) differ from someone, long term T2 with longer term diabetic numbers.

It'll be good to see the findings of the current, ongoing research looking at heart failure for T2s, with a sub-cohort of those in remission. To be fair, I am expecting that this first look may just flag a need for more research, but that can never be a bad thing.

 

[Deleted member 21371]

QRisk for those in remission, irrespective of how long they have been in remission, or what their current A1c happens to be is a very blunt tool. I feel certain that the overall indicators for those whose foray into the diabetic arena is brief (undefinable, obviously) differ from someone, long term T2 with longer term diabetic numbers.

It'll be good to see the findings of the current, ongoing research looking at heart failure for T2s, with a sub-cohort of those in remission. To be fair, I am expecting that this first look may just flag a need for more research, but that can never be a bad thing.

No matter what happens, diabetes, like high LDL, is never going to improve my risk.

 

[nonethewiser]

I have seen several members expressing concern about your cholesterol levels, including @rebrascora and @nonethewiser

Not concerned, purely up to individual how they go about their life & health, just wouldn't want high levels like that myself & if did would be do something about it.

Sometimes wonder about what would happen in a case of life insurance if someone passed away from cardiovascular disease because they failed to accept their risks when alive, example where they ignored their Drs advice on how to treat something like high cholesterol, could that be possible get out clause for insurance companies to avoid paying out to those left behind, wouldn't surprise me one bit if they did.

 

[Kreator]

QRisk for those in remission, irrespective of how long they have been in remission, or what their current A1c happens to be is a very blunt tool. I feel certain that the overall indicators for those whose foray into the diabetic arena is brief (undefinable, obviously) differ from someone, long term T2 with longer term diabetic numbers.

It'll be good to see the findings of the current, ongoing research looking at heart failure for T2s, with a sub-cohort of those in remission. To be fair, I am expecting that this first look may just flag a need for more research, but that can never be a bad thing.

From my limited understanding, there is no 'In Remission' part of QRisk...

Once diagnosed with Type 2, you are forever whether 'In Remission' or not...

Same goes for Cholesterol levels I think...

 

[bulkbiker]

You're still over 20% Eddie, but no probs, it's only a "calculated" risk.
Hope your blood pressure is good.

Wrong again.... and of course that doesn't take into account how well controlled T2 is.. with my results I can of course happily tick the no to T2 box which pushed it down to 8.6%

 

[bulkbiker]

From my limited understanding, there is no 'In Remission' part of QRisk...

Once diagnosed with Type 2, you are forever whether 'In Remission' or not...

Same goes for Cholesterol levels I think...

Which kind of demonstrates quite neatly how useless the whole QRisk3 calculation is..
An HbA1c of 48 mmol/mol is viewed exactly the same as an HbA1c of 100mmol/mol!
Outcomes are likely to be quite different especially when CVD risk is being assessed.