Just a quick question regarding cholesterol

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Gwynn

Gwynn

Well-Known Member
Relationship to Diabetes
Type 2
If my total cholesterol level is high but the ratio is good does that mean that things are ok or does it mean that something needs to be done to bring the total cholesterol level down? Anyone know?
 
Gwynn said:
If my total cholesterol level is high but the ratio is good does that mean that things are ok or does it mean that something needs to be done to bring the total cholesterol level down? Anyone know?
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I suspect you’ll get replies from both camps. It used to be that total was everything, then some research suggested the ratios were more important, now I think new research has found that once your HDL is above 3. something, having any more of it doesn’t give you any more protection, so we are back to total cholesterol again. Watch this space!
 
Like T2D, I'm not convinced they know fully what is going on. There's a lot of research out there and some interesting presentations about the lifecycle of lipoproteins and what causes arteries to rupture.

All this stuff is interesting (It's chemistry, in places) but I decided to stick the guidelines and keep Sat Fat low in my diet, and I believe high Trigs have been linked to Insulin resistance, so I try to keep that down.
 
Well my total is currently 4.8. It was over that for my last couple of tests and my doctor was insisting on statins. I declined. My DN when discussing my diet told me that I needed to eat more fats, I said what about my high cholesterol, she said oh don’t worry about that your ratios are brilliant, so I dunno 🙄
 
Gwynn said:
If my total cholesterol level is high but the ratio is good does that mean that things are ok or does it mean that something needs to be done to bring the total cholesterol level down? Anyone know?
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Like all things, much depends on other factors in your life.

My lipids have always been high, and at the outset my ratios weren't good, but that shifted pretty promptly, but my totals remain
what my old GP referred to as an "inconveniently large total".

A year ago, I took part in research looking at people living with T2, investigating T2 and heart failure (I don't have it). The results in the attached snip, from June 2021 relate to bloods taken the day of the research. The feedback from the Cardiologist and the specialist in caridac imaging was there was no reason to consider statins, but that would be different if I have heart disease, or had already suffered any sort of heart event. That felt good enough for me.

1660232368464.png

Curiously, my numbers have dropped a little this year, with no changes to lifestyle or diet. I take one additional medication (nothing to do with diabetes), but nothing in any of the literature or research papers relating to it (that I can find) suggest any impacts in that area.

The column in blue (May 2014) is from bloods drawn overseas and reported in the local style, so "translated" for my rough records.
 
Thanks for your replies.
 
AndBreathe said:
Like all things, much depends on other factors in your life.

My lipids have always been high, and at the outset my ratios weren't good, but that shifted pretty promptly, but my totals remain
what my old GP referred to as an "inconveniently large total".

A year ago, I took part in research looking at people living with T2, investigating T2 and heart failure (I don't have it). The results in the attached snip, from June 2021 relate to bloods taken the day of the research. The feedback from the Cardiologist and the specialist in caridac imaging was there was no reason to consider statins, but that would be different if I have heart disease, or had already suffered any sort of heart event. That felt good enough for me.

View attachment 21747

Curiously, my numbers have dropped a little this year, with no changes to lifestyle or diet. I take one additional medication (nothing to do with diabetes), but nothing in any of the literature or research papers relating to it (that I can find) suggest any impacts in that area.

The column in blue (May 2014) is from bloods drawn overseas and reported in the local style, so "translated" for my rough records.
Click to expand...

It's an interesting result.
It's very surprising your cardiologist has decided to totally go against NHS recommendations, and strike out on his own as well.
I would loves to hear his defence against negligence if he is wrong, and the NHS is found to be right.

It's a bit like recommending patients carrying smoking because it hasn't affected then yet.

NHS guidance has been discussed here.

 
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AndBreathe said:
The feedback from the Cardiologist and the specialist in caridac imaging was there was no reason to consider statins, but that would be different if I have heart disease, or had already suffered any sort of heart event. That felt good enough for me.
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Whereas at my recent phone review I was asked (again) to take statins with a TC 1 lower than yours, and both matching LDL and trigs, but with just slightly lower HDL (so a higher ratio if that means anything).

To be honest with T1 and my age and diabetes duration I don’t think it matters a jot what my stats are - the recommendations are the same.

So I’ve a prescription waiting for me. Will see how it goes.
 
everydayupsanddowns said:
Whereas at my recent phone review I was asked (again) to take statins with a TC 1 lower than yours, and both matching LDL and trigs, but with just slightly lower HDL (so a higher ratio if that means anything).

To be honest with T1 and my age and diabetes duration I don’t think it matters a jot what my stats are - the recommendations are the same.

So I’ve a prescription waiting for me. Will see how it goes.
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Like you, I’ve just bowed to the inevitable and started taking them. I had an interesting discussion at my last hospital telephone review the other week, though, when the doctor admitted that nobody has a clue whether they will benefit me personally. Out of 100 people, some will benefit, but they will never know which ones were, so in the words of the National Lottery slogan 'it could be you'….but it probably isn’t!
 
Robin said:
Like you, I’ve just bowed to the inevitable and started taking them. I had an interesting discussion at my last hospital telephone review the other week, though, when the doctor admitted that nobody has a clue whether they will benefit me personally. Out of 100 people, some will benefit, but they will never know which ones were, so in the words of the National Lottery slogan 'it could be you'….but it probably isn’t!
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I'll take the chance with "some".
If I don't take them, the chance I'll benefit is a definite zero.
 
Robin said:
Like you, I’ve just bowed to the inevitable and started taking them. I had an interesting discussion at my last hospital telephone review the other week, though, when the doctor admitted that nobody has a clue whether they will benefit me personally. Out of 100 people, some will benefit, but they will never know which ones were, so in the words of the National Lottery slogan 'it could be you'….but it probably isn’t!
Click to expand...

Well yes I’ve had those conversations too.

The data are much more robust once you’ve had a cardiac event, of course, but the stat that stays with me is from the Hope3 trial for those at moderate risk and who hadn’t yet had a cardiac event. From memory the relative risk reduction was shown to be 25% with very low incidence of side effects.

But another way of interpreting the same data called the NNT (number needed to treat) was 91 people for 5 years to prevent 1 non-fatal heart attack or stroke. Which would make a big difference if you were the 1, but perhaps not so much if you were among the 90?

It’s always a tricky sell when the ideal outcome for the person taking the tablets is that nothing happens.

Still I’ll see how I get on with them.
 
travellor said:
It's an interesting result.
It's very surprising your cardiologist has decided to totally go against NHS recommendations, and strike out on his own as well.
I would loves to hear his defence against negligence if he is wrong, and the NHS is found to be right.

It's a bit like recommending patients carrying smoking because it hasn't affected then yet.

NHS guidance has been discussed here.

Click to expand...

I was participating part in a research study into cardiac health - in particular the especially tricky sort of heart failure impacting many living with T2. I neither was nor am under treatment from cardiology or cardiac imaging. He was presenting his view. I'm sure he's entitled to that.

Perhaps we'll repeat the conversation at the 5yr review point.
 
everydayupsanddowns said:
Well yes I’ve had those conversations too.

The data are much more robust once you’ve had a cardiac event, of course, but the stat that stays with me is from the Hope3 trial for those at moderate risk and who hadn’t yet had a cardiac event. From memory the relative risk reduction was shown to be 25% with very low incidence of side effects.

But another way of interpreting the same data called the NNT (number needed to treat) was 91 people for 5 years to prevent 1 non-fatal heart attack or stroke. Which would make a big difference if you were the 1, but perhaps not so much if you were among the 90?

It’s always a tricky sell when the ideal outcome for the person taking the tablets is that nothing happens.

Still I’ll see how I get on with them.
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I respect any individual's right to make a decision in terms of their health, wealth or general life. If we all set our risk dials to the same range it'd be a boring world.
 
everydayupsanddowns said:
It’s always a tricky sell when the ideal outcome for the person taking the tablets is that nothing happens.

.
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I’ve now got a mental image of a load of executives sitting round trying to devise a compelling advertising campaign. 'Take these tablets and feel absolutely…..the same' 'Er, can’t we think of something more catchy?'
 
Robin said:
I’ve now got a mental image of a load of executives sitting round trying to devise a compelling advertising campaign. 'Take these tablets and feel absolutely…..the same' 'Er, can’t we think of something more catchy?'
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[whispery female voice] “This isn’t just nothing… this is superpharmaspecialtabletytablet nothing…”
 
I've been following this subject for many years on this and similar forums and I have found no convergence in what is best practice for controlling blood cholesterol. With regard to Sat Fats, many find that having a low-carb diet and not worrying about Sat Fats still results in good lipids figures. The fact that fats go thru a completely different and complex path in the digestive system than carbs implies to me that that the Sat Fat thing is over done.
 
AndBreathe said:
I was participating part in a research study into cardiac health - in particular the especially tricky sort of heart failure impacting many living with T2. I neither was nor am under treatment from cardiology or cardiac imaging. He was presenting his view. I'm sure he's entitled to that.

Perhaps we'll repeat the conversation at the 5yr review point.
Click to expand...

Ah
"The feedback from the Cardiologist and the specialist in caridac imaging was there was no reason to consider statins"
-So just his personal opinion then?

Just a gut feeling, not a professional opinion based on any factual evidence you feel anyone should follow based on qualifications, standing, or professional status of the person giving it.
Fair enough.
As I say, if he was having that conversation repeatedly with research subjects, I do hope he makes that clear with everyone that could misinterpret it as fact or advice and actually listen to him.
Unless of course the study is to actually see if the conversation can be repeated in five years with the subject?
 
DaveB said:
I've been following this subject for many years on this and similar forums and I have found no convergence in what is best practice for controlling blood cholesterol. With regard to Sat Fats, many find that having a low-carb diet and not worrying about Sat Fats still results in good lipids figures. The fact that fats go thru a completely different and complex path in the digestive system than carbs implies to me that that the Sat Fat thing is over done.
Click to expand...

But it does seem, very very very very many don't see good lipids on a saturated fat diet
Many eat healthy fats instead to achieve that.
And for those that do see "good" lipids, very many of them have to admit they don't actually see good lipids, just that the ratios seem to be able to be presented as looking as if they are good.
 
travellor said:
Ah
"The feedback from the Cardiologist and the specialist in caridac imaging was there was no reason to consider statins"
-So just his personal opinion then?

Just a gut feeling, not a professional opinion based on any factual evidence you feel anyone should follow based on qualifications, standing, or professional status of the person giving it.
Fair enough.
As I say, if he was having that conversation repeatedly with research subjects, I do hope he makes that clear with everyone that could misinterpret it as fact or advice and actually listen to him.
Unless of course the study is to actually see if the conversation can be repeated in five years with the subject?
Click to expand...

Well, I think it noteworthy that in participating in the research study I had already had an ECG, Echocardiogram, Stress Exercise Test, including gas exchanges, CT scans, including an assessment of any cardiac calcium deposits present, MRI and a Cardiac MRI Adenosine Stress Test, along with a raft of bloods, including various cardiac tests and enzymes. That seemed like a fairly decent cardiac MOT to me.

So, in terms of NICE Guidelines, they firstly state advice should be personal. I would rather have feedback based on personal and clinically accepted data that a check box on a decision tree based on a single diagnosis, age and total cholesterol figure.

Of course, you are more than welcome to hold your own view. Clearly mine differs from yours, which isn't wholly unusual.
 
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