Looking for some perspective on statins...

[Daemonik]

The risks are scary and although you can possibly reduce them by controlling your blood sugar well, Type 1 itself is a risk factor, eg:

Type 1 diabetes mellitus (T1DM) is associated with an almost threefold higher mortality than the general population [1]. Premature atherosclerosis is the main driver of this excess mortality for both men and women, with cardiovascular events occurring more than a decade earlier [2].

Cardiovascular Risk in Type 1 Diabetes Mellitus - PMC

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 ...

pmc.ncbi.nlm.nih.gov

Even if your cholesterol isn’t too bad and just slightly above the target, statins also stabilise the plaque in your arteries, reducing the risk of it breaking off. That’s a big reason why I decided to take statins.

Thank you for that resource, Inka. I've added it to my weekend homework pile

 

[rebrascora]

Hi Hayley - more similar than you think, I'm also a humalog / levemir guy, though I don't qualify for a libre
I'm thinking I might wait until I see my consultant in a few months, and have the conversation with them. Because so far it's been quite.. surface level without much detail or depth, as I've described previously.

Why on earth do you not qualify for a Libre? All Type 1s in the UK should be offered Libre as a matter of course for the last couple of years I think. Who has refused you?

 

[helli]

Why on earth do you not qualify for a Libre? All Type 1s in the UK should be offered Libre as a matter of course for the last couple of years I think. Who has refused you?

Are you sure everyone in the UK with Type 1 is entitled to a CGM?
The healthcare system is devolved.
I know, from personal experience, that everyone with Type 1 in England is entitled to a CGM and I think the same is true in Wales and Scotland but I have no idea about Northern Ireland.

 

[Standup]

Interesting reading. As a Type 3c I've been waiting for the conversation about statins but hasn't come up yet. No idea if that's because there's little data/awareness about it although I would have thought you could include 3c in the Type 1s for CVD.

The paper Inka links to isn't very cheerful reading though!

 

[SimonP]

As it stands, under 10%, though moving 10 miles would take it over - I guess one of the factors they use in the calculation is prevalence of CVD within an area. If you move to an area with a high incidence, it increases your risk score, though on a practical level, that's nonsense (unless the location has objectively higher risks, like moving from the open countryside to a house next to a busy motorway or power station or something).
But the over 40, over 5%, Type 1 elements all apply, so I guess that's why they're pushing it.

It's a deprivation index actually, so it's sort of based on areas, but abstracted.

The risks are scary and although you can possibly reduce them by controlling your blood sugar well, Type 1 itself is a risk factor, eg:

Type 1 diabetes mellitus (T1DM) is associated with an almost threefold higher mortality than the general population [1]. Premature atherosclerosis is the main driver of this excess mortality for both men and women, with cardiovascular events occurring more than a decade earlier [2].

Cardiovascular Risk in Type 1 Diabetes Mellitus - PMC

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 ...

pmc.ncbi.nlm.nih.gov

Even if your cholesterol isn’t too bad and just slightly above the target, statins also stabilise the plaque in your arteries, reducing the risk of it breaking off. That’s a big reason why I decided to take statins.

Which takes me back to the stats for average control, which is poor. The question is then how large an effect better than average control (TIR/HbA1c) has on the incidence rate (alongside other things one might do which are not sat in the middle of the normal distribution, like exercise, eating habits, etc., etc.). I don't know the answer (specifically re diabetes), no-one does afaict because the population size is too small. It would be nice to see the raw data though.

 

[Inka]

My thoughts are that even with excellent control our risk is still higher than if we didn’t have diabetes. Type 1s also have that additional heart risk, which I mentioned here before, I think (too tired to look now but will search tomorrow or the next few days) that’s to do with electrical activity/cells.

In addition, Type 1s have a higher risk of heart failure apparently:

The double burden: type 1 diabetes and heart failure—a comprehensive review - Cardiovascular Diabetology

Heart failure (HF) is increasing at an alarming rate, primary due to the rising in aging, obesity and diabetes. Notably, individuals with type 1 diabetes (T1D) face a significantly elevated risk of HF, leading to more hospitalizations and increased case fatality rates. Several risk factors...

cardiab.biomedcentral.com

Added to that the risk of arrhythmias from hypos, and it’s all looking a bit of a downer. Shaving a portion of that risk any way we can seems sensible. If statins can help even a tiny bit, then it seems an idea to take them IMO.

 

[Standup]

My thoughts are that even with excellent control our risk is still higher than if we didn’t have diabetes. Type 1s also have that additional heart risk, which I mentioned here before, I think (too tired to look now but will search tomorrow or the next few days) that’s to do with electrical activity/cells.

In addition, Type 1s have a higher risk of heart failure apparently:

The double burden: type 1 diabetes and heart failure—a comprehensive review - Cardiovascular Diabetology

Heart failure (HF) is increasing at an alarming rate, primary due to the rising in aging, obesity and diabetes. Notably, individuals with type 1 diabetes (T1D) face a significantly elevated risk of HF, leading to more hospitalizations and increased case fatality rates. Several risk factors...

cardiab.biomedcentral.com

Added to that the risk of arrhythmias from hypos, and it’s all looking a bit of a downer. Shaving a portion of that risk any way we can seems sensible. If statins can help even a tiny bit, then it seems an idea to take them IMO.

Well at least that paper takes the view that good control can mitigate the risk unlike the previous one.

 

[mashedupmatt]

Just revisited this thread and it reminded me to take mine tonight (Atorvastatin) which was prescribed shortly after diabetes diagnosis (almost 3yrs ago) despite having low cholesterol - was told it was about the cardiovascular risk so I didn't hesitate and it has had zero effect on my BG and no other side effects

 

[Daemonik]

Why on earth do you not qualify for a Libre? All Type 1s in the UK should be offered Libre as a matter of course for the last couple of years I think. Who has refused you?

Admittedly it's been a few (5 or so probably) years since I had the conversation with the GP (initiated by myself) I was told that because my control was good I wasn't classed as a priority. therefore nope. I never raised it again because as far as I knew, the subject was closed. It's eye-wateringly expensive to self-fund so it just dropped off my radar. They've certainly never proactively raised it to me since either.

 

[Bruce Stephens]

Admittedly it's been a few (5 or so probably) years since I had the conversation with the GP (initiated by myself) I was told that because my control was good I wasn't classed as a priority. therefore nope.

Ask again! The guidelines have changed since then.

 

[Proud to be erratic]

@Daemonik, the defining document is NICE Guidance Note NG17. There was a major revise in spring 2022. Your GP has not been very good in keeping you updated and helped. Are you getting the 8 annual healthcare checks that are mandated for people with diabetes. I would have expected that from one of those annual reviews someone would have asked why you don't have CGM.

 

[rebrascora]

Admittedly it's been a few (5 or so probably) years since I had the conversation with the GP (initiated by myself) I was told that because my control was good I wasn't classed as a priority. therefore nope. I never raised it again because as far as I knew, the subject was closed. It's eye-wateringly expensive to self-fund so it just dropped off my radar. They've certainly never proactively raised it to me since either.

Such a shame you didn't join the forum sooner as CGM really is a game changer for most of us and you could have had it for several years by now. You learn so much more about your own individual diabetes from the extra data it provides and it enables you to fine tune your management to reduce glucose variability which is I believe one of the risk factors with cholesterol.

 

[Proud to be erratic]

I agree with Barbara, @rebrascora, CGM was a game changer for me.

My 1st device was the Libre 2. Even though the sensors proved to be not compatible with my body, I spent a full 12 months grappling with failures, replacements and poor correlation with finger prick results. YET, despite that perception of "why bother", seeing (roughly) what was happening 24 hrs a day was illuminating. I learnt, pretty quickly, to work with the general unreliability and appreciate the trends that my graph was revealing to me. Both on the day and historically, from looking back at previous days, in conjunction with analyses for a week or month; etc.

The change for NG17 in Apr '22 included the opportunity to try different manufacturers. At that time there were 4 lower cost CGMs, which were made available through the NHS. AND (extraordinarily) the guidance included the suggestion that some patients might not be compatible with a particular device and they could change without penalty. How difficult could that be (forgive my sarcasm). That set me on the path of trying the original Dexcom One, which was a lot better and then self-funding the more expensive Dexcom G7 as my trial to see if a more perfect CGM existed for me. It did; my Hospital Consultant saw the improved performance from my sharing my data with the Hospital and the Hospital took over the funding of my G7; much to my relief.

Another huge change to NG17 was to provide GPs with the authority to freely prescribe any of the lower cost CGMs, without needing the involvement of a Consultant. This took time to work through the administrative bureaucracy and gain funding cover from the CCGs which were themselves being disbanded and replaced by Integrated Care Boards (ICBs).

Having told you, @Daemonik, that CGM is a game changer, it is very important that you are aware that CGMs can have limitations. There is a thread pinned near the top of the Pumping and Technology Section of the Forum about CGM limitations and I would advise anyone starting onto CGM to have a look at this. Not to alarm anyone, but to help manage their expectations and keep their feet firmly planted. All tech has its moments: brilliant when it's delivering 100% of its promise, but not so brilliant when it is tech being notoriously techie! Our bodies are compkex, we shouldn't be so surprised when tech exploits that complexity with its own odd moments. A link to this thread is below:

H

Thread 'CGM limitations and precautions'

Sep 8, 2023

Moderator Note: This helpful reply was copied from another thread as it details some of the commonly experienced limitations of continuous glucose sensors.

My blood sugar has been in perfect range for days now, but although I haven't changed anything, I'm starting to get very short periods of hypos while I sleep and this morning I had a hypo alarm.

If these are very short periods of lows and occur overnight, they are more likely to be compression lows - when pressure is applied to a sensor, it will report a false low. The reason I say this is more likely to happen at...

• helli
• Replies: 23
• Forum: Pumping and Technology

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Regardless, I'm grateful that I spent a year with no CGM and dependent on fp testing; that gave me a solid foundation for managing when my CGM glitches. But I'm even more grateful to have CGM and been lucky enough to have tried Libre 2 and now have my utopia of Dexcom G7. My cousin, a T1 for c.50 yrs and a retired State Registered Nurse, initially resisted taking the CGM that was offered to him during 2022. He felt he didn't need it and it would be a burden - something else to learn and master. He finally yielded about a year ago and now freely admits how much easier he finds managing his D.

 

[louisew]

Well at least that paper takes the view that good control can mitigate the risk unlike the previous one.

This is really quite depressing reading. However my father had diabetes, very active with a very healthy diet. He was on metformin but his hbac1 was pretty high. He never had any heart problems, and actually died of oesophagal cancer at 89, with doctors remarking how strong his heart still was, during his illness. . Even my diabetic Father in law, who smoked 40 ciggies a day until quintuple heart surgery at 70, has reached 90 without going into heart failure. I was fit with a healthy bmi when diagnosed and still am, on insulin but very stable blood sugar hbac1 5.3 due to low carb diet. My Qrisk was 8.7% in december, which I’m pretty happy with (live in an area of low deprivation) although it calculates 4.7% without diabetes. So I suppose a 4% extra risk isn’t too bad.

 

[Burylancs]

NICE guidelines seem to be to offer statins to people with type 1 over the age of 40.

The qrisk3 calculator uses Cholesterol/HDL ratio, it doesn't even ask for total cholesterol level, which agrees with what some experts say that the ratio is more important than the total amount. There is also the Triglyceride to HDL ratio. These ratios seem a better predictor of risk of heart disease than the total levels. The fact that the qrisk3 calculator doesn't even ask for the total level is significant.

I would recommend calculating these two ratios and also calculating your qrisk score.
Total:HDL ratio: 3.5 optimal, <5 desirable, >5 elevated risk
Trygliceride:HDL ratio: 2 optimal, >3 elevated risk, >4 high risk, >6 very high risk

Ratios are old hat. The current important figures are Total Chols minus HDL ( to give an estimate of the amount of 'bad' cholesterol) and absolute level of LDL. And there are recommended levels for those two measures. And as Eddie Edson says LDL is the most researched thing in medicine, there can be little argument about the connection of raised levels of LDL and cvd.

 

[Pandora71]

Ratios are old hat. The current important figures are Total Chols minus HDL ( to give an estimate of the amount of 'bad' cholesterol) and absolute level of LDL. And there are recommended levels for those two measures. And as Eddie Edson says LDL is the most researched thing in medicine, there can be little argument about the connection of raised levels of LDL and cvd.

I have high LDL as well as HDL (total c = 8.4) yet no high blood pressure or need for meds. I have probably damaged my arterial lining by having type 1 diabetes for 40+ years so in theory I should manage down my LDL and this is what the computer tells the GP or consultant.
I am very happy not to take a statin because there is NO research to say that high LDL c causes CVD only an unproven hypothesis which happens to benefit the makers of statins. If I ask my GP how much longer I might live by taking a statin then the answer is no longer, or 4 days (if I' have already had a heart attack). The other question is how many people need to take a statin for 1 person to avoid a secondary heart attack? Or how many people need to take statins for 1 person to suffer ALS or less seriously, muscle aches /type 2 diabetes etc. Here is the site which contains both figures based only on the prevention of secondary heart disease:

Statins for Heart Disease Prevention (With Known Heart Disease) – TheNNT

thennt.com

 

[helli]

@Pandora71 as described above by a few of us the reasons for prescribing statins for people with diabetes is not only due to cholesterol levels and many of us experience no side effects.

Many of us have been reluctant to try them until we read the research about the benefits and ensured we were aware and checking for the potential side effects.

 

[Pandora71]

I was offering my perspective! I am aware there is a small anti inflammatory pleiotropic effect and also aware that people like to see their LDL numbers reduce, which they usually do. I personally know many people who suffer no side effects from taking them but again I can see no benefit!

 

[freesia]

I've been on Atorvastatin since just before covid and have never had an issues with side effects or raised levels.

 

[helli]

I was offering my perspective! I am aware there is a small anti inflammatory pleiotropic effect and also aware that people like to see their LDL numbers reduce, which they usually do. I personally know many people who suffer no side effects from taking them but again I can see no benefit!

I was also referring to the added risk on our hearts due to people with diabetes experiencing higher fluctuations in their BG.
But, we all have a choice which is great both ways.