Nice guidelines for statins

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chezpez

chezpez

Well-Known Member
Relationship to Diabetes
Type 1
Hi everyone, hope you can help? I've just had a call from G.P saying they have done a computer audit and I should be on Atorvastatin 20mg for preventive care of heart issues. My cholesterol was 4.5 in Nov 2021 and was never mentioned, by nurse or another G.P This G.P just now said I can tell you categorically you need to be on them coz I'm over 40 and been type 1 for 15 years. Then sent me the nice guidelines via text. Do you think I should go on them?
Thank you
 
chezpez said:
This G.P just now said I can tell you categorically you need to be on them coz I'm over 40 and been type 1 for 15 years. Then sent me the nice guidelines via text.
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Those are (since 2014 by the looks of it) the guidelines. I'd say follow them, but then I've been on a statin (20mg of Simvastatin which is apparently slightly less effective than Atorvastatin) for ages without side effects.

There are possible side effects, but there's also good evidence that many of those are nocebo (though I'm sure not all). I presume there's benefit to trying a different statin (if you do feel you have side effects from what you're prescribed initially). Either way, 20mg is quite a low dose, so likely you'll be fine (if you choose to take it).
 
Bruce Stephens said:
Those are (since 2014 by the looks of it) the guidelines. I'd say follow them, but then I've been on a statin (20mg of Simvastatin which is apparently slightly less effective than Atorvastatin) for ages without side effects.

There are possible side effects, but there's also good evidence that many of those are nocebo (though I'm sure not all). I presume there's benefit to trying a different statin (if you do feel you have side effects from what you're prescribed initially). Either way, 20mg is quite a low dose, so likely you'll be fine (if you choose to take it).
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It's just odd that for the past 7 yrs as I'm 48 in March I've never been told before about having them. I go at least a couple of times a year for blood tests
 
chezpez said:
It's just odd that for the past 7 yrs as I'm 48 in March I've never been told before about having them. I go at least a couple of times a year for blood tests
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Maybe your CCG has sent out reminders to GPs about the advice or something. It feels like the kind of thing GPs might not get around to doing depending on lots of other factors.
 
I have just been "offered" statins after my original nurse and my consultant at diagnosis both initially said I didn't need them.... that was 3 years ago when my cholesterol was 5.2. It has reduced since then and I am fit and healthy and a normal BMI so the only risk factors are my age, sex and my diabetes which is well managed. I am slimmer fitter and healthier now than I was 3 years ago so I personally feel that I don't want to take them and since I follow a low carb, higher fat way of eating it would be unethical for me to take them.... like bingeing on sweets and chocolate and injecting massive amounts of insulin to cover it. I am 58yrs old.
I am not convinced that I need statins and I am prepared to take the risk for now as I feel that my cholesterol levels are not unreasonable. If they were 6 or 7 I might reconsider but my gut feeling is that the scientific knowledge about cholesterol, as with dietary fat, is not as clear cut as it should be and there are very opposing arguments within the scientific community. My Dad ate a lot of saturated fats and had the heart of an ox and lived to 84 when his lungs let him down so I am banking on having his good cardiovascular system genes.
I just had a discussion with my consultant about statins last week as a result of the nurse wanting me to take them. He put my details into the QRisk calculator and came up with a 14% risk for me within the next 10 years. The QRisk doesn't take into consideration how well I manage my diabetes and I work hard to keep my levels stable and within range a very high percentage of the time so I feel that I have less risk than they system calculates and I am happy to make that decision for myself. My consultant was OK with me making that decision and said I could review it at any time. I am open to that if my cholesterol levels start to significantly increase.
 
rebrascora said:
I have just been "offered" statins after my original nurse and my consultant at diagnosis both initially said I didn't need them.... that was 3 years ago when my cholesterol was 5.2. It has reduced since then and I am fit and healthy and a normal BMI so the only risk factors are my age, sex and my diabetes which is well managed. I am slimmer fitter and healthier now than I was 3 years ago so I personally feel that I don't want to take them and since I follow a low carb, higher fat way of eating it would be unethical for me to take them.... like bingeing on sweets and chocolate and injecting massive amounts of insulin to cover it. I am 58yrs old.
I am not convinced that I need statins and I am prepared to take the risk for now as I feel that my cholesterol levels are not unreasonable. If they were 6 or 7 I might reconsider but my gut feeling is that the scientific knowledge about cholesterol, as with dietary fat, is not as clear cut as it should be and there are very opposing arguments within the scientific community. My Dad ate a lot of saturated fats and had the heart of an ox and lived to 84 when his lungs let him down so I am banking on having his good cardiovascular system genes.
I just had a discussion with my consultant about statins last week as a result of the nurse wanting me to take them. He put my details into the QRisk calculator and came up with a 14% risk for me within the next 10 years. The QRisk doesn't take into consideration how well I manage my diabetes and I work hard to keep my levels stable and within range a very high percentage of the time so I feel that I have less risk than they system calculates and I am happy to make that decision for myself. My consultant was OK with me making that decision and said I could review it at any time. I am open to that if my cholesterol levels start to significantly increase.
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Thanks for reply, I'm gonna try and get second opinion from a diabetes nurse. My hba1c is 50 - 53 and has been that for 15 years. My cholesterol is 4.5 I'm fit and healthy active and slim. If I had told about being on before from my normal g.p and nurse then it wouldn't of been a surprise when a random g.p from my surgery never heard of him before says done an audit and I should be on statins.
 
I think @Bruce Stephens maybe right about the edtic from CCG. I had side effects from them so don't take and was suprised when my GP retired a few years agonand the replacement never brought up. I then noticed I had been recorded as being allergic to them. Having said that I have in the last year despite my recorded allergy, had 3 conservations in the last year with 2 differnt Health Professionals about it.
 
grovesy said:
I think @Bruce Stephens maybe right about the edtic from CCG. I had side effects from them so don't take and was suprised when my GP retired a few years agonand the replacement never brought up. I then noticed I had been recorded as being allergic to them. Having said that I have in the last year despite my recorded allergy, had 3 conservations in the last year with 2 differnt Health Professionals about it.
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The G.P ( a new one at practice) said I should of been on them for years and don't know why I haven't as a preventive care! It a funny one when you research it, there's benefits and side effects from taking them. Honestly I don't know what to think??!! I feel I look after myself well and been put into a corner to take them
 
chezpez said:
It a funny one when you research it, there's benefits and side effects from taking them.
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Is that really true, though? The research in general surely suggests they're generally safe and effective. I don't doubt that some people have bad reactions to some statins (my father couldn't seem to take any of them), but that's not common, especially on low doses.
 
I was offered statins when I was in my 40s for the same reason - research had shown that people with diabetes over the age of 40 are at higher risk. However, I was lucky to be offered by a knowledgeable consultant who explained that the research was with overweight people with diabetes who did little exercise and hd high HbA1c. At that time no research had been done on the risks for someone who does nots of exercise, is not overweight and has a lower HbA1C. Therefore, I chose not to take statins.
I am not aware of any more recent studies on people "more like me" but have never been offered them since.
 
helli said:
I was offered statins when I was in my 40s for the same reason - research had shown that people with diabetes over the age of 40 are at higher risk. However, I was lucky to be offered by a knowledgeable consultant who explained that the research was with overweight people with diabetes who did little exercise and hd high HbA1c. At that time no research had been done on the risks for someone who does nots of exercise, is not overweight and has a lower HbA1C. Therefore, I chose not to take statins.
I am not aware of any more recent studies on people "more like me" but have never been offered them since.
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Thanks very much for you input, I will research some more, I was thinking if you go on statins I your cholesterol is good can it go too low?
 
I can't even remember why or when I was put on statins but it is a low dose 10mg atorvastatin, it was probably at the same time as the blood pressure medication and I think prediabetic but I suspect it was because I had the risk factors, family history of heart and stroke having lost both parents for that reason when they were in their 50ies and overweight.
I have had no side effects so have just stuck with them even though cholesterol is less than 3.5.
 
chezpez said:
Thanks very much for you input, I will research some more, I was thinking if you go on statins I your cholesterol is good can it go too low?
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Check out the Qrisk3 calculation. It gives your heart risk and whether a statin is indicated. That's what the GP might have done. 85% of diabetics die of cvd so it is potentially a major issue for you.
 
Burylancs said:
Check out the Qrisk3 calculation. It gives your heart risk and whether a statin is indicated. That's what the GP might have done. 85% of diabetics die of cvd so it is potentially a major issue for you.
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Do you know where that figure of 85% comes from? And is it people with all forms of Diabetes, or just Type 2, for which more research has been done? (every time I search for Type 1 and CVD, I come across 'more research needs to be done'). I find it hard to believe that things like cancer, road accidents, etc all lumped together only account for 15% of deaths in people with diabetes.
 
I think the risk weighting on that calculator for diabetes is based on the general diabetes population and like @helli those of us who are slim and fit and healthy and manage our diabetes well should not be tarred with the same risk factor as a lot of diabetics who are obese or overweight, don't exercise much and don't manage their diabetes well and lets face it there are sadly a lot of diabetics who fit that description.
I resent my QRisk being calculated as higher purely because it gives a high weighting for diabetes, not for how I personally manage it and my health in general. The QRisk calculator should be used in conjunction with an assessment of the individual, not as "written in stone" and applicable to everyone.
 
I've merged the threads to keep your replies in one place @chezpez 🙂
 
Robin said:
Do you know where that figure of 85% comes from? And is it people with all forms of Diabetes, or just Type 2, for which more research has been done? (every time I search for Type 1 and CVD, I come across 'more research needs to be done'). I find it hard to believe that things like cancer, road accidents, etc all lumped together only account for 15% of deaths in people with diabetes.
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I read it about ten years ago from an American scientist who was just starting a research project to determine the links between cvd and Type 1 which aren't well understood. But a bit ago I noticed a Danish study that said it was lower than 85% now because of the impact of Statins and better surgical techniques. I suppose you have to distinguish as well between cvd appearing as the main cause of death and a subsidiary on the death certificate much like diabetes.
 
Burylancs said:
I read it about ten years ago from an American scientist who was just starting a research project to determine the links between cvd and Type 1 which aren't well understood. But a bit ago I noticed a Danish study that said it was lower than 85% now because of the impact of Statins and better surgical techniques. I suppose you have to distinguish as well between cvd appearing as the main cause of death and a subsidiary on the death certificate much like diabetes.
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This references a small Danish study, that seems to suggest that with earlier interventions now, (like Statins, BP meds etc), into consideration, there is now only a small difference in the risk for those with Type 2 diabetes, and the rest of the population.

Risk of heart attacks halves in patients with diabetes in 15 years

Your access to the latest cardiovascular news, science, tools and resources.
www.escardio.org www.escardio.org
It doesn’t mention Type 1.
I'm always interested in looking behind the headline stats, which can be quite frightening. For example, in my husband's family, most of the deaths have CVD on their death certificates, but most of them were around 90 when they died.
 
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