Statin - starting dose

[dannybgoode]

The QRisk thing is scary @everydayupsanddowns My GP didn’t have me listed as having diabetes (!) so my QRisk was great. Of course, with the Type 1 added, it shot up.

It's a made up number based on statistical analysis of a large group of people.

I'm always cautious about these kinds of things as it doesn't really take into account the individual.

I had my health check thing the other week and was given my first qrisk score and was even told by the chap to basically ignore it as things like diabetes skew the figure as it doesn't take into account that some people manage it very well and don't really have any increased risk and some do not manage it so well so are at increased risk.

Personally I think such numbers do more harm than good by causing people to stress unnecessarily. We never used to be given one and people still lived for longer than predicted for them and people still died younger.

In other words, what use is that number? What use is it to know it, particularly when it gets thrown out by adding something like being T1?

 

[everydayupsanddowns]

Questions: if it’s the Type 1 that increases the risk, why does it do so? Is it inflammation? High blood sugar? Blood sugar moving in too large a range? Does changing any of those things reduce the risk? The QRisk thing seems such a blunt too: got Type 1? You’re @**##&! Surely logic suggests trying to modify the risk contributed by Type 1?

It’s a blunt tool to be sure, and one could consider that the bluntness makes it unusable because of the lack of nuance (I pondered this for a long time, trying to work out what my risk might actually be, given that my BG management has always been pretty good).

But in the end, I believe most people with diabetes (including T1) ‘get got’ by a heart attack of some sort. Despite our best efforts we will almost inevitably be having more unstable and spiky glucose levels than someone without T1.

If there’s a theoretical risk reduction to offset a theoretically raised risk, and I have no ill effects from that reduction, it feels like a worthwhile precaution to me.

I wish I’d tried them earlier!

 

[Eternal422]

I was started on 20mg Simvastatin which was switched to 20mg Atorvastatin as cholesterol levels were still high. A further tweak was made to increase the Atorvastatin to 30mg (which is a bit of a pain as it is 2 tablets now - a 10mg and a 20mg) but this seems to keep my total cholesterol at around 4.4, HDL 1.3, LDL 2.5. So I’m hoping this is ok. Luckily I haven’t had any side effects from the statins so will continue with them.

 

[Wendal]

I was started on 20mg Simvastatin which was switched to 20mg Atorvastatin as cholesterol levels were still high. A further tweak was made to increase the Atorvastatin to 30mg (which is a bit of a pain as it is 2 tablets now - a 10mg and a 20mg) but this seems to keep my total cholesterol at around 4.4, HDL 1.3, LDL 2.5. So I’m hoping this is ok. Luckily I haven’t had any side effects from the statins so will continue with them.

Really nice discussion and like many I was reluctant to go on statins despite being familiar with them from a pharmacological point of view for many years.I have always been a little on the high side so about 5.5 for TC but as had no other risk factors I was quite happy.The diabetes diagnosis 18 months ago and the attendant higher risk score meant that I have eventually agree to go on 20mg Atorvastatin recently and due to be reviewed soon.
Although I have not looked at how the cardiac risk score is arrived at they can be a very blunt tool as others have said and although there is an age dimension what it does not do is relate to how long you have been diabetic ( if I recall correctly it is a binary yes or no ) and any material risk factor should have a time component although I fully understand this would make it much more complicated when providing very general health advice protocols.

 

[Ivostas66]

At my first consultation a couple of weeks after diagnosis, the DSN and dietician said my cholesterol was high. My Mum, her Mum and most of the women on that side of the family have had high cholesterol, so it wasn't much of a surprise. My Mum asked me to query it as she thought the level was fine - I can't remember precisely, but think it was around 5. DSN said it was higher than they would like for a diabetic and to reduce the risk of heart attack or stroke, I should consider statins. My Nan and several of her sisters suffered strokes and heart attacks in old age (they were a fit, healthy bunch, some like my Nan living into their 90s and one still going strong at 98). My Mums attitude to statins has always been - anything that reduces my high risk of stroke and that is an attitude I have also stuck with.

My initial dose was 20 I believe. A year in and my consultant reduced my dose as he worried my cholesterol was too low. I've been on them since 2018, no side effects (that I know of!). Like others have said, I sometimes forget to take them. I had two weeks without them when I stayed with my sister in Spain, but didn't worry too as I was swimming and eating extremely well whilst there.

 

[Burylancs]

I was started on 20mg.
Like @Alan44, they were not taken everyday but still halved my ldl (without changing my diet) which is more than enough evidence for me that the dose was higher than necessary.

Does soluble fibre make any difference to cholesterol?

Dose Depends which statin. 20 atorvastatin supposed to have same the effect as 40 simvastatin. But Simvastatin is cheaper ?

 

[helli]

Dose Depends which statin. 20 atorvastatin supposed to have same the effect as 40 simvastatin. But Simvastatin is cheaper ?

That begs another question:
In addition to deciding the statin dose, how does a doc decide which statins to start a patient on?

 

[everydayupsanddowns]

That begs another question:
In addition to deciding the statin dose, how does a doc decide which statins to start a patient on?

I’m not sure - I’d imagine it might be that one or other are recommended as the first one to try.

But also I’d guess each Dr will have their own built up experience of which meds they seem to feel are the optimum starting choice

 

[Burylancs]

That begs another question:
In addition to deciding the statin dose, how does a doc decide which statins to start a patient on?

The local Care Commissioning Group will likely determine which statins they're prescribing and which doses they are advocating. My area went Simvastatin a few years ago.

 

[JJay]

I started back in the dim and distant on either simvastatin or pravastatin (can’t remember which, nor the size of dose), which had unpleasant side effects. Changed to Atorvastatin 20mg. Well tolerated, but not much effect on cholesterol, which stayed stubbornly above 5. Accordingly changed to Rosuvastatin (again, can’t remember dose). Cholesterol hovered around 4.5. Then moved house, new GP in new county. Could not prescribe Rosuvastatin as too expensive. Back to Atorvastatin, but at 40mg. Since then every test has been just below 5, except one in September which was 5.6. Atorvastatin had been stopped for 8 weeks while I was in hospital because they were concerned about my low blood pressure. GP gave go-ahead to restart. Tested again mid-October: 4.7.

I think it’s been accepted now that I will never get down to the 3.9 they’d like. Some people naturally have high cholesterol - a member of our walking group in our old village was told by her GP she was one such and that a
daily glass of red wine would be better for her than statins!

 

[Sharron1]

Atorvastatin 20mg, did wonders for my cholestrol, no obvious side effects, would have been ok to remain on Atorvastatin, unfortunately (I have posted this on many occasions) it elevated my liver enzymes. I was taken off it immediately and am now taking 10mg of a cholestrol lowering drug Ezitimbe without the statin that usually accompanies it. Again, no noticeable side effects. Due for a LFT soon, then I will see how effective it has been or not and if it has not been user friendly for my liver.

 

[DianeD]

I have been on 20 atorvastatin for 3 weeks now. Mostly OK, a few niggles, nose bleeds, cough, insomnia, but hoping these will pass as my body gets used to it. Had tried rosuvastatin (spell?) But it gave me mental health problems even at a low dose.

 

[Leadinglights]

I have been on 20 atorvastatin for 3 weeks now. Mostly OK, a few niggles, nose bleeds, cough, insomnia, but hoping these will pass as my body gets used to it. Had tried rosuvastatin (spell?) But it gave me mental health problems even at a low dose.

I think the message here is that peoples tolerance to statins is so variable just as some blood pressure medications suit some people and not others and it can take some trial and error to find one which does the job without side effects.

 

[Pidgeonpost]

I think the message here is that peoples tolerance to statins is so variable just as some blood pressure medications suit some people and not others and it can take some trial and error to find one which does the job without side effects.

Uncertainty of tolerance is one of the things that is making me reluctant to try statins. Also I'm not sure exactly why my local surgery pushes me to take them every time I see a nurse for my regular blood pressure check - which is under control, typically 135/84-ish. My BMI is 23.2/23.3 depending which calculator I use and my cholesterol levels are OK, I think (see this thread).
Side-effects are a possibility and something of a worry, but reversing them if they should occur can so be a problem.

 

[Chris88]

Uncertainty of tolerance is one of the things that is making me reluctant to try statins. Also I'm not sure exactly why my local surgery pushes me to take them every time I see a nurse for my regular blood pressure check - which is under control, typically 135/84-ish. My BMI is 23.2/23.3 depending which calculator I use and my cholesterol levels are OK, I think (see this thread).
Side-effects are a possibility and something of a worry, but reversing them if they should occur can so be a problem.

Look at QRISK3, this is why they keep suggesting statins to you

 

[Pidgeonpost]

Says 10 year risk is 26.8%, healthy person(!) would be 24.6%, relative risk 1.1, healthy heart age 78.

 

[Chris88]

If your risk is greater than 10% then the GP is expected to offer you a statin , usually atorvastatin 20mg daily is first line

 

[Pidgeonpost]

If your risk is greater than 10% then the GP is expected to offer you a statin , usually atorvastatin 20mg daily is first line

So if an otherwise healthy person my age would be rated at 24.6% they would still be offered statins - or am I misunderstanding something?

 

[Chris88]

QRISK3 was developed using UK patients aged 25 to 84 years old, it looks at your chances developing stroke, pulmonary embolism etc.
It looks at things like BMI, cholesterol, hypertension, smoking status etc. which are all risk factors for developing cardiovascular disease . So the bigger your QRISK score the higher your probability of developing cardiovascular disease, eg stroke. Anybody with a score above 10% should be offered a statin so yes, anybody with a score of 24% should be offered a statin.

 

[helli]

I think it is mentioned previously that QRISK3 is a very blunt tool when it comes to diabetes. There is no consideration of the length of time with the condition or how well it has been managed. I think all that it asks is the type of diabetes ... and apparently Type 1 is higher risk than type 2. Just selecting Type 1 adds 11.6% to my score which means if I was diagnosed yesterday, I should be on statins immediately.
I wonder if it takes into consideration the amazing improvement in care for people with Type 1 (I don't know enough to comment about type 2) such as basal/bolus insulin regimes, CGMs, pumps, etc. or whether it is based on historic data.
For this reason, I paid no attention to my QRISK3 score and only considered my cholesterol levels when deciding whether to take them.