So had my 3 month review after starting on 500mg metformin once a day. My hba1c is now 47 my cholesterol is 4 1. She said I should consider taking a statin ..I wasn't sure so asked if I can consider this first . As my numbers have come down and I need to carry on trying to loose weight. I've only lost 2kg in 3 months though. Anyone have advice on statins please
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Statins/chlosterol
- Thread starter NikkiG51
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Leadinglights
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It is your decision and there is a lot of controversy about statins, several threads here about the pros and cons but ultimately you have to make your own decision. They say that for people in the at risk category that total cholesterol is recommended as being below 4 so really that is pretty well what you are.
Some people find that reducing carbohydrates will lead to cholesterol level coming down without statins.
You are going in the right direction with your HbA1C, diet will have the greatest impact rather than the metformin.
Some people find that reducing carbohydrates will lead to cholesterol level coming down without statins.
You are going in the right direction with your HbA1C, diet will have the greatest impact rather than the metformin.
Windy
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I was offered statins a year ago, and said no, as I had vaguely bad vibes about them, and it came as a surprise to me when the GP offered them. I had another review recently, and asked to take them, as my cholesterol had gone up since last time.
The Nice Guidance [edit - I have removed the link as it lead to a broken page.] that:
GPs should discuss the benefits of changes to lifestyle with patients before initiating treatment with statins. “We’re not saying that everyone with a 10 per cent or greater risk of CVD within 10 years needs to take a statin. The guideline recognises the importance of choice in preventing CVD and that this should be guided by information on the trade-off between benefits and risks.” [CVD is cardiovascular disease]
It sounds like you're making lifestyle changes now, and these will hopefully bring your cholesterol down.
The thing is, you don't have to make the decision right away. I read up (British Heart Foundation and Diabetes UK both have pages about them, and they're not trying to sell you anything). I also watched a youtube video from a NHS Cardiologist which put my mind at rest, so I asked to start them.
A couple of weeks in, I've had no side effects, but if I had, I would have stopped taking them, and asked the GP to try a different statin. I know some people do have bad side effects, but there's an upside and downside to all medication (for instance, metformin can give you the runs, and aspirin can give stomach bleeds). You have to decide if the benefits (potentially reduced risk of heart attacks and strokes) are worth any potential side effects.
Hope this helps, Sarah
The Nice Guidance [edit - I have removed the link as it lead to a broken page.] that:
GPs should discuss the benefits of changes to lifestyle with patients before initiating treatment with statins. “We’re not saying that everyone with a 10 per cent or greater risk of CVD within 10 years needs to take a statin. The guideline recognises the importance of choice in preventing CVD and that this should be guided by information on the trade-off between benefits and risks.” [CVD is cardiovascular disease]
It sounds like you're making lifestyle changes now, and these will hopefully bring your cholesterol down.
The thing is, you don't have to make the decision right away. I read up (British Heart Foundation and Diabetes UK both have pages about them, and they're not trying to sell you anything). I also watched a youtube video from a NHS Cardiologist which put my mind at rest, so I asked to start them.
A couple of weeks in, I've had no side effects, but if I had, I would have stopped taking them, and asked the GP to try a different statin. I know some people do have bad side effects, but there's an upside and downside to all medication (for instance, metformin can give you the runs, and aspirin can give stomach bleeds). You have to decide if the benefits (potentially reduced risk of heart attacks and strokes) are worth any potential side effects.
Hope this helps, Sarah
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Personally my extensive reading on the subject has persuaded me that they are not a good idea for most people.
The side effects can be quite dramatic in some and more insidious in others but they mess with many mechanisms in the body that are pretty much essential. I'll let my body manage my levels.
Eddy Edson
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I think that the link has been removed, possibly because the guidance is being updated. The new draft says statins may be appropriate where risk is less than 10%: https://pharmaceutical-journal.com/...eople-at-lower-risk-of-cardiovascular-disease
The draft guidance recommends that doctors consider atorvastatin 20mg for the primary prevention of CVD for people with a ten-year risk of less than 10% where there is “patient preference for taking a statin or concern that their risk may be underestimated”.
However, the guideline also says that, before offering statin treatment for primary prevention, prescribers should discuss the benefits of lifestyle changes and improve the management all other modifiable CVD risk factors, such as obesity and smoking.
The guidance adds that people at a higher risk should continue to be offered statins and more focus should be placed on increasing uptake among these people in order to have the most impact on CVD prevention.
Anyway, FWIW I've been on a high dose statin for 5 years now with zero side effects, and it has been a major contributor to reducing the impact of peripheral artery disease and being able to vastly improve my walking performance.
More generally, though, I would say it's better to follow advice from yr health care providers than from unqualified people posting on message boards.
Windy
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Thanks Eddy, I've removed the link, as it wasn't going anywhere!
I would say with a total cholesterol of 4.1 you shouldn't need to take statins. It's just above the level of 4.0 that NICE says diabetics should take statins. That figure is pretty well plucked out of the air. The various lipid ratios are more important than the total figure e.g. LDL, HDL, Trigs etc. Your blood test may have included that breakdown as mine always do so have a look online on your surgery's system to see what the various ratios are. Ask for access to your results if you don't already have that.
Deb_l
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Nobody can force you to take tablets you don't want but you need to weigh up the pros and cons.
I'm certainly no expert but I understand the reason statins are often offered hand in hand with a diabetes diagnosis is due to poor diet. Let's be honest, for most people (and I'm not saying everyone), if you have a T2 diabetes diagnosis, chances are you will also have a higher than normal cholesterol level.
High blood glucose and High Cholesterol together are your blood vessel's worse nightmare and can lead to multiple life threatening / limiting conditions
On the plus side (yay!!) both can be lowered with medication and / or diet but only you can decide if you can maintain a diet that will keep both your blood glucose and cholesterol low enough not to need tablets. I've resisted statins because I don't have an up to date cholesterol test. The plan however is to do a test next month, when I'm due my three month diabetes check so I'm actively eating cholesterol lowering foods as well as all the other good stuff.
There's no denying statins have their place in the world of medicine and they have definitely helped my mum with her vascular issues but (for now) I shall resist as long as possible and attempt to turn things around with diet only.
I'm certainly no expert but I understand the reason statins are often offered hand in hand with a diabetes diagnosis is due to poor diet. Let's be honest, for most people (and I'm not saying everyone), if you have a T2 diabetes diagnosis, chances are you will also have a higher than normal cholesterol level.
High blood glucose and High Cholesterol together are your blood vessel's worse nightmare and can lead to multiple life threatening / limiting conditions
On the plus side (yay!!) both can be lowered with medication and / or diet but only you can decide if you can maintain a diet that will keep both your blood glucose and cholesterol low enough not to need tablets. I've resisted statins because I don't have an up to date cholesterol test. The plan however is to do a test next month, when I'm due my three month diabetes check so I'm actively eating cholesterol lowering foods as well as all the other good stuff.
There's no denying statins have their place in the world of medicine and they have definitely helped my mum with her vascular issues but (for now) I shall resist as long as possible and attempt to turn things around with diet only.
The figure of under 4 for diabetics was not 'plucked from the air' . It's based on Edwin Biermann's researches in the 1990s. He found that the acceleration in the rates of cvd began at levels over 5 but the same tipping point for the acceleration in the rates of cvd in Diabetics came at levels over 4. Hence the advice based on EVIDENCE. And that's simply because Diabetic Dyslipidemia is one of the first and most pernicious of the diabetic complications to start.
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'Optimization of the lipid profile is the single most important intervention for improving cardiovascular prognosis in Type 2 Diabetes.'
Diabetes Essentials, O'Keefe et al 2009
This is incorrect.. the 4 or below for people with diabetes was dropped a while ago.
It's all based on your QRisk3 score these days.
Still nonsense but a different nonsense.
And it has been dropped from the NICE guidelines so....
nonethewiser
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Sensible advice by likes of Windy & Eddy Edson.
Read up & follow expert advice on your health, don't be put off by scare stories about statins, they've been around long time now & most be one of the most researched drugs around, consensus amongst experts is they are safe & very affective at reducing cardiovascular risks & events.
Read up & follow expert advice on your health, don't be put off by scare stories about statins, they've been around long time now & most be one of the most researched drugs around, consensus amongst experts is they are safe & very affective at reducing cardiovascular risks & events.
So the data it was based on was so vital that NICE have dropped it. Over the years I have become very cynical about much of the research data used for diabetes, cholesterol guidance etc. Ancel Keys comes to mind....Also NHS diet guidance based on 'research' and which could easily make your diabetes worse.
Do you accept that the advice to keep chols under 4 for diabetics was not 'plucked from the air' ? It was based on the known research at the time ,which is all you can ask for.
Spathiphyllum
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Agreed, with a proviso: Research indicates that what matters most, for most people, is your ratio of total cholesterol to HDL; so that's what the widget they currently use, QRISK3, asks about. (https://qrisk.org/ ) And most people can reduce their total cholesterol and increase their HDL cholesterol through changing their diet.
So-- yes, statins do appear to be safe and effective for the great majority of people; but it's also safe for most people to try changing diet first, because that may also be effective. Heart UK has a nifty "Diet Checklist ... designed to assess the quality of your diet with regard to lowering your cholesterol", available here as an online quiz: https://www.heartuk.org.uk/healthy-living/introduction
nonethewiser
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Totally agree about diet, but sadly diet & exercise isn't enough for some so need help from drugs to bring levels into place.
No. 'ratios' have been downgraded and two other measures taken as important. The first is Total. chols MINUS HDL and absolute kevel of LDL. The first measure gives the amount of lipids potentially depositing chols in the linings of the arteries ( the Intima). The target for Total minus HDL is recommended as under 3.37 ( that's an awkward translation of American measures in other units).The second measure re-emphasises the importance of LDL as the main culprit in the problem.
Spathiphyllum
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There seems to be some confusion regarding what the current NICE guidelines are, so I looked them up!
The current "Summary of national guidance for lipid management" (last updated 8 December 2022), can be downloaded from here: https://www.england.nhs.uk/aac/publication/summary-of-national-guidance-for-lipid-management/
Two things in particular can be noted:
1) They still rely on QRISK3, and I gave the link for that previously (https://qrisk.org/ ). The only lipid information QRISK3 uses is "Cholesterol/HDL ratio".
2) The goal of statin treatment is repeatedly described as "reduction of non-HDL-C > 40% from baseline". No specific figure is given.
So the experts at NICE have decided-- on the basis of reviewing the relevant research-- that, in relation to lipids, the key risk trigger is the ratio of total cholesterol to HDL. And that, in terms of reducing risk, the key thing is reducing non-HDL cholesterol, but there is no magic number.
If you know of actual research, done within the past year, demonstrating that NICE is wrong on these points, please do post links!
The current "Summary of national guidance for lipid management" (last updated 8 December 2022), can be downloaded from here: https://www.england.nhs.uk/aac/publication/summary-of-national-guidance-for-lipid-management/
Two things in particular can be noted:
1) They still rely on QRISK3, and I gave the link for that previously (https://qrisk.org/ ). The only lipid information QRISK3 uses is "Cholesterol/HDL ratio".
2) The goal of statin treatment is repeatedly described as "reduction of non-HDL-C > 40% from baseline". No specific figure is given.
So the experts at NICE have decided-- on the basis of reviewing the relevant research-- that, in relation to lipids, the key risk trigger is the ratio of total cholesterol to HDL. And that, in terms of reducing risk, the key thing is reducing non-HDL cholesterol, but there is no magic number.
If you know of actual research, done within the past year, demonstrating that NICE is wrong on these points, please do post links!
Check out this link on Cholesterol National Guidelines (2020).
Summary of national guidance for lipid management for primary and secondary prevention of cardiovascular disease
Spathiphyllum
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You didn't actually include a link; and, when I search for "Summary of national guidance for lipid management for primary and secondary prevention of cardiovascular disease"-- what I get is the link I posted. Which says "Document first published 9 April 2020" and then says it was updated in December 2022 ...
I feel I should emphasise I'm not being sarcastic! If you do know of very recent research casting doubt on what NICE recommended as of late 2022, I genuinely want to know.
As it is, it looks as though you may have been looking at something out-of-date which has been overtaken by further research?
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