Statins in type 1s with no complications... any thoughts?!

[Pippa]

Hi everyone,
As I said on my "newbie" post I'm trying to make a few decisions at the moment regarding my treatment.
The first is that my new consultant in Leeds would like me to take Simvastatin tablets to try and prevent any cardiovascular problems in the future. I'd never heard of this before for young type 1s with no complications (I'm 23 and have had diabetes for 19 years). I did have a touch of background retinopathy last year but this is now resolved. The consultant himself said that this is controversial and upon a google search I've found that this is the general consensus. I'm willing to try most things to help my diabetes and obviously feel that I want to decrease my risk of complications as much as possible but with so little evidence I wasn't sure whether I wanted to start taking tablets on top of my insulin for the rest of my life.
Does anybody have any information about this? Or does anybody in the same position as me take statins? Any thoughts or advice would be much appreciated!
Thank you! x

 

[Northerner]

Hi Pippa, do you know what your cholesterol levels are? I was put on statins when first diagnosed three years ago (I'm now 53) but I decided to stop taking them after I had side-effects and also because they brought my levels down to 2.4 (people with diabetes are recommended to have levels below 4.0). After 2 years without them my level is 4.6 but my consultant is fine with the fact that I don't want to take them as my 'good' cholesterol (HDL) is fine. I think that unless you have particularly bad cholesterol levels then 23 is very young to be taking them, but that is my personal opinion. It might be worth seeking a second opinion from another doctor. It is a personal choice and you need to know the full details of the advantages and the potential risks.

Cholesterol is essential for life, but like many things (like blood sugar!) we need to have the right balance - as I feel I have that balance personally, I feel the risks of not taking them outweigh the risks of taking them - they are powerful drugs.

 

[Robster65]

Much like Northerner, I was put on statins last year due to slightly elevated chol. but also for their protective effect.

My chol. is now fine but, following a chat with the GP, I feel that I have no objection to still taking them providing I dont get any adverse reactions.

Obviously we're both much older but the evidence points toward long term diabetics having a greater risk of cardio problems, so maybe it's your time since diagnosis rather than your age that makes them a good idea.

The info on the net and elsewhere is fairly polarised with much evidence and statistics from both sides. So it really is difficult to know what to believe but my GP said that the evidence at the moment shows them to be positive although future research could turn that around. Until that time, we decided to go with what we know now rather than speculate.

Good luck in your decision.🙂

Rob

 

[Copepod]

Pippa, I reckon you need to base your decision on the facts of your situation - female (males have higher risks for cardio vascular disease), age 23 years, 19 years since diagnosis, complications status (none apart from background retinopathy), blood pressure, physical activity levels, your cholesterol results (both total and types), family history of cardio vascular disease etc. Then make decision for yourself, with advice from your consultant. If you use research papers, then ensure that they are peer reviews and check who funded the research, as well as matching yourself to the nearest possible group in the study.

Plus, while some people highlight side effects of statins, not all statins are the same, so it's usually possible to find a suitable one for each person who needs / chooses to take them.

No-one had suggested that I take statins, although I'm older (46, have had type 1 diabetes for 16 years (but didn't pass through teenage rebellion phase with diabetes - might be same for you, too, Pippa), no diabetic complications, normal blood pressure, no family history of cardio vascular problems (both grandmothers lived into their early 90s, both grandfathers into their late 80s), fit & active, cholesterol levels not elevated. If they did suggest, then I'd think very carefully about my decision, but can't say what it would be, as it's hypothethical for me. I would base my decision on my situation and peer reviewed research papers, not the opinion of people on a messageboard - not that you shouldn't ask or consider other people's opinions.

 

[PattiEvans]

Pippa

Statins should be avoided by females of childbearing age because they are known to be Teratogenic, in other words they will cause deformities to fetuses. I'm rather surprised that the specialist suggested that you take them without first being 100% certain that you had no chance of becoming pregnant.

Personally I came off them because of side effects (no, I'm not of childbearing age) but IMHO too low cholesterol is worse that elevated cholesterol providing the components of the cholesterol are good i.e. a good ratio of HDL to low triglycerides.

If I were you I'd give it long and serious thought before accepting the premise that "they're cardio-protective". FWIW they can degrade muscle tissue and the heart is the biggest muscle in your body.

 

[Robster65]

Pippa

Statins should be avoided by females of childbearing age because they are known to be Teratogenic, in other words they will cause deformities to fetuses. I'm rather surprised that the specialist suggested that you take them without first being 100% certain that you had no chance of becoming pregnant.

Personally I came off them because of side effects (no, I'm not of childbearing age) but IMHO too low cholesterol is worse that elevated cholesterol providing the components of the cholesterol are good i.e. a good ratio of HDL to low triglycerides.

If I were you I'd give it long and serious thought before accepting the premise that "they're cardio-protective". FWIW they can degrade muscle tissue and the heart is the biggest muscle in your body.

Just to clarify that statement Patti, it is safe for women to take statins and become pregnant, but the statin needs to be chosen with care.
Here's some advice from a reputable source (I think 🙂) on the subject...

http://www.gpnotebook.co.uk/simplepage.cfm?ID=x20070211072151295600

I've heard this said before and looked into it and it seems that it may have been pushed beyond the facts by the anti-statin lobby.🙂

Rob

 

[Robster65]

I apologise Patti. 😱

It says at the end of that article that it's prudent to withdraw statins for women trying to conceive.

But they do say that there is no evidence for Pravastatin causing abnormalities, even in animals (do I get away with it on that score ? 🙄).

Rob

 

[mcdonagh47]

Just to clarify that statement Patti, it is safe for women to take statins and become pregnant, but the statin needs to be chosen with care.
Here's some advice from a reputable source (I think 🙂) on the subject...

http://www.gpnotebook.co.uk/simplepage.cfm?ID=x20070211072151295600

I've heard this said before and looked into it and it seems that it may have been pushed beyond the facts by the anti-statin lobby.🙂

Rob

The evidence on statins and pregnancy is thin.
In mouse research statins did affect the foetus but in rabbit research they didn't. Confusing. Older women are likely to be on statins rather than younger women of child bearing age so the dataset is small.
The warning about dropping statins three months before trying to get pregnant is basically because nothing is known for sure not because they are definitely teratogenic.
And of course there is plenty of ongoing research about statins in pregnancy ...
1. They were suggested in 2008 as a means of obese women avoiding needing caesarians ( the statin widens the birth canal).
2. they are currently under research as a very effective treatment for pre-eclampsia in pregnancy.
3. Statins are being researched specifically for pregnant diabetic women because they keep the placenta down in size - abnormal growth of the placenta in pregnant diabetic women is a major cause of foetal death and abnormalities.

 

[Pumper_Sue]

I've been on insulin for 47 years and have never taken statins and never will.

 

[Ellie Jones]

The statin question is a hard one and really personal choice..

Like most things you can find one set of evidence that says yes it's a good idea and another one telling you it's a bad idea.

I don't take them for very similar reasons to Northener,

Have a good think, and perhaps a word with your GP about them see what his/her opinion is, and perhaps with both your GP and consultant ask about pregnancy what happens if I decide I want a baby?

 

[trophywench]

Ellie I'd extend that Q to "and what happens if I don't decide to have a baby, but become pregnant anyway?"

and then if he said it would be NP, being me I'd want that in writing with evidence LOL

You wouldn't put diesel in a petrol engine cos some cars do OK on it ...... LOL

 

[PattiEvans]

I'd just like to add that the information I posted came from Dr Katharine Morrison who is a co-author of dsolve.com a GP and prominent mover and groover diabetic wise in the formulation of guidelines for Scotland. Katharine has been a member of forums for a while and a very informative person. Her son is T1 which led her to specialise.

 

[Ellie Jones]

Oh yes the Dr Katherine

Extreme Low Carb diet + insulin pen + extreme injecting = insulin pump😱

And who felt that it was perfectly expectable that her son could inject 12 times a day!

I know her work, met her via forums and thankful she has nothing to do with guide lines that effect me!

And she's not a specialist in diabetes.. She's a GP and a police surgeon (or was the last time I looked)

 

[trophywench]

I wonder why the Scots NHS involved her so much in their 'NICE' Guidelines then, if she's just another GP ......

(It isn't called NICE in Scotland, can't remember what it is though.)

Anyway, let's not argue about it.

 

[Donald]

I wonder why the Scots NHS involved her so much in their 'NICE' Guidelines then, if she's just another GP ......

(It isn't called NICE in Scotland, can't remember what it is though.)

Anyway, let's not argue about it.

it is sign in scotland

 

[mcdonagh47]

sign says their guidelines are developed by "multidisciplinary working groups" so Dr. K was one voice among many.

I wonder if she was responsible for the SIGN recommendation that all T2s over 40 should be on statins regardless of cholesterol figures. And that all
T1s over 40 should be automatically considered for them ?

 

[FM001]

The consultant I spoke to only 3 weeks ago give a similar account of statins needing to be prescribed to all diabetics regardless of cholesterol levels, he said that the risks may not be present now but taking a statin will prevent heart disease in possibly 10 to 20 years time.

On leaving he was writing to my doctor, not heard a word from him so don't know if he's binned it or waiting until I book an appointment with him, when I last spoke about statins to my doctor he was dead against it so unsure what he'll suggest.

 

[Northerner]

I wonder if she was responsible for the SIGN recommendation that all T2s over 40 should be on statins regardless of cholesterol figures. And that all
T1s over 40 should be automatically considered for them ?

I find that sort of recommendation genuinely frightening 😱 Medicalising the entire over-40s diabetic population with a powerful drug no doubt based on some statistical result of studies on a very limited proportion of the population? Regardless of how 'good' their cholesterol appears to be? Is this for the mysterious 'as yet unknown' benefit of statins? And what about the as yet unknown problems of statins 20-30 years hence?

In my opinion statins should only be prescribed to those who have a clear reason to benefit from them, not simply based on a crude two variable formula Diabetes+over40=statins. Human body chemistry is not that simple. If doctors and consultants cannot agree then who do we believe?

 

[Andy HB]

I find that sort of recommendation genuinely frightening 😱 Medicalising the entire over-40s diabetic population with a powerful drug no doubt based on some statistical result of studies on a very limited proportion of the population? Regardless of how 'good' their cholesterol appears to be? Is this for the mysterious 'as yet unknown' benefit of statins? And what about the as yet unknown problems of statins 20-30 years hence?

In my opinion statins should only be prescribed to those who have a clear reason to benefit from them, not simply based on a crude two variable formula Diabetes+over40=statins. Human body chemistry is not that simple. If doctors and consultants cannot agree then who do we believe?

I'm inclined to agree.

Whilst the statistics may show that statins are a 'good thing' for a group of people, I'm an individual and am only interested in what is good for me personally. That isn't necessarily the same thing!

Andy 🙂

 

[FM001]

I'm inclined to agree.

Whilst the statistics may show that statins are a 'good thing' for a group of people, I'm an individual and am only interested in what is good for me personally. That isn't necessarily the same thing!

Andy 🙂

I'm inclined to agree with you both, surely lifestyle, diabetes control and family history need to be considered before handing out statins to everyone with diabetes.