type 2 / high cholesterol / statins / anti-depressants > advice please

[horsesforcourses]

Hi to everyone. I am 56 and was diagnosed with type in 2017. Am managing to control it through diet so don't have to take any meds for it. My cholesterol has always been on the high side even when I was in my twenties. It's about 8. Because of the type 2 I was referred to an Endinocrinologist before Christmas who recommended I take a statin. To complicate matters further, running alongside this has been a need to take anti-depressants since my teens for anxiety & depression. I had the worst breakdown I've ever had in 2016 and it took months to recover and get back to my normal. (I think the menopause factored very much into this also). I'm well aware of all the negative press statins have had but thought I'll give them a try. I'm now on my second trial of a statin because they impact on my mood and make me more anxious. First I was given Atorvastin and now I'm trying Provastin. When I look at the side-effect information sheet for the tablets it says they can cause depression & diabetes! For my quality of life, I feel that my mental health being good is the most important thing to me. I've been listening to talks on Youtube about cholesterol and lots of people writing reviews saying that they've binned the statins. Has anybody else been in this situation and what have they done ? This is making me worry a lot ..

 

[Felinia]

Like you I am Type 2 and with cholesterol higher than the doctors would like. I tried 2 different statins - Simvastatin and Provastatin - over an 18 month period. However, although I really persevered, I had very bad side effects with the Simvastatin so was switched to the 2nd one. It didn't make a scrap of difference and the surgery said I had the worst side effects they had seen, as they conflicted with my Diverticular Disease amongst other things. So when I said I would rather have quality rather than quantity of life I was taken off them. It took me 9 months for the side effects to completely go.
My GP told me to take a cholesterol lowering drink each day. Since then 3 successive new GP's have said they want to put me on statins. This makes me so mad as clearly they never bothered to read my notes which flag my sensitivity to them, along with my other allergies. My latest GP and I did discuss taking Bezafibrate instead (it was the medication before statins), but she came back and said it was contra-indicated for diabetics. So I manage with diet and Benecol (it has less carbs than supermarket own brand ones). I follow a healthy diet but avoid so called 0% or reduced fat items as they are loaded with sugars. I was originally 7.8 and my last reading was 5.4 - still higher than my target of 4 but better than it was.
BUT that is just one side of the story. People do take them with minimal or no side effects, and for people with cardiovascular problems taking them is supposed to outweigh the side effects. It is something you will have to decide for yourself, depending on how you feel on the current statin.

 

[Drummer]

I'd not take a statin - the more evidence of benefits I look for, the more it looks as though lower cholesterol, for women past menopause, is not a good thing.

 

[everydayupsanddowns]

Welcome to the forum @horsesforcourses

Members here can only really share their own experience, and can’t really give you advice.

I would suggest you have a good, open and frank conversation with your Dr, and let them know your concerns, and your priorities for your mental health.

Of course, knowing a side effect is quite a powerful thing, especially if you already struggle with anxiety. Clinical trials with a placebo arm (ie people taking no active ingredients) often report side effects as if people were taking pharmaceuticals.

Hopefully you can find a selection of meds which meet your needs.

Having said that, I believe there is some evidence that post-menopausal women do rather better with higher cholesterol than is generally recommended.

 

[Eddy Edson]

Having said that, I believe there is some evidence that post-menopausal women do rather better with higher cholesterol than is generally recommended.

Do you have any refs for that? Asking for a friend.

There's nothng in any of the expert body guidelines, so I assume it's not a factor worth considering.

There are some studies showing an increase in bleeding stroke risk for women with very low LDL cholesterol levels: eg https://pace-cme.org/2019/04/18/low...ted-with-risk-of-hemorrhagic-stroke-in-women/

But expert commentary notes that bleeding strokes are relatively uncommon, apparently (~10% of all strokes, or something like that); the risk is probably heavily influenced by smoking status and hypertension; and the well-established reduction in risks for other kinds of more common stroke and other CV probs from lower LDL would generally outweigh any increased bleeding stroke risk.

 

[Drummer]

I found this - but it was removed - I think that there are powerful disbelievers - though arguing against the factors seems problematic - age at death seems set in stone, and LDL levels are accepted as reasons to medicate -

cholesterol
Abstract from bmjopen.bmj.com
Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review

Objective It is well known that total cholesterol becomes less of a risk factor or not at all for all-cause and cardiovascular (CV) mortality with increasing age, but as little is known as to whether low-density lipoprotein cholesterol (LDL-C), one component of total cholesterol, is associated with mortality in the elderly, we decided to investigate this issue.
Setting, participants and outcome measures We sought PubMed for cohort studies, where LDL-C had been investigated as a risk factor for all-cause and/or CV mortality in individuals ≥60 years from the general population.
Results We identified 19 cohort studies including 30 cohorts with a total of 68 094 elderly people, where all-cause mortality was recorded in 28 cohorts and CV mortality in 9 cohorts. Inverse association between all-cause mortality and LDL-C was seen in 16 cohorts (in 14 with statistical significance) representing 92% of the number of participants, where this association was recorded. In the rest, no association was found. In two cohorts, CV mortality was highest in the lowest LDL-C quartile and with statistical significance; in seven cohorts, no association was found.
Conclusions High LDL-C is inversely associated with mortality in most people over 60 years. This finding is inconsistent with the cholesterol hypothesis (ie, that cholesterol, particularly LDL-C, is inherently atherogenic). Since elderly people with high LDL-C live as long or longer than those with low LDL-C, our analysis provides reason to question the validity of the cholesterol hypothesis. Moreover, our study provides the rationale for a re-evaluation of guidelines recommending pharmacological reduction of LDL-C in the elderly as a component of cardiovascular disease prevention strategies.

 

[everydayupsanddowns]

Do you have any refs for that? Asking for a friend.

Looks like this might be the analysis that Drummer refers to: https://bmjopen.bmj.com/content/6/6/e010401

30 cohorts of 68,000 older people aged 60+ with (if I’m reading it right) an inverse association in 92% of subjects and no association of increased risk from LDL-C in the rest.

The author suggests the inverse association is quite well known, and an Internet skim of menopause and cholesterol seems to suggest a known increase in LDL for women at that stage of life.

I will see if I can find others, as I’m sure I first came across this viewpoint before 2016.

 

[everydayupsanddowns]

Here’s another which is primarily taking about hypertension, but which states that TC generally increases with age, and becomes less and less significant in evaluating CHD risk at the same time:

https://www.ncbi.nlm.nih.gov/m/pubmed/10999646/

Total cholesterol levels steadily increase with age from 20 to 65, following which they decrease slightly in men and tend to plateau in women. Elevated cholesterol levels are not uncommon in the elderly (61% of women aged between 65 and 74 have total cholesterol levels over 6.2 mmol/L [240 mg/dL]). From the data available, it is reasonable to conclude that after the age of 65, increased blood lipids, although still a risk factor for coronary heart disease (CHD), become less pronounced as risk factors and that by 75 years of age their predictive value has disappeared. Indeed, in the very elderly, there is evidence to suggest that high total cholesterol is associated with longevity. ​

 

[Toucan]

Hello @horsesforcourses, welcome to the forum.
As you can see from the replies above there is a great deal of experience and knowledge here, - and that in line with all the research you have already done there are varying opinions about statins. It is a personal decision on what to do, and as @everydayupsanddowns suggests, maybe another frank discussion with your doctor.
A big positive though is that you are managing to control your Type 2 by diet which is a considerable achievement - Well done.
If you can, it would be good to make a decision quickly about the statins, then try to 'park' it and move on, as worrying about it can cause more issues than the problem itself sometimes.

 

[ianf0ster]

I'm don't know if I can find the studies but I recall there were several which showed no protective effect from CVD or stroke in women, even younger ones.
So for a post menopausal woman, rejecting statins would seem to be a no-brainer. The benefits in men seem to be better founded, but for me Simvastatin and Atorvastatin are out of the question since I discovered they cross the Blood Brain Barrier and according to some studies help prevent Alzheimers and Parkinsons, though in other studies possibly make them worse!

I feel I would rather have a heart attack than Alzheimers.