I’ve gone through all of this. In particular the best study overall looked at 14 trials. That study concluded that statin therapy for those with diabetes had less benefit than statin therapy did for non-diabetics. Other effects were no different between non-diabetics and those with diabetes. And from this we draw the conclusion that 30 million Americans with diabetes should be put on statins. Why them? Those with diabetes don’t even get the same benefit as non-diabetics. This is not good science and I think as patients we should ask hard questions about these guidelines.
I refuse to take statins and I regularly have short conversations with my endocrinologists about heart disease and diabetes. I make two assertions that they have not been able to refute. I tell them, “Show me the the study that demonstrates statins increase longevity.” I also request the clear cause and effect evidence that high cholesterol causes heart disease. That’s when I get a blank stare and moving on to the next topic.
I decided several years ago that the best thing I could do for my long term health is to keep my blood glucose levels closer to normal.
Some people with high cholesterol live long lives and die from unrelated causes. Some people with excellent cholesterol die from cardio vascular disease. If the medical establishment is so sure of their evidence, why can’t they explain these two circumstances?
The thing that really galls me about these guidelines is that they remove the doctor from the medical decision. Whether I am advised to take a statin is no longer a medical decision. The doctor can just “follow the guideline” even if it harms or kills the patient. The guideline serves as exculpatory evidence in a malpractice suit. We shouldn’t have guidelines based on weak evidence that subverts the medical decision which should weigh the benefits and risks associated with such treatment for each patient.
You know, I feel fortunate to have doctors that are open to ideas outside “the guidelines.” And I don’t mean alternative mumbo-jumbo, which isn’t my style. I have borderline high cholesterol, and my Dad’s family has silly-high cholesterol but no incidence of CV (and regularly live past 100). So after discussing all this, we decided statins weren’t indicated for me, and instead I’m just focusing on BG management and correcting for some vitamin deficiencies (B3, notably). I feel grateful that my team doesn’t just say “it’s in the guidelines, so you need to be taking this…” over and over and over.
The practice of “cherry picking” data to prove the writer’s favored belief is so widespread and prevalent that once you realize how common it actually is, if you’re not careful it can easily leave you wondering whether to trust any study.
With specific regard to the diet/cholesterol/statin/CVD model, Malcolm Kendrick confronts it head on in The Great Cholesterol Con. While his writing style is too breezy and snarky for my taste, he does an excellent job of pointing out the cherry picking, illogic, and most of all the lack of real hard data in this debate.
Personally I refuse to use statins, a subject on which my doctor and I go round and round occasionally. My lipids are excellent—not simply okay but excellent—since switching to LCHF, and when I did use statins a few years back the side effects were horrendous. To each his own.
As a practicing, writing, publishing scientist, I never “trust” any study. I do trust consensi, however. Even when they are developing. Doesn’t mean they’re always right, but I feel it’s generally a safe bet to assess the direction the evidence is blowing and “trust” that particular directionality (until proven otherwise).
As far as I can tell, the wind is blowing against the “CV is caused by saturated fat, high-fat diets, dietary cholesterol, red meat, and dairy” consensus of the 80s and 90s. And it’s blowing against the “statins are useful in borderline high-cholesterol cases,” which is probably where most diabetics live (of either Type). To me it’s really about assessing overall risk. While I have fluctuating triglycerides (from low to high and back again, quarterly to quarterly review), my overall cholesterol and VLDL have been trending downwards since adopting a low-carb diet. My HDL has been trending upwards since adopting a low-carb diet (with a big Omega-3 supplement of nasty lemony fish oil). While my numbers aren’t “ideal,” and while my algorithmic “CV risk” is still slightly elevated for my age group, it doesn’t seem warranted to take a statin in my case.
Especially since statins depress HDL, and low HDL is highly correlated with death from CV issues. I mean seriously: unless you’re the mythical unicorn diabetic with high VLDL cholesterol and high HDL at the same time, I don’t see how lowering VLDL at the expense of lowering HDL is particularly useful (at least it isn’t in my case).
For a well-written and easily understood take on the changing scientific consensus on cholesterol, I always recommend Peter Attia’s blog www.eatingacademy.com. He’s also got a nicely moderate take on low-carb diets for athletes: how they can be beneficial and also how they can be harmful to performance.
Actually it dates from the 1950s, when Eisenhower’s heart attack and Ancel Keys’s “research” gave rise to it, though it’s now clear that Keys’s data was egregiously cherry picked and even he himself later backed down, partially.
I’m glad you said “correlated”, because this particular correlation is riddled with exceptions in different populations. Like so many areas that are subjects of debate, it’s up to the individual what to credit.
Right, but my actual point is that “high cholesterol” is a compound variable, because it’s made up of several different components: LDL (including VLDL and other sub-components); HDL; and Triglycerides. And while CV risk is correlated with different components, it’s not linearly correlated with a given component being high. You know this, but I want to clarify it for others that may not:
- No single component of total cholesterol (other than possibly VLDL particle count) is cleanly and linearly correlated with CV risk.
Then again, I’m not sure placing one’s faith in the cholesterol-CV risk “algorithm” is necessarily unfounded either. It is based on decent statistics. The question is really about side effects of low-strength statins and risks of high-strength statins vs. risk of CV. And how one values the risks likely changes from patient to patient. If you aren’t sure about a family history, might just be safest to take your doctor’s advice
I only feel confident in my “no statins” policy because I have a minimal family history of CV disease while having a ridiculous amount of diabetes and cholesterol issues. In my family, having diabetes and elevated cholesterol levels doesn’t appear to be correlated with death by CV disease. That’s a good enough reason for me to avoid taking medication that I’ve had side-effects from (increased light-sensitivity) or that in stronger forms can impair cognitive function.
Precisely correct, except that some highly credentialed people claim to have demonstrated such a correlation. Which is why I view the entire discussion with a jaundiced eye.
And statistics can mean anything you want them to, depending on the contextual model in which they are framed and the assumptions (stated or unstated) that underpin the model. Absent clear and definitive proof, it’s up to the individual to determine where they place their credibility. We simply don’t approach if from the same direction. No harm, no foul.
Right! In the absence of a clear model of CV risk being caused by dyslipidemia, it’s best left up to individual patients and their doctors. I’m opting for the “no statin” route, but that doesn’t mean I think other people should or shouldn’t Each person should get as much info as they can and make a decision, or consult with a physician they trust. I’ve made the decision to not take statins at this point, and that is more or less the end of it with me. Despite the annoying little “Risk of CV disease” flag on my quarterly metabolic panel, I don’t see a point in worrying much about it at this point.
Curious, you had a link to the study where the final interpretation is: “Statin therapy should be considered for all diabetic individuals who are at sufficiently high risk of vascular events.”
When you get into the weeds of looking at the numbers you still find a “similar” reduction in all cause mortality even though it was a 9% reduction for PWD instead of 12% without diabetes. There were also a 20% reduction in other heart disease risks of vascular mortality, vascular events, heart attacks and stroke.
The big picture is that diabetes increase the risk of heart disease and statins have been shown to reduce that risk. The current evidence reflected by the guidelines are to take a statin. Page S79
What is right for you is to be decided by you and your healthcare provider.
And for me, that says it all. “Should be considered.” “Sufficiently high.” A completely nebulous conclusion with no specifics or concrete guidelines. How absolutely typical of the “science” that is offered up. A professional politician could do no better job of leaving all the options open, Reminds me of the ancient joke about the aviator who crashes in a farmer’s field and asks the farmer, “Where am I?” The farmer replies, “you’re in a pasture.” The aviator responds, “That’s the kind of information I get from my stockbroker: 100% accurate and entirely useless.”
lol you guys are arguing out of both sides of your mouth… both complaining that the guidelines are too specific and not individualized enough and now too vague. My bottom line will always be to do what my doctor tells me is in my best interest (that’s what I pay him for) if I ever reach a point where I don’t think that’s the best bet, I’ll be looking for a new doctor instead of affirmation of whatever I happen to want to think from dr google.
There just seems to be some kind of strange anger towards doctors and medical advice at work here that I really don’t understand or relate to… because it’s evident in these threads that the underlying common denominator is the notion that no matter what your doc tells you it must be wrong… makes me wonder what you think you’re paying them for
I often find these sorts of conclusions made at the end of scientific papers. I’m not necessarily disagreeing with this statement “Statin therapy should be considered for all diabetic individuals who are at sufficiently high risk of vascular events.” But the results of the meta analysis doesn’t support universal use of statins, yet that is the interpretation and the result.
In my personal case, statins caused me harm, but my doctors didn’t feel personally liable for the decision to prescribe statins. It was in the guideline and the fact that I was being observably harmed didn’t matter. They followed the guidelines, got bonus points for “quality of care” and as long as I didn’t die of high cholesterol they had done their job. So please understand I strongly object to these guidelines. I think the decision should be in the hands of our doctors to consider our situation and make individual decisions about risks and benefits.
Thee are many different statins now and patients and providers often need to try multiple one to avoid the side-effects of muscle cramps. Guidelines are written for populations and there are alway individual cases and and patients get to have a choice in their treatment.
We now also have Jardiance and Victoza to lower glucose that have been shown to reduce heart disease risk in high-risk diabetes patients in trials. Although this data is new and there is a long history of benefits from taking statins. It also depends on how much you value reducing heart disease risk. I personally appreciate the risk reduction and take a statin and metformin.
I’d be willing to trade quite a few muscle aches for a heart attack. When viewed in that light it is no mystery to me why physicians continue to recommend them even if side effects are reported in at risk populations. I agree though that it should be an individualized assessment about risk profiles and not a black and white rubber stamp decision… and good doctors agree with that philosophy completely. I wouldn’t pay for one who didn’t… And of course if a physician determines you are at significant enough CVD risk to justify intervention with statins, I would suggest it might be in ones best interest to try to work it out with them and try a few different options before convincing ones self that those risks are not actually worth mitigating (against medical advice) because some side effects were experienced
There is an offal lot of “I” in all these comments. I would never, I would do as doctor said, I would never take …
If there is one thing I have learned and I think we all know this, what works for me, might not work for you. And for that matter what works for me right now, might not 6 months from now.
There is so much that needs to go into the discussion one should be having with all your doctors before starting any medication. Current issues, family history, your history, side effects with other drugs. I don’t always go along with what my medical team suggests but we sure do talk about it and samples have been a great way for me to try something first. So let’s remember that I doesn’t usually work with diabetes. And as we have discovered here, all of us whether we take statins or not have very strong opinions but that doesn’t make the opinions right or wrong. They are opinions. Take it with a grain of salt or sugar.
And in regards to the first posting, I think if you and your doctor are not on the same page, a second opinion is not always a bad thing and as suggested a retest is not always a bad idea. Can’t tell you how many times my A1C wasn’t the same when retested. Best of luck and Happy New Year to everyone!
For the first time in decades we have recently seen a reduction in the average life span in the USA… I am wondering to what extent the internet has played in that where everyone thinks with just a few clicks of a keyboard they can know more than their doctor with decades of experience of managing the health of thousands of patients… not trying to stir the pot I just truly do think that may be part of an alarming trend… there is a lot of wisdom available on the internet too… like offering each other tips on blood sugar management… but sometimes with the good comes some bad as well
I’m going to go out on a limb and guess it really had nothing to do with it. Looks more like a greater number of people are committing suicide or drinking themselves to death:
There have been signs for years that health and socioeconomic problems might be chipping away at improvements in longevity for parts of the U.S. population. In 2008, the IHME reported that life expectancy had stagnated or declined for about 4% of men and 19% of women in the U.S. in the 1980s and 1990s. The report cited diseases related to smoking, high blood pressure and obesity as contributors and noted wide disparities in life expectancy between poor and wealthy U.S. counties.
Now, deaths from suicide, drug overdoses and similar causes appear to be playing a bigger role. Research published in November showed that white middle-aged Americans—both men and women—have been dying at a rising rate since the beginning of this century, due in large part to suicide, alcohol abuse and chronic liver diseases.
In 2014, increases in the number of deaths from suicide, alcohol or drug overdoses offset declines in deaths for both white men and women from cancer, heart disease and other major chronic killers, Dr. Arias said. The increases were higher for white women, she said. A rise in deaths from alcoholic liver disease or other forms of chronic liver diseases also affected life expectancy for white women, she said. The CDC report is based on data derived from death certificates
The factors cited in that caption are “playing a bigger role” than they have historically… but the main culprits appear to me to be others:
“Most notably, the overall death rate for Americans increased because mortality from heart disease and stroke increased after declining for years. Deaths were also up from Alzheimer’s disease, respiratory disease, kidney disease and diabetes”