Statin for Age 29?

Type 1 and LADA
1

Hi all. I've really been making an attempt to get back into A+ health, so I got an endo toward the end of last year. I think he is very good, and he also happens to be Type 1, which only helps.

Now that we have had 2 rounds of blood work, he wants me to go on a statin (e.g., Lipitor). I am not much for pharmaceuticals, but I will do what is necessary (he also prescribed an ACE inhibitor, which I -am- going to take).

I know that there is much debate about the old ratio/Framingham Study way of doing things vs whole number/Cleveland Clinic Study methods of analyzing one's cholesterol, but it just seems like he is being hasty here. I know most of the people he sees are 65+ and probably belong on a statin along with whatever else they are taking. I most definitely wish no offense to those who are older, but I feel like this might be his default suggestion for everyone coming into the office (how many people actually have LDL below 100? naturally?). I am curious on the opinions of some of you as I am relatively new to the cholesterol game. Here are my numbers (which I am definitely still improving):

NOVEMBER 2011:
Total cholesterol: 241
HDL: 72
LDL: 154
Triclycerides: 76
Chol/HDL ratio: 3.3
A1C: 7.2 (yes, I know this sucks)

APRIL 2012:
Total cholesterol: 233
HDL: 71
LDL: 143
Triglycerides: 96
Chol/HDL radio: 3.3
A1C: 7.2 (yes, again, it sucks))

Between the two tests, I lost 5 lbs., and I have another 25 to lose over the next 9 months or so. I know there are many elements to cholesterol that are simply out of our control, but I want to at least work on the ones I -can- control such as some elements of diet, my overall weight/percent body fat, and my blood glucose control. My actual LDL number (what my doctor believes in examining more closely than the ratios), has improved, and I am hoping it continues to do so.

He wants it under 100, which seems almost an absurd demand. He brags that his is 70 (through statins), something in which I see little benefit. Also, I've read that some elements of the Cleveland Study do not explain everything, and a big thing nowadays is to do an LDL density pattern test because not all LDL is bad (Type A vs. Type B).

Okay, sorry if I wandered around a bit; I am just curious on the opinions of all of you who may be in similar situations if you think my doc is correct and I should just shut up and take the pills, or if maybe I should push for additional testing (all while losing weight and eating correctly of course). Thanks!

2

I'm no expert about the numbers, but I think its a reasonable strategy to make some lifestyle changes to improve your cholesterol profile. Especially at your age.
I fought off my doc on statins for similar reasons. This motivated me to do some small changes:
(almost) daily exercise
adding sardines into my weekly diet (or any of those "oily" fish)
eating nuts daily
My cholesterol numbers, never bad, improved a great deal within 6 mos.

If you make similar commitments to living healthier, your A1C should improve & hopefully your cholesterol profile.

3

Since you are going to lose weight, and that may have a significant effect on your cholesterol, it may make sense to wait and see what that does to the numbers.

Since most diabetics are killed by heart disease, and statins have been proven to reduce deaths by heart disease (both in diabetics and non-diabetics), the Dr. is not crazy. LDL <70 is the target for diabetics. Though mine is 110, I do intend to drive it down below 70. I also want to get an LDL pattern test done, because, as you said, there is evidence that it is the type of LDL that matters as well as the absolute number. Lots of folks on here freak out about kidney complications, eye complications , neuropathy, etc. and do all sorts of unproven voodoo medicine to avoid them, yet ignore heart disease , the number 1 killer of diabetics, and don't want to take advantage of proven techniques to lower their risk of heart disease (on top of good BG control). I am not saying the other things aren't important - they are - but heart disease is a biggie too.

4

Actually, an A1C of 7.2 is not all that sucky. If you compare against the superstars who are in the 4's or 5's, sure it might seem sucky, but that fraction is very very small.

And you are right, diabetics are expected to have tighter cholesterol numbers than the average guy. Given our predisposition to heart disease, starting to work early on this, rather than later, sounds like an excellent idea. I would go even further, and say that in addition to statins, that diet and exercise be "turned to 11" (to quote Nigel from Spinal Tap) for all heart disease concerns.

I've been T1 for 30 years, and if I could go back to my teenage years, and start working on all the cardio risk factors more thoroughly back then (even using statins which didn't really exist back then) I would.

5

If you make lifestyle improvements and take the pills and your numbers get better, you'll never know what was responsible. I never had high cholesterol, but on a low carb diet my A1C came down to the low 5's and my cholesterol immediately dropped to 123 (overall). My BP improved as well. I'm 65. It seems to me you're young enough to see what you can do on your own. Then if it doesn't work you can fall back on the pills, but frankly there are a lot of people who take those pills and their improvement is minimal, whereas the risks are scary.

6

Some data from another thread on this subject that I posted:

Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis.
(PMID:18191683)
Abstract
Citations
BioEntities
Related Articles
Cholesterol Treatment Trialists' (CTT) Collaborators, Kearney PM, Blackwell L, Collins R, Keech A, Simes J, Peto R, Armitage J, Baigent C
Lancet [2008, 371(9607):117-25]
Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't
DOI: 10.1016/S0140-6736(08)60104-X
Abstract Highlight Terms
Gene Ontology(1) Diseases(4) Chemicals(3)
BACKGROUND: Although statin therapy reduces the risk of occlusive vascular events in people with diabetes mellitus, there is uncertainty about the effects on particular outcomes and whether such effects depend on the type of diabetes, lipid profile, or other factors. We undertook a prospective meta-analysis to help resolve these uncertainties.
METHODS: We analysed data from 18 686 individuals with diabetes (1466 with type 1 and 17,220 with type 2) in the context of a further 71,370 without diabetes in 14 randomised trials of statin therapy. Weighted estimates were obtained of effects on clinical outcomes per 1.0 mmol/L reduction in LDL cholesterol.
FINDINGS: During a mean follow-up of 4.3 years, there were 3247 major vascular events in people with diabetes. There was a 9% proportional reduction in all-cause mortality per mmol/L reduction in LDL cholesterol in participants with diabetes (rate ratio [RR] 0.91, 99% CI 0.82-1.01; p=0.02), which was similar to the 13% reduction in those without diabetes (0.87, 0.82-0.92; p<0.0001). This finding reflected a significant reduction in vascular mortality (0.87, 0.76-1.00; p=0.008) and no effect on non-vascular mortality (0.97, 0.82-1.16; p=0.7) in participants with diabetes. There was a significant 21% proportional reduction in major vascular events per mmol/L reduction in LDL cholesterol in people with diabetes (0.79, 0.72-0.86; p<0.0001), which was similar to the effect observed in those without diabetes (0.79, 0.76-0.82; p<0.0001). In diabetic participants there were reductions in myocardial infarction or coronary death (0.78, 0.69-0.87; p<0.0001), coronary revascularisation (0.75, 0.64-0.88; p<0.0001), and stroke (0.79, 0.67-0.93; p=0.0002). Among people with diabetes the proportional effects of statin therapy were similar irrespective of whether there was a prior history of vascular disease and irrespective of other baseline characteristics. After 5 years, 42 (95% CI 30-55) fewer people with diabetes had major vascular events per 1000 allocated statin therapy. INTERPRETATION: Statin therapy should be considered for all diabetic individuals who are at sufficiently high risk of vascular events.
----
42 fewer per 1000 had major vascular events.
Note the careful words they used: statin therapy should be *considered*.

The linkage was to reduction in LDL... so if you can get the reduction in LDL through lifestyle changes, so much the better.

For reference in the graph above, 1 mmol/l of LDL cholesterol corresponds to 38 mg/dl of LDL in the US system.

So reducing your LDL by 38 points brought about a 20% reduction in the incidence of CHD events.

7

Wow, some great replies. Thanks so much. I forgot to mention that my doctor thinks it is impossible for me to achieve a satisfactory (for a diabetic) LDL naturally and seems to blame genetics for the whole affair. I don't discount the uncomfortably large role genes play in certain things, but I think we also have a chance to decide how much we want to mitigate the role of bad genes.

In other words, let's say that my genes have me at the present point--there is no changing what that effect is; it is already present. However, taking into account the following intertwined _controllable_ factors:
(1) I am most certainly going to lose the remaining weight--albeit not for some months.
(2) I am also going to be changing my diet, and that means fewer high cholesterol items (yes, I know these aren't as big of a deal as we used to think, but given a fatty hamburger and a lean piece of grilled chicken, chicken wins just on general principle).
(3) I'll also be eating more of so-called cholesterol reducing foods such as steel cut oats and I'll be sure to try and get in the fish that Deborah mentions, thanks!
(4) I have been exercising again much more regularly (4-5 days per week in the gym, weights and cardio).
(5) Blood sugars should come down more, reducing the overall stress on my body (which also could follow from a few of the other items above).

I see no reason not to be able to cut a significant chunk out of it.

I lost 5 lbs. between blood tests last time, and that was--to be perfectly honest--without trying, with exception to cutting calories to achieve the weight loss.

It is good to get a feel from all of you, though, what ranges are considered acceptable so that I know that my doctor is being dramatic about ranges. Good to see his 70 show up. Just from doing a little more perusing on the Internet, the LDL density really could shine a light on to things--I know Bernstein mentions it in his book. I am going to see about it next time around, because--as HPNpilot mentions--lots of people can freak out and go overboard about what certain numbers. Therefore, I think we need to see how meaningful those numbers actually are. Not trying to be a know-it-all, because really I am a know-very-little here--that's why I have long speculations and questions I suppose. :)

8

My cholesterol in Jan 2012

Component Your Value Standard Range Units
HDL 62 40 - 59 MG/DL
CHOLESTEROL 125 110 - 200 MG/DL
TRIGLYCERIDE 44 40 - 149 MG/DL
LDL CALCULATION 55 50 - 99 MG/DL

The bolded number is my result, and then also the standard range. Only my HDL's are a little high, and that's the good cholesterol. And I am on ZERO statin's or Ace inhibitors. My endo doesn't see the need in it with my levels.

Last A1c was 5.7

I'm very leary about taking drugs JUST because with no real clear indication for taking them...I MIGHT get a brain tumor but I'm not going to take chemo just because.

PS I have a strong family history of hypertesnion and high cholesterol and people being overweight.

9

I take statins. I am not stopping them anytime soon. They work for me. When I began taking them, my LDL Cholesterol was over 500. now, it is just over 100 and continues to drop. Yes, there are those who say they cause muscle pain, and other rotten side effects. That may be true. However, without open heart surgery, due in part, to high cholesterol, and the continued use of statins, I doubt that I would be sitting here typing this response. My advice frompersonal experience: If you need the statins to get that cholesterol down, take them! Live is worth every breath,

Be well.

Brian Wittman

10

Oh I agree if there are legitimate reasons to be taking them such as highly elevated cholesterol I would be...but just to take them JUST because when my cholesterol despite nearly 30 years of being diabetic is PERFECTLY NORMAL, no Im not doing it. To me the benefits of taking something just because doesn't outweigh the serious side effects and risks these drugs carry, to take something I don't need. We all have to take into consideration our personal cholesterol levels, what other risk factors we may have and make an educated choice regarding the use of statins. For me I don't see the need for me to use them, just for prophylatic reasons.

11

Christy your numbers are enviable - both A1c and cholesterol. Your numbers already put you into the lower risk category, so your personal decision makes a lot of sense. You are blessed with good biology and you probably work hard at good health.

There are other people, though, like Brian above, who had an LDL of 500 and previous heart trouble, for whom it makes a world of sense. People's bodies differ and some people, no matter how skinny they get or how much they change their diet and exercise, still have high cholesterol and high heart disease risk. In this case, medical intervention has been proven to help.

It's very instructive to use one of the heart attack risk calculators, put your own numbers in, and see the effect of changes.

The ARIC study calculator, here , can take into account diabetes.

http://www.aricnews.net/riskcalc/html/RC1.html

You can try turning diabetes on and off and see the effect on projected heart attack risk. .. it is rather dramatic. You can also see the effect of lowering cholesterol on risk... with the right numbers, you can take out some of the excess risk that diabetes brings.

Some of the other calculators, like the one from the AHA, automatically place everyone with diabetes in the high risk category (> 20% risk in 10 years).

http://www.heart.org/HEARTORG/Conditions/HeartAttack/HeartAttackToolsResources/Heart-Attack-Risk-Assessment_UCM_303944_Article.jsp

12

HPNpilot believe it or not, my family history sucks for high blood pressure and cholesterol...but funny enough no one else in my immediate family has problems with diabetes despite the ways they eat, high blood pressure problems and cholesterol. Go figure.

I completely agree I think the use of statins and ace inhibitors can certainly be beneficial to many. I think it's something you need to evaluate your own risk factor, your own numbers etc in making that decision. It just kinda scares me when doctors want to put people on medications for no real reason other than just because your diabetic. My internal medicine doctor was really kinda surprised I wasn't just because I'm diabetic...Im like I don't see the need, I have really good blood pressure, really good cholesterol, my kidney function is all within normal limits...she was like do u mind if I discuss it with your endo, Im like you can discuss it all you want, my minds made up and as for now, no I'm not taking these medications, If and when the time comes and I start having problems I'll consider it. Endo backed me up on that one, and said I don't fit the risk profiles and doesn't see a need in me being on them at this time.