T1 Diabetes and Statins

There actually is some evidence that "well controlled" diabetics including those with an A1c below 6 are at a somewhat elevated risk for cardiac and other complications.

That fact seems well understood when many of us push for tight control and complain when doctors think 7.5/7/6.5 (pick your number) is good enough. It seems to become an open issue when we think about taking steps beyond working on our blood sugar control to protect our health.

Statins are not without risk but we tend to over estimate the risk of complementary therapies and under estimate the risk that our diligent efforts at blood sugar control won't turn out to be sufficient.

WWGirl,

There seems to be a thread on this issue every month or so. In terms of the science
that underlies the effect of lowering cholesterol on heart disease in diabetics, there are
*many* studies that show lowering cholesterol *is* effective in reducing heart disease.

Since heart disease is the #1 killer of diabetics, this is a big thing to think about.

See the my posting in another thread about statins here:

https://forum.tudiabetes.org/topics/statin-for-age-29?commentId=583967%3AComment%3A2729986

The graph in that post shows the results of numbers studies covering thousands of people that shows the clear relationship between reduction in cholesterol and CHD events. I include the graph here for reference, but see the post for the link to the study.

HOW you reduce the cholesterol is up to you. I am not going to go into that because the voodoo science people will go crazy citing their brother's sister's friend who went crazy when they took drug X.

A cardiologist will tell you that the extra heart disease risk of having diabetes is similar to someone who has *already* had a heart attack. It *is* related to how well you control your blood sugar *and* to cholesterol levels.

Copying the rest of my old post here:

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.

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Below are my comments
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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.

Hey HPNpilot,

Thanks for the link to the thread! I agree I need to do more reading and this is a good start. One statistic that jumps out from the abstract of that study is that data was analysed for 1466 individuals with type 1 and 17,220 individual with type 2. Just from the results in the abstract, its not clear that these two populations were compared separately to the non-diabetic control group. We'll have to read more carefully.

True.

I suspect the reason for the ratio of type 1 to type 2 in the study is related to the proportion of T1's and T2's in the general population....it's not far from the 10% T1 statistic that is frequently quoted.

Perhaps there are some studies that are T1 specific.

I agree with Brian. Everything I have read in the past year points to statins being of very little use, with a high probability of side effects for most people. Eating cholesterol (as in eggs), or fat, does not make your cholesterol higher. Eating carbs does. Especially sweet carbs fried in the wrong kind of oil (bye bye donut). Google Dr. Peter Attia, he did a series on cholesterol on his blog a couple of months ago that explains everything in amazing detail.

Maurie-I think that in the end, it’s probably a crapshoot when it comes to evaluating our individual risks. I am thin, but lately studies seem to come out and say that I’d have a better life expectancy if I were mildly overweight. I have a good a1c, but now it sounds as though my life expectancy would be better if it were higher. My cholesterol is naturally low with my HDL being in the 90’s. I personally don’t see any reason to add statins, especially when there are studies saying that cholesterol that is too low is dangerous.

I used to take a daily lo-dose aspirin. I am on prescription-strength NSAIDS for inflammatory arthritis, but studies show that these NSAIDS negate the effect of a daily aspirin. Also, the daily aspirin has been shown not to help women as much as men. I think my internist is OK with that decision, but he mentioned at my recent physical that it would really be a bummer if I had a stroke before my next physical. It was a joke, but…

I am finishing my bottle of multi-vitamins, but recent studies shown that people who take multi-vitamins have a higher death rate than those who don’t take them. My internist said to stop taking them.

I think I’ll have a donut, no two donuts tomorrow morning.

A crapshoot is a good way to put it. High cholesterol runs in my family and my mother was on statins for decades before passing away from lymphoma at the age of 89. I haven't had any bad effects from the statins yet (knock wood)and will continue them unless I start having problems.

My point wasn't that everyone should use statins; that's an individual choice. I was pointing out that we tend to underestimate the risk we still face while doing what we do every day and overestimate the risk from following medical advice.

I’m actually a very compliant patient and tend to do everything my doctor’s recommend. It does kind of burst my bubble when the things I do to try to stay healthy are shown maybe not to be important.

The one thing I have always done is to exercise and stay active. I have always considered that to be one of the biggest factors in my staying healthy with Type 1 and I think it’s the only thing that has!n’t been dismissed by medical studies.

And I suppose the other thing that has kept me healthy is pure dumb luck. I don’t think it’s completely understood why some people get every complication and others seemingly thrive with Type 1.

I was recommended to take a statin by my endo 5 years ago; when my tests revealed with an LDL of 77. He said I had some risk factors for heart disease: diabetic, African-american, midde aged. He said that although my other cholesterol numbers were acceptable, but that he knew that I could not get my LDL under 70 without statins, in fact, in fact he said it was " impossible." Later, I got side effects, very low BP. I almost passed out in my backyard and in the drugstore. My blood pressuere was dangerously low, like 65/54. I had to have help to keep from fainting. Had muscle cramps and weakness from time to time.. I reported this,he changed me to Crestor. Similar effects. After about a three weeks of this, I stopped taking any of the statins. He said I was "non-compliant". I said, ""So be it."
I started taking Omega -3 gel capsules, 300 mg. 2-3x daiy. At the next appt, 3 months after, my LDL was 66. Every other reading was normal and I had an HDL of 89. I have continued to take the capsules and all is well.
My most current lipid panel( I get them checked 2x yearly, this report was late June 2012) was:
Total cholesterol 162; Trigycerides 34; HDL 101;Chol/HDL ratio 1.7;
LDL 54.
My doc looked at me with surpirse and said, " Now as I remember you are NOT on statins?" I told him ,"no, I am not." He said that he has never seen an LDL that low in his diabetic patients.
I think I do not have a need for statins and will never take them. A conscientious type 2 friend of mine, who doesnot takee statins either, told me that another relibale measure of cardiac disease risk was the c-reactive protein test, which measurse inflammation in the body. I got mine checked 2 or 3 years ago. I do not remember the exact number and have misplaced the paper, but it was rated at an "optimum" levels.

I do not know if my most curent lipid test are at any way related to my bood sugar control at the time. I am not proud to say my a1c was 7.9 at the time, due to the stress and the southern comfort food feasts during the months I was in Ga. when my father was ill and subsequently died..the rollercoaster ride blood glucoses did not apaear to effect my cholesterol levels at all. In fact, they tend to say low ALL the time.

It is probably genetics:I do not have a family history of heart diesease, none of the woMEN have Veer had heart disease and all of us tend to get thinner with age, rather than heavier; which is also a risk factore. No statins EVER for me.
I am back on my regular dietary and exercise regime now: moderate carbs 120-140 a day. I walk daily, taske dance classes weekly. I eat as much cheese and mayonaise and Olive oil as I want; a lot of leafy green veggies, and plenty of nuts. I have eggs 4-5 times a week.Lots of greek yogurt. I do nt really calorie count at all Carb count constantlyy and carefully . SWAG when I must ( or sometimes just WANT to) I am not a vegetarian, but i do not eat pork and take in very limited anounts of beef. Lots of fish
We are all so individual and unique in how diabetes effects us.
To the OP, would tell your partner to not start statins at all. It appears to me that you are both doing things that are benficial for your health. To me, He is not at risk.

God bless,
Brunetta,
Type one 43 years
Age 57

I can only give you my personal experience with a statin. After 48 hours on Simvastatin I began to have frequent PVCs (pre ventricular contractions). I was put on a holter monitor for 24 hours which revealed I had two couplets (precursor to ventricular tachycardia which then leads to ventricular fibrillation which then leads to death). I had 2400 episodes of PVCs in that 24 hour period. In spite of my primary care doctor's reluctance to think it was the statin I discontinued it and all my symptoms went away. Needless to say I think statins can be much more dangerous than treating a total cholesterol level that ws 200 or lower to begin with.

I visited LIPITOR's website, I couldn't remember if it was a STATIN. Still looking I googled "Is LIPITOR a statin." Up came the FDA warning released a few months ago showing ELEVATED BLOOD SUGARS as one of lipitors side effects.
Add to that the potential to damage the liver.
I'm not going to take it anymore. It seems really stupid to prescribe a drug that actually raises blood sugar levels to a diabetic, especially considering that elevated blood sugars actually contribute to elevated cholesterol.
I have improved my own diet but am still unsure whether eggs are bad.

I love tudiabetes.org because everyone posts such great info.

I was on statins for months if not a year and suffered from really horrible weakness and soreness in my legs. It was really bad, achy, sore, weak. I run so it was very disturbing when I felt like my legs were going to give out and it took every effort to just get them moving. I just stopped taking them after learning that this can be a side effect. I take an low dose aspirin, just started fish oil and lisinipril but after stopping my statin for a several months, my cholesterol was fine. I'm all for anything that will stave off any potential risks but I'm glad I tried NOT taking these. I started eating oatmeal every day, take the usual vitamins and run and lift weights three times a week. As long as I can keep this up and my Cholesterol remains good, I'll hesitate going back on.

I agree Super_sally. Also add fish oil to the mix.

My own experience is similar. About 4 years ago my cholesterol levels started climbing up. I was being reasonably active (1 hr moderate/intense exercise 4 days a week) and I have always eaten mostly home made food, heavy on vegetables, though high on animal protein. To make the story short, my endocrinologist recommended me to start on statins to control cholesterol that was still under 100, due to the new recommendations for diabetics. I decided I did not want to risk a possible side effect and decided to change my diet a bit and increase my level of exercise. What I did:
For breakfast: Oatmeal (1 c) on 1 1/2 cups of 2% milk, 1 Tb freshly ground flax seed, 1 Tb cinnamon
Reason: Oatmeal worked as a good substitute for eggs for bf and the flax seed and cinnamon have been reported to help control cholesterol.

Exercise: Increased to 6-7 times a week, average 1h15m per session, mostly swimming (Underwater Hockey specific workouts), indoor soccer 2x and basketball once a week.

After three months of these changes my next cholesterol reading was still going up, but at a slower rate, 3 months later (6 months from the time my endocrinologist said I really needed to consider statins), my cholesterol had dropped dramatically (under 80) the HDL was higher than my LDL.

In short, my experience is that you can manage cholesterol without drugs, you just need to put time into it and make small diet adjustments.

Hi Jorge,

In short, your experience is that YOU can manage cholesterol without drugs. Your case is simply anecdotal information with regard to the rest of us. It doesn't make it wrong - it just means that it isn't necessarily right.

Maurie

WWGirl, I read this article and it certainly made a lot of sense to me. I also sent this article to my CDE at the Joslin Clinic. Her answer is below.
http://myscienceacademy.org/2012/08/19/world-renown-heart-surgeon-speaks-out-on-what-really-causes-heart-disease. It makes perfect sense to me.
“How does eating a simple sweet roll create a cascade of inflammation to make you sick?
Imagine spilling syrup on your keyboard and you have a visual of what occurs inside the cell. When we consume simple carbohydrates such as sugar, blood sugar rises rapidly. In response, your pancreas secretes insulin whose primary purpose is to drive sugar into each cell where it is stored for energy. If the cell is full and does not need glucose, it is rejected to avoid extra sugar gumming up the works.
When your full cells reject the extra glucose, blood sugar rises producing more insulin and the glucose converts to stored fat.
What does all this have to do with inflammation? Blood sugar is controlled in a very narrow range. Extra sugar molecules attach to a variety of proteins that in turn injure the blood vessel wall. This repeated injury to the blood vessel wall sets off inflammation. When you spike your blood sugar level several times a day, every day, it is exactly like taking sandpaper to the inside of your delicate blood vessels.
While you may not be able to see it, rest assured it is there. I saw it in over 5,000 surgical patients spanning 25 years who all shared one common denominator — inflammation in their arteries. “
This is how my CDE answered my questions about the article.
Clare this is why I consider diabetes to be a form of heart disease. The CRP inflammatory marker is very often elevated in people who have diabetes or heart disease. Carb counting improves the way you "cover" the carbs ingested but the meal plan as we teach it is to a heart healthy one. You are looking at complex carbs as well as the fat intake. To do one without the other would be a disservice to your cardiovascular health. So really nothing new there. I usually say to people to look at your meal and if a person with heart disease shouldn't it eat then either should you. This is why we have an epidemic of obesity type 2 diabetes and metabolic syndrome including hypercholesterolemia and hypertension. So consider your meal plan a heart healthy one with good fats and saturated fats less than 7% of it

I'm in the same boat as well. Last endo appointment, they did a lipid test, and my total was down in the 160s, HDL was high, Trigs were low, but my LDL (it was a calculated result) was at 120, so she prescribed a statin (she phoned it into the pharmacy, didn't bother even talking to me about it). I haven't filled it yet for two reasons.

First: the lipid test was supposed to be fasting, but I hadn't realized that she was going to do blood tests that morning, so I'd eaten breakfast. Cholesterol is so food dependent that I have no reliance on that test.

Second: my father has had some liver issues, specifically fatty lumps that they surgically removed, because of a "preventative" statin. With that kind of family history, I'd rather be certain that the prescription was necessary. I will have that talk with my doctor at my next appointment.

barbraann Please repost your discussion from yesterday as it was lost due to server issues -
"Question about air travel. Need to fly to a wedding and want to place my pod on my leg so it isn't noticeable under my dress but I'm afraid they'll want to see it. I have, so far, never been asked, j..."