LDL and statins

[banK]

Since Feb 2016 I have been having my lipids tracked every 2 months. Reason for the regularity was that I had hyperthyroidism and attended the hospital for around 2 years on a 2 monthly basis. The hyperthyroidism is now thankfully put to bed. I did a repeat test recently after 6 months to confirm all was ok.

 

I was aware of my LDL being rather high (highest 170, lowest 125) over that period of time. The range was mostly between 140-160.

I conscientiously  made sure that I stuck to a good diet i.e. no fried food, lean loin of pork, steamed skinless chicken, veggies, salads with olive oil dressing, oats - boring diet but I thought would be effective. Not so successful!

 

I have a treadmill that I use every day at a fast walking pace  5.7 - 5.9 km/hr with incline - sweat a bit after that!, I also usually find some physical work in the afternoons to keep things moving.

 

I have just turned 70 , 170cm and 73kg.

 

The last visit to the hospital a couple of days ago had a chat about the stubborn LDL numbers. This doctor, (different one that I had 6 months ago), said that I ought to start taking statins due to the fact that I had a AAA stent fitted (Jan 2016) and that  I had vascular disease, (plaque buildup), in my veins so at risk. My heart is fine, had an angiogram done prior to fitting of the stent in 2016 - don,t smoke and don't drink now, these vices complimented each other when I was a smoker - can't do one without the other!

 

The latest lipid test:-

glucose                 108(H)

cholesterol            203 (H)

Triglyceride             58

HDL-Cholesterol     63

LDL         "               154 (H)

VLDL                          12

Chol/HDL-C ratio    3.22

LDL/HDL ratio          2.4444

 

Doc said ideally LDL should be <100mg/dl (prefer <70) because I am a high risk for vascular  disease.

 

Generally the glucose level is in the 90's, only a couple of times has is strayed above  the 100's (highest 110).

 

The doctor explained about the function of the liver and the production of cholesterol and the possibility of increased glucose levels being produced when taking a statin.

My concern is that I could tumble into type 2 diabetes seeing as I have wondered above 100's a couple of times.

 

Also, could someone tell me what is the glucose number that determines a diabetic.

 

If one becomes diabetic due to taking a statin and you then stop taking them will you revert back to being "undiabetic"?

 

Another question - I wasn't aware until I did a bit of research that there are 2 type of LDL, one good and one bad. How do you determine which one you have? 

 

Lipids to me seems like a black art - difficult to get your head around.

 

Thanks for listening

 

banK

 

 

 

 

 

 

[ezzra]

You should add 10 mg Ezetimibe (ezetrol) to your lipitor/ statin take, what it does is it boost the plaque prevention properties of the statines, also increase your statin take up to 80 mg if need be, i have been taking 80mg for many years now with no side effects, lately they have combined lipitor and ezetrol into one tablet called Atozet,

not sure if you can get the above meds i Thailand though....

Edited June 29, 2018 by ezzra

[Sheryl]

He is not yet on statins and with his numbers (excellent triglycerides and good HDL. Excellent ratios) it is debatable if he should take anything.

OP this is complicated and you are right to question. I will respond further when at my computer


Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

[Sheryl]

OK here goes.

 

1. Total cholesterol alone is if no importance.

2. Your triglycerides are excellent.  And, because they are low, it is important that all  LDL  measurements be direct rather than indirect estimate because indirect estimate of LDL is inaccurate in people with low triglycerides.

3.Your HDL is excellent, in a range that is protective against vascular/hear disease.

4. As  result of the above, your cholesterol/ HDL ratio is good, in the desirable range (<3.5)

5. Your LDL is in the "borderline high" range, however your HDL/LDL ratio is excellent, in ideal range, and your VLDL is also very good (desirable range is 2-30).

6. Your trigylceride/HDL ratio is .92 which is superb. (Ideal range is under 2.0). This is probably the most important ratio of all. See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664115/

 

So everything is great except the LDL. As it seems you know, there are different types of LDL particles in the blood: small, dense particles (phenotype B)  and  larger, more buoyant particles (phenotype A). Pheontype B poses a greater risk than does A. Blood tests by phenotype are not widely available. However, the trigylceride/HDL ratio is a very good predictor and people with low TG/HDL ratios are known to have predominately Phenotype A LDL particles.

 

So in short, although your LDL is in the borderline high range, the other parameters suggest that it is mostly the large, buoyant type of LDL rather than the small dense type.

 

If you did not have any specific risk factors, it would be a slam dunk that there is no need to treat your LDL. But it is true that with pre-existing plaque buildup and a stent in place, you are at higher than average risk.  If you were to ask say 50 doctors, assuming they are all up to speed on latest findings re lipids (often not the case in Thailand), you would likely find opinion divided with some saying treat and some saying no need. I note that your prior doctor did not recommend treatment even when your LDL was much higher. Ultimately you have to decide. I suggest you  check your C-reactive protein level (CRP) as this is a marker for inflammation which is a risk factor for coronary artery disease. Levels of 3 or above are a risk factor. If it were me,  and if the CRP came back normal, I would not take medication for the LDL but rather just carry on with diet and exercise and regular monitoring for now. A CRP of 3 or above, and I might treat.

 

You have already done a great job with diet and exercise. If you can get your sugar a little lower this may help reduce the LDL. You don't mention what you eat in terms of carbs but you want to steer clear of white rice. white bread/pasta etc as well as, obviously, anything with processed sugar in it.

 

Regarding your question about diabetes,  fasting blood sugar levels in the range 100 - 125 are considered "pre-diabetes" and over 126 or over = diabetes.  So what you report is towards the lower end of pre-diabetes, more reason to look at your carb intake.

 

However I also suggest you get a home blood glucose monitor and test yourself there. You may find that at home you are always below 100. I had very similiar labs to yours and this proved to be the case in me. Stress elevates blood sugar and the stress of being in a hospital/having blood drawn can make a difference. Not a huge one, but enough to make the difference between normal and pre-diabetic ranges.  Sort of the blood sugar equivalent to "white coat syndrome" . Testing for Hb1ac rather than glucose will avoid this problem because the hb1ac reflects blood sugar over time rather than at a single point in time. I have done this for past few checkups and consitsently the hb1ac is normal despiute very slight elevation in the fasting glucose (100 -110) on the day of testing.

 

Besides helping determine whether your true fasting glucose is in pre-diabetic range, home glucose monitoring can help you, if necessary, modify your diet for better levels.

 

Hope all thsi helps, and sorry it is so complicated.

 

[partington]

If you have existing arterial disease which has already had to be treated by stenting,  common sense tells you that your apparently protective lipid ratio has not been protective!

 

Every single statin trial for secondary prevention (that is treatment of people who already have heart disease to help prevent further incidents) without exception has shown benefits in terms of outcome compared to no statin treatment.

 

Statins, despite a rather large campaign by untrustworthy anti-statin anti-vaccine campaigners like Mercola to suggest otherwise, are one of the safest pharmacological treatments known and have such a low incidence of serious or persistent side effects that the disadvantage/advantage balance of taking them is fairly easy to adjudicate.

 

 The latest Lancet published review of safety and efficacy of statins

Interpretation of the evidence for the efficacy and safety of  statin therapy Rory Collins et al Lancet 2016; 388: 2532–61

includes information on how low this incidence of side effects really is and how  much benefit statin treatment actually confers.

 

It is lengthy and difficult and includes a long first section on how to interpret clinical trials that is hard for non-scientists. However the last half is a thorough analysis of the fully described harms and benefits of statins that is worth a look even if it seems hard. I have included this paper as an attachment.

 

It includes the results of 26 studies that show when people are unaware that they are taking statins the muscle side effects they report are not different from placebo groups.

 

It also emphasizes that statin treatment guidelines are now based mostly on assessment of overall risk and NOT on LDL cholesterol concentrations. This means that high risk individuals with "acceptable" or borderline LDL should be treated.

 

Side effects:

In a meta- analysis of 26 masked trials (including STOMP) that involved at least 6 months of statin therapy,250 there was little difference in the reported rates of muscle problems during an average treatment duration of 3 years: 12·7% among 59237 participants allocated statin versus 12·4% among 54458 allocated placebo; an absolute excess of 0·3% (95% CI 0–0·7; p=0·06) or, alternatively, a range from zero to 20 cases per 10000 years of treatment. s 183 (0·58%); p=0·37. [...]

 

Typically, treatment of 10000 patients for 5 years with an effective statin regimen (eg, atorvastatin 40 mg daily) would be expected to cause about 5 extra cases of myopathy (one of which might progress to rhabdomyolysis), 50–100 cases of diabetes, and 5–10 haemorrhagic strokes. Statin therapy may also cause symptomatic adverse events (eg, muscle pain or weakness) in up to 50–100 patients per 10000 treated for 5 years.

 

The absolute excesses of adverse events with statin therapy are increased in certain circumstances (eg, with higher statin doses and in combination with certain drugs, or in particular types of patient or population), but they are still small by comparison with the beneficial effects. Moreover, any adverse impact on major vascular events that is caused by the excesses of diabetes and haemorrhagic stroke has already been taken into account in the estimates of the overall benefits.

 

Prevention of future heart attacks and strokes

 

Statins have been shown to produce similar proportional reductions per mmol/L LDL cholesterol reduction in the risks of major vascular events in many different types of patient (eg, lower and higher risk, women and men, older and younger), irrespective of their presenting cholesterol concentrations.29–34Consequently, the absolute benefits of lowering LDL cholesterol by a given amount depend on the absolute risk of the individuals being treated rather than their presenting cholesterol concentrations (or other characteristics). For that reason, treatment guidelines now focus on an individual’s risk of vascular events rather than on their LDL cholesterol concentrations alone.162,163 L

 

This finding is reflected in the recent American College of Cardiology/ American Heart Association guidelines,162 with the high-intensity statin regimens considered to be warranted for patients at elevated risk of vascular events even if they present with average or below average LDL cholesterol concentrations (ie, a change in emphasis towards treating high risk levels and away from treating only high cholesterol concentrations). 

 

 

Collins2016LancetReviewOnStatinSafetyEfficacy.pdf

[Sheryl]

His stent is for an AAA not for coronray artery disease.

 

 

[partington]

Ooops! Fair enough, missed that, but clear evidence of plaque buildup still applies I think!

[tifino]

If he's eventually taking the path to reduce the 'bad' cholesterols, then why not take the COQ10 path?

 

kills off the LDLs, all the while not reducing his HDLs 

 

 

at the ripe age of 70, HDL production/maintenance needs all the help he can get.

 

 

Having been down that path, it's also a hoot to see your Dr's reaction when you tell him you have taken yourself off the 'statin path!

The Dr's face reaction displays negatively, but he won't say anything against you, as he inwardly realises you know you've done yourself a favour, at the expense of big pharma

 

My mrs did the very same, as what I did, and her Dr was the same in his reaction...

 

and he/they never brought up the 'cholesterol' word ever again... but then, the Dr didn't need to anymore

[Lumbini]

Possibly get an HbA1c test to get more insight on that glucose / insulin issue . I find it helpful to get fasting insulin tested along with HbA1c and fasting glucose and really stay on top of this as insulin resistance can cause many issues and really increases for so many as they get into their 60's . Sheryl made a great suggestion also about getting a glucose meter so you can check daily at home .

 

 

PS ... since home glucose monitors are not real accurate it's helpful when you get it to take it with you next time you go to the hospital for fasting glucose blood work and when they test your blood also test at same time with your meter there and see the % of difference so when you use at home you can factor in this difference so your home testing is understood with better accuracy .

 

[banK]

4 hours ago, Sheryl said:

OK here goes.

 

1. Total cholesterol alone is if no importance.

2. Your triglycerides are excellent.  And, because they are low, it is important that all  LDL  measurements be direct rather than indirect estimate because indirect estimate of LDL is inaccurate in people with low triglycerides.

3.Your HDL is excellent, in a range that is protective against vascular/hear disease.

4. As  result of the above, your cholesterol/ HDL ratio is good, in the desirable range (<3.5)

5. Your LDL is in the "borderline high" range, however your HDL/LDL ratio is excellent, in ideal range, and your VLDL is also very good (desirable range is 2-30).

6. Your trigylceride/HDL ratio is .92 which is superb. (Ideal range is under 2.0). This is probably the most important ratio of all. See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664115/

 

So everything is great except the LDL. As it seems you know, there are different types of LDL particles in the blood: small, dense particles (phenotype B)  and  larger, more buoyant particles (phenotype A). Pheontype B poses a greater risk than does A. Blood tests by phenotype are not widely available. However, the trigylceride/HDL ratio is a very good predictor and people with low TG/HDL ratios are known to have predominately Phenotype A LDL particles.

 

So in short, although your LDL is in the borderline high range, the other parameters suggest that it is mostly the large, buoyant type of LDL rather than the small dense type.

 

If you did not have any specific risk factors, it would be a slam dunk that there is no need to treat your LDL. But it is true that with pre-existing plaque buildup and a stent in place, you are at higher than average risk.  If you were to ask say 50 doctors, assuming they are all up to speed on latest findings re lipids (often not the case in Thailand), you would likely find opinion divided with some saying treat and some saying no need. I note that your prior doctor did not recommend treatment even when your LDL was much higher. Ultimately you have to decide. I suggest you  check your C-reactive protein level (CRP) as this is a marker for inflammation which is a risk factor for coronary artery disease. Levels of 3 or above are a risk factor. If it were me,  and if the CRP came back normal, I would not take medication for the LDL but rather just carry on with diet and exercise and regular monitoring for now. A CRP of 3 or above, and I might treat.

 

You have already done a great job with diet and exercise. If you can get your sugar a little lower this may help reduce the LDL. You don't mention what you eat in terms of carbs but you want to steer clear of white rice. white bread/pasta etc as well as, obviously, anything with processed sugar in it.

 

Regarding your question about diabetes,  fasting blood sugar levels in the range 100 - 125 are considered "pre-diabetes" and over 126 or over = diabetes.  So what you report is towards the lower end of pre-diabetes, more reason to look at your carb intake.

 

However I also suggest you get a home blood glucose monitor and test yourself there. You may find that at home you are always below 100. I had very similiar labs to yours and this proved to be the case in me. Stress elevates blood sugar and the stress of being in a hospital/having blood drawn can make a difference. Not a huge one, but enough to make the difference between normal and pre-diabetic ranges.  Sort of the blood sugar equivalent to "white coat syndrome" . Testing for Hb1ac rather than glucose will avoid this problem because the hb1ac reflects blood sugar over time rather than at a single point in time. I have done this for past few checkups and consitsently the hb1ac is normal despiute very slight elevation in the fasting glucose (100 -110) on the day of testing.

 

Besides helping determine whether your true fasting glucose is in pre-diabetic range, home glucose monitoring can help you, if necessary, modify your diet for better levels.

 

Hope all thsi helps, and sorry it is so complicated.

 

Hi Sheryl,

 

Well it has taken me about 3 hours to absorb what you have written. Looking back over my records and graphs I have analysed the ratios and have now included the ideal numbers for VLDL and Cholesterol/HDL-C Ratio which were not included in my results.

Also, I do not have the ideal range for HDL/LDL ratio, would be grateful for that information.

 

The only time that the cholesterol/HDL ratio has been below 3.5 was the latest test done as in my op. -3.22!

 

I don't know whether it is a coincident but in March 2017 I started taking Omega 3 1000mg tablets in the evenings after the meal if I didn't have oily fish. All of the lipid tests after that date were between 3.6 - 3.9, whereas before that time they were generally between 4 - 4.6 with a couple above 5.

I also noted that the Triglyceride/HDL - all were below 2, whereas before that date about 50% of the readings were between 2.5 - 3.7 the rest were below 2. (maybe I was eating more oily fish then!?

 

Over the two years of taking the Lipid tests I have had 3 different doctors. I think I told the first one that I didn't want to take statins because I was on hyperthyroid tablets and baby asprin and didn't want any more chemicals. This doctor didn't push back on that.

The next one didn't mention statins at all.

The current doctor, who I saw for the first time the other day, recommended that I take statins. Unlike the previous doctors, this one actually explained how cholesterol is produced by the liver and what happens with LDL and plaque. Before this I was under the impression that it was all to do with diet and exercise.  The doctor did not mention the significance of the ratios as you have done, this truly is a black art!! 

 

Since then I have found out much more due to your post Thankyou for that!

 

With the information that I have from yourself and other posters I feel that I will be able to converse with the doctor with more confidence.

 

I'll follow up with the 2 types of LDL, the ratios and the CRP test.

 

I have had an "accu-chek active" monitor for a while but seldom used.

 

I said that I would try a statin for a month (LIVALO 2mg), I didn't want a strong dose to start with, he said with these I might decrease the reading by 10 - 20%. He did not mention the possibility of increased glucose numbers.

 

In one month I will revisit and have in addition to a Lipid test, a liver function test, a CRP and Hb1ac percentage test.

My liver function test about a year ago was all normal - so have a good datum point.

 

Could you please give me the ideal numbers for HDL/LDL ratio.

 

Thank you for the information supplied, I'll let you know of the outcome after my revisit next month.

 

One final question - If I do stop taking them after one month, what would I expect my LDL numbers to do and for how long to get back to "normal"?

Ps The Livalo tablets were 2280 baht for 30.  Inquired at the local pharmacy and they would charge 3500 for 100 tablets, I wouldn't be surprised if I could get them cheaper, as I told the pharmacist the price that the Bangkok Hospital in Khon Kaen charged me!!

 

banK

[Oxx]

Livalo is very expensive.  It's not normally used as a first statin.  It's metabolised in the liver by a different pathway from more common statins and is useful for people whose livers don't cope will with those statins.  Unless there's a clear reason to the contrary, it would make more sense to start with simvastatin which is very, very cheap.

[banK]

35 minutes ago, Oxx said:

Livalo is very expensive.  It's not normally used as a first statin.  It's metabolised in the liver by a different pathway from more common statins and is useful for people whose livers don't cope will with those statins.  Unless there's a clear reason to the contrary, it would make more sense to start with simvastatin which is very, very cheap.

This now makes me suspicious about how much is driven by the financial aspect and not for the good of the patient.

 

Buyer beware!

 

banK

[Sheryl]

13 hours ago, banK said:

Hi Sheryl,

 

Well it has taken me about 3 hours to absorb what you have written. Looking back over my records and graphs I have analysed the ratios and have now included the ideal numbers for VLDL and Cholesterol/HDL-C Ratio which were not included in my results.

Also, I do not have the ideal range for HDL/LDL ratio, would be grateful for that information.

 

The only time that the cholesterol/HDL ratio has been below 3.5 was the latest test done as in my op. -3.22!

 

I don't know whether it is a coincident but in March 2017 I started taking Omega 3 1000mg tablets in the evenings after the meal if I didn't have oily fish. All of the lipid tests after that date were between 3.6 - 3.9, whereas before that time they were generally between 4 - 4.6 with a couple above 5.

I also noted that the Triglyceride/HDL - all were below 2, whereas before that date about 50% of the readings were between 2.5 - 3.7 the rest were below 2. (maybe I was eating more oily fish then!?

 

Over the two years of taking the Lipid tests I have had 3 different doctors. I think I told the first one that I didn't want to take statins because I was on hyperthyroid tablets and baby asprin and didn't want any more chemicals. This doctor didn't push back on that.

The next one didn't mention statins at all.

The current doctor, who I saw for the first time the other day, recommended that I take statins. Unlike the previous doctors, this one actually explained how cholesterol is produced by the liver and what happens with LDL and plaque. Before this I was under the impression that it was all to do with diet and exercise.  The doctor did not mention the significance of the ratios as you have done, this truly is a black art!! 

 

Since then I have found out much more due to your post Thankyou for that!

 

With the information that I have from yourself and other posters I feel that I will be able to converse with the doctor with more confidence.

 

I'll follow up with the 2 types of LDL, the ratios and the CRP test.

 

I have had an "accu-chek active" monitor for a while but seldom used.

 

I said that I would try a statin for a month (LIVALO 2mg), I didn't want a strong dose to start with, he said with these I might decrease the reading by 10 - 20%. He did not mention the possibility of increased glucose numbers.

 

In one month I will revisit and have in addition to a Lipid test, a liver function test, a CRP and Hb1ac percentage test.

My liver function test about a year ago was all normal - so have a good datum point.

 

Could you please give me the ideal numbers for HDL/LDL ratio.

 

Thank you for the information supplied, I'll let you know of the outcome after my revisit next month.

 

One final question - If I do stop taking them after one month, what would I expect my LDL numbers to do and for how long to get back to "normal"?

Ps The Livalo tablets were 2280 baht for 30.  Inquired at the local pharmacy and they would charge 3500 for 100 tablets, I wouldn't be surprised if I could get them cheaper, as I told the pharmacist the price that the Bangkok Hospital in Khon Kaen charged me!!

 

banK

HDL/LDL ratio ideal is above 0.4. Yours is 0.41 (note that the lab result you got gave this ratio in reverse)

 

Of all the ratios the one that shows he strongest correlation to risk of CAD is the tg/hdl ratio. 

 

If you go on statins and then stop there can be a rebound effect with ldl rising higher than it was before you went on meds.  Studies suggest this effect is more dangerous than not starting statins in the first place so these are not drugs to just try out for a while. (though obviously if there are serious adverse effects would have to stop o change to a non-statin agent. There are other classes of drugs besides statins).

 

As I mentioned given your low triglycerides you need to make certain the result you have is a direct measure of LDL and not an indirect estimate.

 

The presence of an elevated CRP would definitely aid the decision to treat.

 

I am not aware of any advantage to Livala vs other statins that would apply to you. Its action on LDL is comparable to other statins, not better. It does seem to do a letter better at reducing  Tg and raising HDL but neither of those are concerns in your case.

 

Like other statins, it can elevate blood glucose so monitor closely if you go on it or any other statin. This concern also will be clearer after you get more blood work (Hb1ac, home  monitoring).

[banK]

On 6/30/2018 at 8:41 PM, Sheryl said:

Your triglycerides are excellent.  And, because they are low, it is important that all  LDL  measurements be direct rather than indirect estimate because indirect estimate of LDL is inaccurate in people with low triglycerides.

I've spent a few hours researching all things lipids on the internet!

Is there a clue in a discrepancy I have found in the figures quoted in my OP that may point to the fact that the LDL is direct as opposed to calculated

:-" Total Cholesterol 203"

By adding VLDL + LDL + HDL (12+154+63 = 229) and not 203.  I then used the "mayo clinic"  LDL calculator.

 

If I input the figures from the OP the calculator arrives at an LDL measurement of 128.4mg/dl.

If I input 229 then the calculator arrives at and LDL measurement of 154 as quoted.

 

I backtracked on all the previous results  and found that if I add VLDL+LDL+HDL for the total cholesterol then the mayo calculator agrees with all previous results.

There was a discrepancy on all the previous results regarding the total Cholesterol.

 

Of course I will ask the doctor if direct or indirect when I go back to the hospital next month.

 

On 6/30/2018 at 8:41 PM, Sheryl said:

You have already done a great job with diet and exercise. If you can get your sugar a little lower this may help reduce the LDL. You don't mention what you eat in terms of carbs but you want to steer clear of white rice. white bread/pasta etc as well as, obviously, anything with processed sugar in it.

As for carbs, I have brown rice, dark brown pasta, brown bread, steer clear of all processed food - have fresh veggies and the only added sugar is teaspoon brown sugar in the occasional coffee.  But I do have normal potatoes with my meal about 3 times/week and also have been having 0% fat yoghurt - but now have greek yoghurt with added frozen mixed berries/strawberries - I suppose you can call that processed food.

 

I also read several Q+A sessions re statins. Many people seem to start/stop/change their statins due to various side effects, so changing a statin doesn't seem to be a big deal.

 

Also in my travels found a reference to IDL (intermediate density lipoproteins)?? Is this in the same family as Phenotye A and B?

 

banK

 

 

 

 

[Sheryl]

IDL is formed from VLDL and HDL. Don't worry about it.

 

As you may have gathered the science around lipid metabolism is very rapidly evolving and will continue to, what I have explained above was not known just a short time back and may well be rendered obsolete in the near future as new understandings supersede it.

 

Getting a direct measure of LDL if that is not what you had is important, and getting CRP will help round out understanding of your degree of risk from CAD.

 

Changing statins is indeed not a problem, it is going off them altogether that is problematic.

[banK]

Went back to the hospital today (6 days after starting statins).

Reason for this was that on the 2/7 morning did a check on my accu test meter, the measurement fasting glucose went up from 96 to 114 the following day but back down to 92 today??!!

Have been doing alot of research on the internet including the valuable input from this forum, Sheryl et al.

 

I backtracked all 2 years results and composed various cholesterol ratio graphs with ideal/good limits. This showed especially over the past 12 months, very good figures.

 

I had a good conversation with the doctor (was able to show him that I understood about lipids etc.) and presented   the

facts in a form that told it's own story. He agreed with me that it would be best if I come off the statins.

 

I repeated the tests I had on the 28/6

 

On 6/30/2018 at 12:05 AM, banK said:

The latest lipid test:-

glucose                 108(H)

cholesterol            203 (H)

Triglyceride             58

HDL-Cholesterol     63

LDL         "               154 (H)

VLDL                          12

Chol/HDL-C ratio    3.22

LDL/HDL ratio          2.4444

 

Today these are the results after 6 days on statins:-

Glucose                      105 H

Cholesterol           153

Triglyceride             92

HDL-Cholesterol    49

LDL-Cholesterol    109

VLDL                         18

Cholesterol/HDL-c ratio  3.12

LDL/HDL ratio                    2.2245

 

Sheryl - I did a HbA1c   -  5.4%

est. avg glucose               108

 

The C-Reactive Protein High Sens. (CRP)  was 1.36.

 

When I was there I checked out my accu meter and found that the reading from the veinous blood was 103 - 2 points lower than their figure, then I did a measurement from a finger prick that gave a reading of 98 - 7 points lower than veinous blood.  I can now add the calibrated figure to hopefully arrive at a correct figure when I test at home.

 

I also asked whether the LDL measurements taken at the hospital are a direct measurement - yes they are.

 

I have an appointment in 3 months for a follow-up.

 

I now have 24 Livalo tablets (2mg) exp. 11.2020 in blister packs which I suppose I'll have to bin .........or for free to anyone in Phu Wiang /Khon Kaen area.

 

banK

 

 

 

 

 

 

 

 

 

 

 

 

[Sheryl]

CRP   low risk = < 1.0 mg/L

           average risk 1.0 to 3.0 mg/L

           high risk (>3.0 mg/L)

 

So you are at the low end of average risk for CAD.

 

If you want additional assurrance and if you have no contraindications to it, an Exercise Stress Test will detect about 85% of underlying CAD.

 

I think most cardiologists, if up to date, would agree that for your lipid profile treatment not indicated.

 

There may be a rebound effect from stopping the statin but by 3 months it will have evened out. Resist the urge to retest too soon.

[Lumbini]

CRP   low risk =            average risk 1.0 to 3.0 mg/L
           high risk (>3.0 mg/L)
 
So you are at the low end of average risk for CAD.
 
If you want additional assurrance and if you have no contraindications to it, an Exercise Stress Test will detect about 85% of underlying CAD.
 
I think most cardiologists, if up to date, would agree that for your lipid profile treatment not indicated.
 
There may be a rebound effect from stopping the statin but by 3 months it will have evened out. Resist the urge to retest too soon.

You think exercise stress test will pick up about 85% of CAD Sheryl ? How about getting a scan and a calcium score ? I have been told this is really also good indicator to see if further investigation is warranted ? I know little but uncovering much and have scan at Chula scheduled to get exact calcium score.

[Sheryl]

Yes, EST (if conducted properly and interpreted properly) can pick up to 85%, that means there are 15% of people with CAD who will nonetheless have negative EST. It is noninvasive, inexpensive and no radiation exposure.

 

Calcium scan involves exposure to ionizing radiation. Not gigantic amounts, but certainly more than an Xray. However, it can give useful information on risk. 

 

In OP's specific case though, since he had lung cancer in the not so distant past which may have included radiation therapy, he should discuss with his doctors before undertaking this.

[khlongtoey]

You can also look at your 10 year risk  of  heart attack/ MI ; use the American Board of Cardiology,  your LDL can be quite high and if you < 5% may still not 'need a statin'

 

frankly, even the lowest dose of 2 different statins, and while using high dose coQ10  gave myself    mental vagueness, and I can't live with that , not to mention the  low grade muscle aches, that might be age might be the statins , etc

 

for the right person, they are great , but I don't think I'll ever be able to take them