just after some advice please - I had Afib 9yrs ago but been ok since then, just had a blood test which shows my cholesterol is high (5.5) and because of my history of Afib my Gp wants to put me on statins - im 44 years old - I don’t want to go on them and have told my Gp that I want at least 3 months to try and lower my cholesterol with diet and exercise before I start on statins for the rest of my life - what’s everyone’s thoughts ? I think the NHS are way too quick to stick me on pills for the rest of my life ? Thanks
AFib & high cholesterol : just after... - Atrial Fibrillati...
AFib & high cholesterol
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BobDVolunteer
In UK sadly statins are a bonus issue for GPs so suggesting them is normal and it is hard to find balanced views. I politely refused after discusssing the matter with my GP and she assured me she would get her points just for having the conversation. I was on them for many many years until about fifteen years ago when leg pain enlightened me to the problems they were causing me.
Make your on mind up on that matter.
Statins eroded my partner's muscles in his legs, he got to a stage where he was in too much pain to get out of the car. Because he had a heart attack they have put him on some other drug that lowers cholesterol but it isn't a statin
I think three months is a reasonable amount of time to try to reach your cholesterol goals with diet and exercise.
But from someone who is paying the price for not starting statin therapy earlier, I urge you to take the statins if you cannot reach your goals with diet and exercise.
Like with the Covid jabs, there seems to be an anti-statin bias among some without any real evidence.
My understanding is that doctors in the UK get "points" for recommending all guideline medication's, not just statins. And that includes anticoagulants. Does that mean we don't take anticoagulant because doctors get "points"? No we make the decision based on both our doctors advice and any independent research, we may choose to do.
That said, if you are still hesitant about statins after doing your research, ask your doctor about doing a Coronary Artery Calcium (CAC) Scan. It will give you a good indication about the amount of plaque in your coronary arteries. Should you score 0 or very low, an argument might be made to hold off on statins. Conversely, should you score high, statins would be almost mandatory.
Another important test that is being recommended at least once in a lifetime is blood test called lipo(a) which is a hereditary marker for coronary artery disease. If it turns out yours is elevated, another factor to take into consideration regarding statins.
Again I wish I had paid more attention to cholesterol and treatment when I was younger. Some of us are very lucky, often through heredity, and do well without statins or even lifestyle modifications. Others are not so lucky. Do you really want to gamble?
Jim
Very good advice Jim, especially about LP(a). We’re learning more all the time, but for now LDL and the Total non-HDL numbers are the ones to pay attention to with the standard NHS blood tests. I imagine these will be replaced by ApoB at some point, though a better test could come along in the future.
Regarding CAC, my understanding is that it is of less value in a younger adult because ordinarily, by age 45, there would not be much evidence of plaque build up at that age. It is said to be more useful later on in life. It seems to be a popular test for young guys into fitness in a big way, but they have it at an age when these changes haven’t had time to happen. Of course there will be exceptions but 45 might be a wee bit on the young side for the results to show anything of significance. I stress I’m not an expert on this, so I don’t take my word on face value. We all need to verify that our facts are accurate and maybe 45 is a good time to test.
The decision to prescribe anticoagulants depends on how many points the patient has (certain risk factors having a numerical value which are added up). I don’t know if that’s what you’re referring to. I’ve never been offered statins but the decision to prescribe depends on a patient’s risk factors, so someone with a pre existing cardiac condition or at increased risk of CVD or stroke are offered a statin with a lower cholesterol target than someone without these risk factors, who would not be prescribed anything, so it’s along similar lines to the anticoagulant prescription. It’s the patient who gets a numerical score according to risk.
As with cholesterol, there should be no one-size-fits-all or formula for anticoagulation.
LDL is a good starting point for statin intervention, however many of the other things you have mentioned can influence the decision.
Likewise with anticoagulation. The CHA₂DS₂-VASc score is a good starting point, however, if you don't take into consideration other factors, you're taking a cookie cutter approach to a very complex situation.
Take an inactive grossly overweight person in permanent afib whose blood pressure has not been controlled even with several drug interventions. Compare to an active, fit person, who now has their blood pressure is under control with medication and has not had an afib episode in years since their ablation. They can have identical.CHA₂DS₂-VASc scores! Do you really think their stroke risks are identical?
Many doctors and researchers like Dr. Ron Passman at Northwestern are challenging the notion of a one size fit all formula for a complex issue. His REACT-AF trial is a very good start.
I read an interview once from the doctor who initially developed the CHADS score, and he was was surprised at how firmly the medical community grabbed onto it. I have a feeling if you ask him, he would be the first to agree that while CHA₂DS₂-VASc is a good starting point. It is not a good end point for decision-making.
Jim
Yes, I get all that, but the scores are for things like high BP and diabetes, so a young healthy fit person would be less likely to tick those boxes. I don’t “qualify” for because I don’t tick enough boxes, even though my specialist thinks AF and 60+ is reason enough. So, differing opinions. I know that some people come off anticoagulants after an ablation. Then again, ablations don’t always hold out and some people don’t know they’re in AF because they don’t feel it. There are many moving parts. Everyone has some degree of background risk, even the young fit post-ablation person. It might not be as high as the obese sedentary person but not as low as the never-had-AF young fit healthy counterpart. There are no absolutes.
Everyone has some degree of background (stroke) risk, even the young fit post-ablation person
I don't think anyone disagrees that afib lowers stroke risk in the afib population. But the real question is do the benefits of anticoagulation outweigh the risks?
I realize you understand that because you're not taking thinners, but I think this point often gets lost in these discussions for others.
Recently someone here posted they are taking thinners with a risk score of zero. Well, it's a free country, but not talking enough about bleed risk in these discussions can lead to that kind of misguided thinking.
Jim
Agree. There is a bleed risk. It’s always a weighing up between the potential risks and benefits. I think we need to bear that in mind with all medication.
I have blood type O Positive so more risk of bleeding and less for strokes I think.
Sorry Jim, Anticoagulants were never part of the QOF system introduced by the Blair administration more's the pity. We as an organisation have spent many years changing doctors' reluctance to prescribe anticoagulants. I remmember Professsor Greg Lip (who created CHADS2Vasc2) commenting that UK had the worst record in Europe for prescribing anticoagulants to at risk patients resulting in 8000 uneccessary strokes every year. Things have improved thankfully but still not prefect.
BobD: Anticoagulants were never part of the QOF system...
According to "Management in Practice", afib management, including using the CHADS risk score and prescribing anticoagulation are part of the QOF system. (See below). So, using your example of statins, I could likewise cynically say maybe that is why so many of you are on anticoagulation?
Statins like anti-coagulations are important and necessary for many. and just because doctors are awarded QOF points for following guidelines is not a strong argument for or against either of them.
Now, whether you agree with the guidelines is another issue, but the fact is that most doctors follow them. But we as patients have a right, and perhaps a duty, to look further at times, whether that means not taking a statin when recommended, or in some cases not taking an anticoagulant just because a simplified score tells us to.
Jim
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AF001 – Register: 5 points for maintaining a register of patients diagnosed with AF.
AF006 – Stroke Risk Assessment: 12 points for assessing stroke risk using the CHA2DS2-VASc score annually for patients with AF.
AF008 – Anticoagulation Therapy: 12 points for ensuring that patients with a CHA2DS2-VASc score of 2 or higher are prescribed anticoagulants, or documenting if they decline or are clinically unsuitable for it
I totally agree regarding taking personal responsibility for ones treatments but have always worried that giving incentives to doctors as in the orginal QOF system risks lack of impartiality. My own GP privately agrees with my own choices and as mentioned, the point is to have the conversation not necessarily force the patient to accept. I would be so much happier discussing choices with a doctor if I really knew they were of independent mind. (as is mine)
If you want get rid of the whole QOF system, fine. I don't see it as particularly sophisticated, but then I don't see the way most GP's practice medicine particularly sophisticated either. It's basically guideline medicine and all the QOF system does is support those guidelines.
But more back to the point, you can't keep saying doctors are biased toward prescribing statins because they get points, without acknowledging they may be biased toward prescribing anticoagulation because they also get points. Maybe just better to argue the guidelines and/or merits of each, for or against, and leave the doctor's motivation out of it?
But yes, as in commerce, when it comes to medicine, Caveat Emptor applies.
Jim
I refused for many reasons. The value of statins is the anti inflammatory effects, many foods and supplements work to both lower cholesterol and anti inflammatory.
May I suggest you go to Zoe on YouTube or their website & listen to their podcasts on Cholesterol, how very little comes from food, how your gut biome is so important at clearing lipids and anti inflammatory foods. As they are constantly researching they will give you solid info based on latest research.
Zoe is an expensive luxury which not everyone can afford. I’m glad you have found it helpful for your own circumstances, ultimately the “personalised” dietary advice is pretty much the healthy eating advice you can get elsewhere for free — eat more plants, especially pulses and legumes, nuts and seeds and a variety of plant fibre sources. There is zero evidence that being hooked up to a CGM is particularly helpful in non diabetic people. The recent study showed a reduction in hbA1c in the Zoe group of 0.05% compared to the “control” group (dietary advice via a leaflet and weekly emails) of 0.03% — and yes, that decimal point IS in the right place. The 0.05% only just achieved *statistical significance but is clinically meaningless.
If people find Zoe helpful, and they have the spare cash to pay for it, that’s good for them. Otherwise, eat more plants, lots of different fruits and vegetables, pulses and legumes, nuts and seeds, healthy fats, different sources of plant fibre, a bit of fermented food if you like, reduce the refined carbs and go for whole foods, etc etc. There. I told everyone that for free.
Lots of YouTube videos on Zoe channel, free and very interesting, informed by their research.
I don't pay anything and enjoy listening to the Zoe podcasts which cover a wide range of health topics.
Yes, I know about the podcasts and I listen to them myself from time to time, and yes, podcasts are free. I don’t consider Zoe the last word on all things health and nutrition. They do push their programme rather heavily and oversell their own studies, the results of which are unremarkable. I will need to re-read it to see what the results were on blood lipids. I get that it’s not easy to find reliable sources of health information online and there’s a lot worse than Zoe out there especially as misinformation is rife.
And you said all there is to say, I suspect. Very useful - thank you. My son's mantra is nearly the same as you laid out diet wise and he has for very many years followed a healthy lifestyle using the best evidence he can get.
The trouble with health regimes such as Zoe is not that they aren't necessarily useful, but proving scientifically what is what with them is so difficult. There are strong confounding factors, such as that those who are more likely to choose this kind of regime will not only be rather better off, but also be naturally more concerned about their health and be better educated, too. That all sounds good, of course, but those are just the people who tend not to get so ill as those who eat poorly and exercise little.
I have been looking at TENS devices, vagal stimulation and the (over-priced!) Nurosym of late as I sleep badly. The clinical work around that really isn't helpful in my view - for much the same reasons.
Steve
Zoe is a very expensive way of encouraging people to eat more vegetables. I don’t believe their core advice is wrong either but when it comes to taking actionable steps, the advice is about adopting a more plant based diet with the emphasis on whole foods. Their study produced some very unremarkable results. I mentioned hbA1c but I went back to check the other metrics. The effect on LDL-C was no different from their control group (who received generalised healthy eating advice only); there was a small reduction in triglycerides and a drop in waist circumference in the group on the Zoe programme who also received one-to-one support from a registered nutritionist. But I need to caveat these results with the fact that the participants had an average BMI of 34, so they were mostly a “clinically obese” population. The problem I have with this study is that it doesn’t seem to know what it’s actually trying to achieve. Is it reducing hbA1c? It doesn’t seem to do that. Reducing LDL-C? It doesn’t do that either. The evidence isn’t there.
However… I’m totally for adopting a more whole foods plant based diet, I’m all for more beans and legumes, nuts, seeds, eat the rainbow, add in some healthy fats, all of that. No gadgets required, no expensive purchases necessary.
Interesting - and not surprising. I’m fascinated how technology and - most especially - medico-technospeak allow very effective marketing campaigns to be created. These all exploit the ridiculously lax social media advertising rules to sell some very dubious products.
Steve
It’s a minefield out there and I fully understand how difficult it is for some people to discern what is good, evidence based information and what is complete nonsense. Even the “good” influencers who are well qualified in many respects, start to feature more and more wacko types with dubious messages with the need to create more and more content if they are to maintain their position as a popular podcaster/YouTuber or whatever. I’ve seen the quality of output diminish over time from the ones who started off being reliable sources. They’re trying to make a good living but if they become repetitive, their audience will move on. It’s the constant demand for novelty that dilutes the quality of information, I think.
Yup - it amazes me how respected writers are diluting, extending and sometimes polluting their output to attract followers. Making money by monetising content must be rather like a drug. There are doctors revered by some who have done it and to show any level of disrespect for them will incur what used to be called "flaming".
Another aspect that is irritating is the lengthening of videos or written scripts simply to hold the readers gaze for longer to allow more advertising content to be shown.
Steve
I avoid YouTube if I can. If someone has a podcast I prefer the audio version and I can fast forward through the ads. I know there’s no such thing as a free lunch but online everything is about getting eyeballs on ads now. I’ve lost a lot of respect for many of the people I used to follow because they feature people who peddle pseudoscience and garbage, but they are very popular. It’s more about each party extending their reach into each other’s audience and increasing the potential market for what they’re selling. You really have to dig deeper for the good stuff now. And then you get the self appointed “mavericks” who talk utter garbage and rely on their audience having a very poor standard of media literacy/health literacy/science literacy. You know, say something “controversial” and you’ll get more eyeballs on ads, which means an income stream which can be very lucrative with a high viewership. A percentage will buy the books, buy tickets to the talks or pay to view online. The audience is just a sort of canon fodder whose purpose is to provide an income. They don’t care one bit about who follows them nor do the give a thought to their healthcare decisions. It’s sad, but what can you do?
It surprises me how many people do watch YT given the ratio of useful content vs. length of the vlogs. I just can't cope with the long rambling discussions that are so common. When the dialogue is succinct and meaningful, then it can be informative and interesting - but it seems it so rarely is these days.
As for the the increasing acceptance of pseudoscience, well, we appear to be in a new age, one reinforced or created by the impact of social media and the internet. How truly important this will turn out to be and where that will lead, goodness knows, but I hope it is being measured and assessed academically. The problem with academia is it has been affected, itself, by some irrational current ideologies.
I suspect it will all lead to nothing important, though, since life tends to trundle on regardless - but it might. The history of consumerism and marketing shows that snake oil has always had great appeal: the internet just makes it more obvious as it brings people together who feel empowered by the sense it brings that they are not alone. Worse, perhaps, is the cynicism it seems to be creating towards science and much else but, again, that might be an internet illusion.
The real and useful changes in society are and will always be driven by science and lots of that is happening now - on the medical front, too, thankfully. Time will tell. There's certainly a deal of anti-Enlightenment and anti-intellectualism afoot, with a sad rise in supernatural beliefs of various kinds.
If you like poetry at all, you might enjoy a poem by the late Philip Larkin called "Faith Healing". It's online. It's a poem of its time in some ways, but Larkin's point of the human need to overcome loneliness and to feel loved is an important one.
Steve
Just listened to the poem, how true it is indeed.
A poem of its time, maybe, but the message is universal and very much of "now"; just as when the poem was written, describing people falling for televangelists in smart suits, rimless glasses, white hair, so do they fall for the same spiel today, be it a preacher or an online 'influencer'....
They do not see the avarice, the calculating mind, behind those fake messiahs.
They follow their idols like creatures bewitched.
pigeon
Oh - if you only knew what it means to read your post. Thank you. People who appreciate poetry seem fewer and farther between these days. Larkin is a star in the firmament of poets in my estimation. Most of his poems are still entirely current in their themes, despite their age. I felt I needed to put what I did about this poem because I was worried someone on the forum might not see beyond his other archaic use of a woman as the subject of the poem.
Yes, indeed, I feel that little has changed since he wrote that wonderful poem. His ability to write using straightforward seeming words, yet to be able to convey universal and timeless insights about the human condition is something I admire in him a very great deal. He had his personal faults, as do we all, but his art is often astonishingly good.
Steve
Steve, I must confess to my ignorance, have never read any of Larkin's work, until you mentioned "Faith Healing". You know what I think about this poem. So I googled Larkin, and learned that he had refused to accept the post of Poet Laureate. If nothing else, this single act is so so telling of the man he was.
This has immediately brought to my mind Lawrence of Arabia, who had refused a peerage, and was an altogether a complex and utterly misunderstood man. He had also written a unique and mysterious poem as a dedication in his "Seven Pillars of Wisdom". Some poem it is!!!. Once read, never forgotten.
But anyway, talking about Larkin, I have just read Aubade......OMG... Dawn and Death.
pigeon
What a poem! 
Aubade is one of the poems that brought Larkin his reputation of being a pessimist. Nothing could be farther from the truth in my view but the reputation has stuck in certain quarters. I find some of the lines in that poem are simply such a wonderful use of language confirming that poetry is able, paradoxically, to say more than words can:
"Religion used to try,
That vast, moth-eaten musical brocade
Created to pretend we never die"
Larkin has a way of expressing ideas and thoughts that leaves me in awe at times. That is his art and skill and the apparent simplicity of his verse is a part of its beauty. His central theme is, perhaps, that we are all easily deceived by various aspects of society - consumerism, fear of death, love and so on. He seems to have seen through this and far from it depressing him, left him better prepared to deal with and enjoy life. I can relate directly to him in that respect and all of my life have hoped for a less deceiving society to develop. In the sixties and seventies, it looked as if it might, but there has been a reversal since and we are as disingenuous as ever we were. Well - that's my view.
Another poem of his that struck a chord is "At Grass" and "Maiden Name". I think you'll enjoy them - much less dark than Aubade!
Steve
I will look up the poem online. It sounds intriguing.
The poem brought to mind a few scenarios I’ve witnessed or heard about in the ME/CFS world. As there’s no treatment of any real effectiveness, people are just left to their own devices after diagnosis which leaves people vulnerable to all sorts of promises of fake cures. Our local group was once targeted by a so-called “healer” who did the hands on thing. I witnessed one man uncontrollably sobbing when she did the “healing” ritual. Whatever that was all about, I have no idea. It puts me in mind of those churches where people go hysterical and faint. Whatever the waving of hands over someone was about, it didn’t help his health in anyway. I didn’t trust the woman one bit. I took an instant dislike to her. I thought she was quite literally a confidence trickster. But I do understand people will try anything if they’re desperate. I’ve seen so many fake therapies come and go with promises of miracle cures but I’ve never known one person who gets better from them.
If ever life brings us together, we would enjoy a coffee and putting the world to rights! We seem to be entirely on the same wavelength.
Steve
I hope not in a NHS waiting room with coffee from a vending machine!
Amen! You don’t need to fork out money to eat healthily. It’s been pushed for years by doctors and dieticians for free but now it’s an industry!
Eat more fruit and vege, reduce processed and packaged. Reduce fats, salt and sugars. Drink more water. Eat less red meat and more fish. That’ll be £50 please.
You’re obviously much smarter than me, Ennasti! You charge £50. I give it all away for free! 😂
Whoever thought of just turning on the tap for a glass of water? Don’t you need magic wands or something to make it more coherent? I saw that on TikTok so it must be true. 😂
Seriously though, it’s not rocket science. The information is freely available and easily accessible — soluble fibre, plant protein from beans and legumes, nuts and seeds, healthy fats, and if those four elements are not bringing down LDL enough, add a plant sterol/stanol supplement. Apart from the plant sterol/stanols products, ALL of those are part of mainstream healthy eating recommendations.
I get that it might be hard for people to incorporate more plant based ingredients into their regular diet, like recipes that are based around beans, and also the seasoning becomes more important so I fully understand that it’s not easy when people are not au fait with combining spices etc.
There are a lot of plant based recipe bloggers, and increasingly there are more plant based recipe books in the local libraries too — you don’t need to buy recipe books or subscribe to an app, there is a lot out there for free, and yes, I’ve discovered some recipes that I’ve added to my repertoire this way.
I’m far more of the mindset that giving people info that they can act on today or tomorrow so they can make those changes starting now. And cost nothing.
With respect - that is not what Zoe is about at all. It is fundamentally a research project on an epic scale to develop personalised medicine and that is why I participated. You don’t have to join the coaching eating plan if you don’t need or want to but I found it VERY useful to know that my gut biome doesn’t have the flora to clear lipids so I must be careful about when and how I take in essential fats. Just as some people sensitive to carbs can mitigate the effect by eating green salad prior to the carbs - wasn’t that always a thing in the US? Certainly is in Italy and Spain. On the other hand, as I didn’t have one even small glucose spike I also know I seem to have low risk of developing insulin resistance or diabetes
It’s a personal choice to involve yourself, as it to take any medication that may be recommended. I had very similar tests done 10 years ago through my Lifestyle Medicine Doctor, who was also my NHS GP and a Nutritionist and can tell you that cost about x3 the amount Zoe charged for the testing.
And all the things you said about healthy food - eat the rainbow, curb the carbs, limit meat, eat pulses, take 3 fermented foods a day are all there and I did that anyway and as many who have read my posts for the last 10 years know I have advocated for long before Zoe but through Zoe I now know a hell of a lot more about my personal physiology and gut biome so feel more informed to make decisions that apply to me personally and are not a blanket prescription based on herd statistics.
Still will never take stains, Beta Blockers, Anti arrhythmias, PPIs or COVID vaccines - but that doesn’t make me anti anything - just my personal choice because all the evidence points that for me personally they harm, not help!
Whatever happened to critical and discriminative thinking
As I said, great that you found it helpful for your individual circumstances. If you consider it money well spent, good for you.
It’s far more helpful to offer people actionable steps that they can take today, that cost nothing. There is evidence for soluble fibre, beta glucans, plant protein from beans and legumes, nuts annd seeds, and adding healthy fats. These have all been shown to reduce LDL cholesterol. That’s the information that someone can apply today or add to their shopping list or whatever. It’s very simple, affordable and accessible.
I have been a Zoe member and would recommend it, especially for people who are overweight and want to start living in a more healthy way, as an educative tool it is great. I am not overweight and joined because of gut problems and it has helped no end with that. The recipes are great, and so is the support from nutritionists. They are constantly researching the data they get from members and set up trials to find out more. All in all my feedback is positive, it is quite expensive though, but if you are desperate it is undoubtedly worth a try.
Suggest you research the subject on the internet. Lot of professional, credible info directly from NHS and BHF.
Keep in mind, the LDL (bad) cholesterol is the key. Your overall cholesterol may be within limits but statins are normally recommended when the LDL is high.
Also, consider if you may have other health conditions besides afib which could affect the decision.
LDL is the number to watch. I know Apo(B) is supposed to be a better measurement but it’s not the standard test used by the NHS, probably because of expense. No matter what test is used, the advice is going to be the same, and the same measures that reduce ApoB will also reduce LDL. Unfortunately there are a lot of rabbit holes to fall down on the internet, with respect to this topic. We have to be very careful about which neighbourhoods we stray into!
By all means try lifestyle measures as 5.5 really isn’t that high. Nevertheless, CVD incidence tracks with LDL levels *at the population level* so that’s the number you want to watch if you want to see if you can get your numbers down without medication.
I suggest you take a look at the portfolio diet or alternatively the “ultimate cholesterol lowering plan” at heart.co.uk, which is more of a “portfolio lite” approach. This approach is about incorporating the types of foods that have been shown to reduce LDL cholesterol rather, and you can adopt one of these recommendations at a time. Each one may reduce your LDL by a small amount, so the more you can add in, the better.
All you can do is give the diet and exercise approach a decent shot and then retest. 3 months is enough time, then you can take it from there.
In my early fifties I moved to work at a different hospital and they were testing all new employee's cholesterol. If I remember correctly mine was 6.8. No one was at all concerned. 20 years later and had PAF by then it was 7.2. GP had filed as no further action but I asked for a consult. Tried 2 types (though to be fair, didn't give atorvastatin a fair crack of the whip) after GP showed me a very misleading picture of rows of hearts and how much less likely I'd be to get heart disease. Felt 10 yrs older on both!The actual improvement in mortality for a 75 yr old was minimal ( no I didn't look at QOL)
I have just started plant sterol tabs and my diet is mostly quite good so I feel I'm trying
The sterol tabs worked for me and I had very similar experiences. In my 50’s my total cholesterol was 4.2, 60’s 5.5, now in my 70’s around 6.8-7.2 but my cholesterol ratio is good and slightly over the triglycerides but as the surgery know I am never going to take statins they no longer monitor my cholesterol so I pay privately about every 2 years. I’m not against statins as I know they help some people, I’m against blanket prescribing and advising without taking into account medical history and personal experience.
My GP surgery has taken the, unusual. step of taking age out of the equation when running cholesterol tests. If my age (early seventies) were put in to the algorithm I would be recommended for statins. My GP leaves it out and I then fall below the score needed so I do not take them. I consider this very enlightened thinking from my, excellent, GP
I am currently taking Flecainide and Metropolol as a PIP and I have been for the last 10 years. Gradually taking a wee bit longer for AF to revert to NSR. This being the case I requested a referral to my Cardiologist specialist. Upon consultation we agreed that I commence with an anti-coagulant - Apixaban. CHADSVASC score 0 but my choice to commence anti-coagulant.Whilst I was with Cardiologist he mentioned that my cholesterol level (5.2), was a bit high. He advised taking Statins and I agreed to disagree. We agreed we would monitor my bloods and next tests were in 3 months. My GP is good with my bloods and testing(same GP for 20 years) and he did say it was a wee bit high but not too bad. I am not keen on taking medication if not required but had blood tests last week and cholesterol level is down. Good cholesterol up and bad cholesterol down. (HDL and LDL). As has been advised by our learned friends on this site it is your choice but lowering cholesterol can be achieved without statins. All the best with your endeavours re cholesterol and in general.
Cheers Cam
Requesting the three months using diet, hydration and exercise is sensible.For one thing if your cholesterol remains the same or it gets worse it proves that you could have a very common cholesterol issue which often causes no early symptoms called Familial HyperCholesteroleimia which would require a long term statin.
If it improves and you don't have any other cardiac problems which would mean a statin is used to stabilise plaque in the arteries and not just to reduce cholesterol then you could continue on a strict diet and eat more plant sterols and be fine like that.
If you do need to use a statin they aren't the villains they are often painted to be.
I use Rosuvastatin, and many people do , because it has less side effects than the first offered option of Atorvastatin so you could request to use that and start on a low dose then retest again after a further three months to see if that's enough.
I agree my GP tried to put me on statins a couple of years ago I like you said I would try to do it myself through diet and I asked if he'd test my colesteral again in six weeks I replaced butter with benecol and take two plant sterols every day I eat healthy any way only eat red meat once a week and limit cheese after six weeks my cholesterol went from 5 .6 to 4 I had blood test recently it is now 3.5 I asked the nurse if it could get two low she said the lower the better
i would question that as our brain’s need cholesterol to function well, especially Omega 3’s.
thanks I'll question that looked on Internet says high can risk dementia and one said low can raise risk lor
And therein lies the difficulty- obtaining balance.
not easy can you get home colesteral kits rather than bother the gp
A cholesterol level of 5.5 doesn't sound high to me, it's just not as low as the pharmaceutacal company influenced figure of 4.2 which came in some years ago from a level of 5+.My cholesterol level has measured 6.5 for decades but never a suggestion from my GP to take statins, my ldl was only slightly over range with good hdl and trigliceride level,
These days the ratios of total cholestetol/hdl and triglycerides/hdl is seen as more meaningful figures to take notice of.
There's lots of evidence backed research showing that ldl isn't as important as once thought and in fact stastistics show that as many people die of a cardiovascular event with low ldl as people with high ldl.
Dr Malcolm Kendrick is interesting on lack of evidence on lowering cholesterol being beneficial.
And he has a book ( I have not read it) on the cholesterol and statins con (on Amazon) that is favourably reviewed by the British Journal of General Practice so cant be utter rubbish.
Also take a look at Dr Aseem Malhotra's new film which takes a serious deep-dive into the statins story...
I have read both the Cholesterol Myth and The Clot Thickens and Doctoring Data, eye watering stuff.
He is a VERY controversial figure and if mentioned on BHF you will be banned. He is constantly attacked and vilified so for that reason alone I find him a person of interest.
Yes, medical profession tend to hound doctors who don't tow the conventional line, which is not helpful for scientific subjects as you need to think widely. It is not that he some wild and wacky thing that he promotes to make himself money ( which may make sense to ban), but critically evaluates the scientific evidence presented which is so valuable. Just won a court case too
Yes I agree, try and lower it first.I was also put on statins(preventative after stroke) .Have never taken them and cholesterol has been fine for 7 years. Stroke at 47, small pfo in heart likely cause.They are very hard on the liver and like you didn't want to be on them for life.Think GPS just randomly prescribe them. Pharmaceutical companies making a fortune!
Try adding a benecol yoghurt drink to your diet and exercise .
I'm surprised your score is considered high - maybe different countries have different standards (I'm inSouth Africa) - but it was only when mine was nearly 7 that I was prescribed a statin togather with slight diet adjustments. MY doctor was horrified when it went down to 2,5 and immediately halved my dose of 10mg per day to 5mg per day. This regulated my reading to 4 and maintains it. Cholesterol is vital especially for the brain.
Which statin?
Atorvastatin !
Rosuvastatin here, 5 mg. lowered LDL about 30% as expected. Also considered Moderate Intensity. I see why your doctor was shocked, 10mg Atorvastatin should not have lowered LDL 60%, just 30% also according to Cleveland clinic article with title "What You Should Expect From Statin Therapy." Search for that title if the link below gets disabled (kind of new here I do not know if links are allowed) health.clevelandclinic.org/...
Thanks, will do. I have been on the 5mg for several years now, and my annual full blood count has always been good, with the 'good ' cholesterol high and the accompanying 'lipids' or whatever they are? (I don't have the test sheet in front of me) absolutely fine. ,
It could be me writing this ! My cholesterol was found to be the same as yours ( not very high ) and myGP pharmacist rang me to suggest statins. Like you I was wary. I told her I would try and lower my cholesterol myself. I cut out butter altogether - there is half a woman’s saturated fat allowance in the amount of butter you smear on two slices of toast ! - and cut down on cheese. I am a cheese-aholic, and ate it every day so I usually have the lower fat cheddar and save the ‘good stuff’ for special occasions. Added to that regime, I ate a pot of Benecol with a banana for lunch instead of cheese, every other day. After three months, my cholesterol was down to 4.6 Nowadays, I only eat that yoghurt maybe twice a week, but I do look at the saturated fat content of any packaged food I buy. I find those very small changes - cutting out butter and reducing cheese - must have made a big impact, even without the yoghurt. I rarely eat cakes and biscuits as I don’t have a sweet tooth, but they would be something that could be reduced by someone with high cholesterol. I will, however, check with my GP next time I see him to ask if there might be benefits to taking statins, other than reducing statins. Go on Northernowl - give it a go.
Annie
That’s very good, and well done you! I like how you’ve said what steps you took to achieve this. I’m all for giving people actionable advice that they can do for themselves for little or no cost.
I got my cholesterol down by going on the Zoe diet. Expensive so depends if you have the money. Otherwise eat more plants, beans and less meat.
More plants, more beans. A definite yes to that! I’m all for giving people actionable advice that they can use at no cost or at very little cost. I’m very much a believer in a plant based diet with the emphasis on whole foods.
I think it’s box ticking! I am 80 and have never been overweight and have eaten healthily for many years - no meat or dairy and plenty of fruit and veg. When I was put on statins, I thought it was because it seems I have developed a huge gallstone but it seems it’s just my age and the obsession with preventing other heart trouble I am unlikely to get! The info in the pack actually said they were unsuitable for people over 70 though the pharmacist said that didn’t matter, and when I finally managed to get one of the doctors to appreciate that she prescribed a lower dose statin that I’ll take! It also seems my gallbladder has thickened walls but as they are not cancerous and I’m not in much pain, nothing is being done about that! Eventually, the medical profession might realise that we are all different and need to be treated accordingly.
How was your a fib cured please?
69 and had cholesterol 6.6
Medic advised statins about 3 years ago. Refused.
After check up last January no change in cholesterol level and again statin advised.
Agreed and put on 10mg Rosuvastatin. Plus I made efforts to eat more healthily/sensibly.
3 months later chlo level 3.3
Asked medic to reduce my dosage to 5mg. Agreed. I continue, mostly, to eat healthily.
Due for next chlo check next month.
Hi, I think your cholesterol at 5.5 is high. Mine was under 4, but I had a small stroke 2 yrs ago. Its now 2.7 but the docs say its still too high for someone who's had a stroke and want it lower. I have been taking benecol for about 3 yrs and that helped reduce it from 3.5 to 2.7 so you could try that along with exercise and less red meat. I was reluctant to start statins cos of possible side effects but I have started last month and so far no side effects.
I too resisted statins with a level of 7. For years that was fine bow suddenly, 5 is the new 7. I had the chat with GP about how my arteries could be clogged until I reminded them that I'd had a CT angiogram a couple of months before, showing nothing.
I said I would prefer to try and get it down myself and it has dropped to 6 in 10 months without my really trying too much. Just switched to a lighter butter and lower fat cheddar, have the odd Aldi cholesterol lowering yogurt drink and increased my fibre. All of my LDL, HDL, triglycerides and HDL ratio are all in the normal bands as per the BHF website.
I'm going to be stricter with myself and make sure I have a yogurt drink everyday to see if that chips away a bit more.
I really don't want another tablet and have heard too many stories about folk having issues with statins so will resist for now.
I recall that 5.5 was once never “high” unless there was a family history of cardiovascular disease.
It seems from the latest studies and thinking that morbidity from such diseases is now so prevalent that we would all live better and longer with truly low levels of these fatty acids - if we can he cope with it.
Sadly, statins have become one of several treatments that have been “weaponised” by conspiracy thinkers who distrust “Big Pharma”. This makes it more difficult to find useful information on the internet, and too easy to find highly convincing misinformation.
I would look back into your family for evidence of CV illnesses and early deaths before I decided but I feel sure also that diet and most especially regular daily walking or other exercise would do the trick.
Steve
The body of evidence is always changing. These days HDL isn’t considered “good cholesterol”. It’s probably more helpful to see it as neutral than “good”. The genetic studies using Mendelian randomisation have shown that people with lifelong low levels of LDL have better health outcomes over their lifespan than those who have higher LDL. It seems that the risks are of cumulative exposure over the decades, and there are those who believe that we should be testing earlier in life rather than middle age and beyond. So what people thought “years ago” compared to what we know now is based on the current preponderance of evidence and not “big pharma” conspiracies. 🥱
I daresay in a few years we’ll have different targets and different ways of reducing blood lipids. It’s more important to keep up to date in my opinion than be like one of those who hark back to the 1950s when so-and-so said such-and-such. We know a lot more than we did 70 years ago.
Indeed we do. A recent study I read , which was large, complex and well controlled, seemed to suggest a very low figure for these lips was likely the healthiest.
There is, of course, truth in the (often used by conspiracy theorists...) claims that the body makes and needs cholesterol, but that seems to be little to do with this, scientifically.
If you can point me to any recent studies, I'd be grateful.
Steve
I don’t have any links immediately to hand right now but I will send you them when I next look into it.
The body does make its own cholesterol but that doesn’t mean high levels of blood lipids are somehow “better”. Blood lipids don’t cross the blood-brain barrier. The brain can synthesise its own cholesterol, so the “prevents dementia” argument doesn’t stand up to scrutiny.
I can understand that people don’t want to take medication because nobody actually wants to if they can help it. There are the dietary modifications as suggested as part of the portfolio diet but each of these can only reduce LDL so much, so for some it may not bring their cholesterol down to their target range. It can work for some, and much of it is general healthy eating advice — soluble fibre, plant protein from beans & legumes, adding in nuts and seeds, healthy fats like olive oil and avocados, and if necessary taking a plant stanol/plant sterol product. I don’t see it as a medication or lifestyle either/or. It’s what gets results for that individual that matters and I don’t think anyone should be shamed or blamed for not trying hard enough when their genetics may be going against them.
The biggest medical threats to health are surely cancer and cardiovascular disease, and the biggest controllable contributors are surely obesity and lethargy. And yet controlling them is hard going - and, for some, incredibly so.
It seems, too, that those dietary guidelines you mention need to be part of our lives from a very young age to have a fully useful effect. When I see overweight youngsters, I fear for their futures and wonder how much their parents are responsible - but it must be very hard indeed these days to keep children active and slim.
We lost a good friend a year ago who lived to be 94 years of age. That sounds wonderful but, no. She was very overweight and her final decade was, well, no less than hellish for much of the time owing to that excessive weight. Before that she had been an amateur pianist, a wonderful singer, vibrant and creative. But her weight ruined so much and in those last ten years or so sealed what turned out to be a very tragic fate.
Whatever it takes, whenever possible, we do need to eat more wisely and exercise more often.
Steve
hello, I also refused statins when my overall cholesterol was found to be high. Having read quite a bit I'm not convinced the NHS advice is really up to date, personally I use triglyceride/HDL ratio to determine my risk, mine is just about 1.1 which is OK. Below 2 is deemed good. This is not advice to you, but it's the way I deal with it. best of luck
diet and exercise got my cholesterol down from 6.1 to 5.1 in six months. A bowl of porridge with a couple of dates every morning I believe helped get it down
Soluble fibre 👍
I have eaten nuts every day for years. two Brazils, two walnuts and five almonds. My doctor and I joked about my high HDL Cholesterol some years ago which is the good one He asked me what it was and I joked saying it must be the Nuts. He comment was that it was..
Nuts for the win 👍
I personally think it would be beneficial to try lowering your cholesterol on your own first before adding another drug to your regimen. If it doesn't do the trick, then ask your doc for a low dose of statins.
If you have not had Afib for 9 years, please tell us what you have done/not done to keep it away for so long? Thanks.
it’s difficult as no underlying reason for the AF was ever found but I had an ablation 6 months later, I stopped smoking and reduced my alcohol intake from appx 60 units to around 10/15 units a week
What do YOU think is the reason for the appearance of Afib? So, a reduction of alcohol and cessation of smoking were the only changes you made? Thanks.
I’ve honestly no idea, no history of any medical issues other than asthma as a child, no family history of heart problems, I was 35, I woke up one morning and my heart felt funny - that’s it
Diet rarely has an effect on cholesterol levels, as the body itself manufactures more cholesterol than ingested.
JimF
It’s very individual. How much cholesterol our body synthesises is determined by our genetics. It’s not the only factor but I can be a big problem for those who have been dealt a bad hand in the genetic lottery. Diet won’t do much for those people. I know someone who is in that situation.
Yes, try lowering with diet and exercise. Good luck
l would not consider taking statins until l had tried every other possible way of reducing my cholesterol. It is another life-long medication and as we all know has side effects. I get fed up with statistics and theories and prefer to be practical and use my intuition. I have a friend who reduced their cholesterol by taking a tablespoon of olive oil everyday, as well as all the other cholesterol reducing foods- porridge, vitalite etc. it can be done if you persevere. Good luck.
A brief comment would simply be that I totally agree with your alternative solution.
Red yeast rice, and plant sterols are alternatives you can look into , my gp told me my cholesterol was high whilst my EP told me it was reasonable.
try and reduce naturally.
Its fascinating how some people demonise medicine, specifically medications and preventative measures. Statins, vaccinations, HRT and a lot of other things.
My advice for what it’s worth is to discuss your treatment plan with your doctor. You and she/he are in the best position to decide if you should try diet and exercise first, or take statins.
I think it’s hilarious how you get people whose sense of identity is defined by *the medicines they don’t take* 😂 I just think “so what?”
I don’t believe people should be shamed for taking medication. Especially by someone who’s had successful surgical procedures that mean they no longer need a particular medication any more. It’s not as if you get “surgery shaming” is it? But people over-identify with this “no meds” thing, as if anybody cares what they do.
I so understand. My chol was 6 and I didn't want statins so on friend's suggestion I started taking chol drinks daily(I drank the Aldi ones) after 3mths chol down to 5.1 yippee. Best of luck.
Eve y body produces cholesterol for its purpose. If it is elevated there must be a reason. It is not much to do with one's diet. Cholesterol is vital for brail and for healing. The whole story around statins is dark and not very well explained. Some lipids ratios are more important to know than total cholesterol btw
I’m 70 and also suddenly had a higher cholesterol reading. But I’d only just got over Covid. Anyway, I’m doing what lots of others on here are. Introduced daily plant sterols eating Benecol Yogurt, using the spread and also the skimmed milk containing plant sterols. Have also upped all the cholesterol lowering fruits and veg. Added abundant seeds to my porridge. Swapped Koko milk super which I really enjoyed, for Soya and Oat milk on my daily porridge.
I’m hoping these self help measures will do the trick. Also joined a gym and am doing two aqua aerobics twice a week. One Pilates and a gym session. Trying to also fit in my daily walk which is proving a challenge!!
Hoping this will all help.
I too listen to Zoe and have the new recipe book. I eat kefir yogurt daily.
I’ve taken on board ‘dose the diet’ and just check my INR weekly with all the new foods that could interact. All good so far. My INR levels have always been really stable.
Hope it works!! 😊
Good for you! I hope it helps. Wishing you a full recovery from Covid.
Thank you! It was my second dose in two years. First time I didn’t have more than a stuffy nose. This time I was a bit more feverish and quite chesty. But it fortunately responded to honey and lemon and didn’t get too bad. But I was much more shattered this time. Took a little while to get back to normal activities. But very happily I was suddenly much better. Though it has left me with an excess of catarrh. 🤦♀️
I’ve not had that vaccination simply because the Moderna I had for my third vaccination triggered weeks of Afib between October and the following summer. I had all the others this year Flu and Shingles just waiting for the pneumonia one
I’m hoping the other type of Covid vaccine will gradually become more available. The one that is more like the way the flu one is made. Once it does, I’ll definitely have it asap. 👍
A lot of people are saying this year’s Covid variant is a nasty one. It was the Covid infection that messed up my AF, not the vaccine, but I can understand that either or both could kick off the AF. As could any infection or vaccine for that matter. My arrhythmia specialist at my first appointment told me that viruses can be a trigger but unfortunately they are an unavoidable fact of life.
You sound like you’re doing really well, keeping fit and eating well. I hope you get the results you are hoping for. I don’t know if you like aubergine and okra, but these are very good sources of soluble fibre. Apples and pears too. I don’t know if there are any aubergine recipes in the Zoe cookbook. These will all help, besides the oats which I like too. I’ve just prepared a “carrot cake” style overnight oats with grated carrots and I’ll add some cooked apple tomorrow to sweeten it.
Sounds a delicious porridge idea.
I love okra. but have never seen it fresh to buy anywhere. . I do like aubergines too, but forget them sometimes as being a great veg to use. Aiming to eat 30 different plants a week, which includes herbs and spices and seeds etc.
Agree with everything in the first part of your reply.
Here’s to healthy eating without losing perspective. Small changes yield results. We can but try. 😊💕
Hi
Great. 5.5 pretty good.
Have you taken off the 'god cholesterol' tiotal from this?
We all need cholesterol.
You can bet that cholesterol will lower if you lose weight even 1-3 kg.
My pharmacist who also studied statins does not like them. Her husband has AF as I do as well.
cherio JOY. 75. (NZ)
Yes do it your way but monitor and listen to what your body tells you from time to time.
My cholesterol which had previously been excellent suddenly rocketed to 6.3 following starting on various new heart drugs. My GP wanted to start me on statins but I decided I didn’t want to risk yet more side effects. I am now taking plant sterols from a company called British Supplements following reading a bunch of positive reviews from other customers on their website. Worth looking into. I had a repeat cholesterol test last week so should find out soon what difference they are making.
Please let me know me know if the supplements have had a positive effect 👍
Just got my test results & my cholesterol has gone down from 6.3 to 5.7 since I started taking the supplements in June. Still not down enough but it’s a good start. I have plenty of the good cholesterol apparently.
Have you done anything else other than taking the plant sterols ?
I also take turmeric and fish oil and eat porridge for breakfast, and have a daily Benecol drink, but the reduction in cholesterol does seem directly attributable to starting on the plant sterol capsules as the other things didn’t seem to do much to help once I started on all my heart drugs. My doctor thinks being on amiadarone may have affected my cholesterol.
Good to know, thank you 👍
that’s great - well done - I’m sure it will keep going down now
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