Cholesterol levels, what's the latest advice?

[tunybgur]

After my heart attack 8 years ago I was put on Atorvastatin 80mg. I was 65.

I asked my consultant what my levels should be and he said as long as my total cholesterol was comfortably below 4 mmol/l he was happy.

After a bit of experimentation I found that 40mg kept me at a total Chol3.6, HDL1.64, LDL1.6, Tri0.79 and Ratio2.19.

Over the years my level has slowly increased, Chol is now 4.5, HDL 1.78 and Ratio 2.5

My question is 'what is the latest advice on cholesterol, and should I increase my statin?'

I am still on 40mg and I think the next step is 80mg, why such a big jump? Why isn't there a 60mg tab?

The BHF site no longer gives target numbers....why is this?

Anybody know the latest advice on this subject before I get involved with the 'experts'?

[Peony4575]

choosingwisely.org/patient-...

Am not very good with links hope it works

[tunybgur in reply to Peony4575]

Thanks Peony, the link worked fine, but unfortunately didn't answer my question, in fact it posed a few more....hey ho

Food for thought

[Peony4575 in reply to tunybgur]

I know it didn’t . Have you thought of adding Benecol to your existing statin ? It does actually work. I always think a variety of views are good before making a decision . Good luck with it anyway

[tunybgur in reply to Peony4575]

I'm already using spreads with stanols and avoiding high fat/high cholesterol foods (difficult over Christmas) but I don't want to become paranoid about diet, I want to enjoy my food as well as being sensible.

I've had a few slices of Viennetta which was delicious, but I avoid ice cream during the rest of the year as it's not too good for us, but occasionally must be ok?

[Peony4575 in reply to tunybgur]

Good for you . As our grandparents would have said , a little bit of what you fancy does you good or everything in moderation excess in none . I never waste the calories / cholesterol on rubbish . I savour my treats . Don’t want your last thought to be bug*er I wish I d had that slice of viennetta . It’s the big picture of what you eat that counts in my opinion not an occasional detail.Hope you enjoyed it

[Kimkat in reply to tunybgur]

I have thought about what we eat long and hard and I have come to the conclusion that if your body can control cholesterol on it’s own, your just one of the lucky ones. My Mum ate everything, including butter, all meats, puddings, you name it she ate it but always in moderation. She was stick thin and extremely fit and not necessarily because of constant exercise but she never sat around for long, always keeping herself moving. She lived until she was 85 but lung cancer got her in the end. My weight has piled on during lockdown and I have found that I just cannot get myself motivated, everyday I promise myself that I will go for it, so perhaps today will be the day 🤞🏼

[Greenfingers20 in reply to Kimkat]

I piled on weight too and cholesterol high. To avoid stating I'm eating soluble fibre low fat foods like oats and vegetables to lose body fat. First week in lost 3lb. Oat muesli and oat milk really fills me up till lunch. Dont need elevenses. Just nice fruit or ginger teas.

[84green]

Hi tunybgur

I don’t have a definitive answer I’m afraid but will share my experience. I haven’t had a heart attack but was diagnosed with mild coronary artery disease a year ago. For reasons that aren’t relevant, I saw a cardiologist privately at first. He prescribed 40mg Atorvastatin and gave me a target of Total Cholesterol below 4mmol/l and LDL below 1.7mmol/l. In the reading I have done, I have seen these figures quoted regularly.

My cholesterol had never been high before but my total was above that. Within a month my levels had decreased and he recommended I reduce my dosage by half. He also said that our bodies need cholesterol.

In the meantime I’d been refered into the NHS for a stress echocardiogram which was was conducted by a seperate cardiologist. The test was normal but he queried why my dose had been reduced. His recommendation was to take the maximum dose (ie 40mg for non heart attack patients) as long as I could tolerate it. This on the basis that research had shown the benefits in terms of reducing inflammation and inducing plaque regression in the arteries (in addition to lowering cholesterol).

So I’m now on 20mg Rosuvastatin. Last week my TC was 3.2, LDL 1.1, HDL 1.7 (1.1 a year ago) and triglycerides 0.8.

Two experienced cardiologists whom I trust but two different opinions.

[tunybgur in reply to 84green]

Hi Thanks for that, it's really useful to know that 4 mmol/l is still advocated. My LDL wasn't reported on my last test, I think perhaps they consider the LDL/HDL ratio to be sufficient?

After my heart attack I was on BP lowering meds and aspirin etc, but the only med which was likely to change the 'diffuse coronary artery disease' that I had was the statin I had been prescribed.

I was aware of all the anti statin stuff, but I was not overweight, had a good diet and was as fit as a fiddle, running, gym, squash etc etc. so I needed something to blame....stress was the favourite culprit as I loved my job but it really took its toll on me.

The statin at least was a med which would possibly improve my arteries, and I needed something that gave me hope to avoid a second heart attack, I have had no side effects and I hope it has stabilised all the plaques in my arteries....e.g a 90% blockage of the distal LAD for one!

8 years now and still fit as a fiddle!

[ling in reply to tunybgur]

No stenting in the distal LAD?

Thank you

[tunybgur in reply to ling]

Apparently they could not stent the distal LAD, the blockage which occasioned the heart attack was in the RCA, which was stented.

[ling in reply to tunybgur]

Wow, the distal LAD 90% blocked did not cause the heart attack. How much was the RCA blocked?

[tunybgur in reply to ling]

Not sure, but enough to put me on my back and get a ride with all the blues and twos going.....now that was a fun part of the day!

[ling in reply to 84green]

Thank you, I really like the sound of this "and inducing plaque regression in the arteries".

My cardio insisted that statins do not help in reducing existing plaque.

[fergusthegreat in reply to ling]

Get a better cardio, he is wrong.A number of studies including the Jupiter statin trial, show plaque regression with high intensity statin treatment.

[ling in reply to fergusthegreat]

If its a moderate dose statin and one takes it long enough, will it induce plaque regression?

Re cardio. This was the only off thing she's said so far. Otherwise, she's the smartest cardio I've had to date : )

[tunybgur in reply to fergusthegreat]

The Jupiter statin trial is really interesting, although there is a suspicion of conflict of interest with some of the authors.

[Milkfairy Heart Star in reply to fergusthegreat]

Could you please share with the forum the relevant research articles?

The Jupiter trial took place over 10 years ago and the interpretation of the results are controversial.

medscape.com/viewarticle/72...

acc.org/latest-in-cardiolog...

[fergusthegreat in reply to Milkfairy]

Sorry but I'm not very good with computers and technology but I think this offers an overall statement and some links. My apologies if it is not what you meant 😊

pubmed.ncbi.nlm.nih.gov/306...

[Pollypuss in reply to 84green]

What I always ask is if Statins reduces inflammation why are so many people with side effects having to take anti inflammatory medication to address the pain caused by the side effects of Statins. I know this because my sister suffered for years on Statins until she came off them and the relief she felt . She has been off them fo four years and not had another heart attack at 87

[MichaelJH Heart Star]

The total and ratio suggest your LDL is higher than desirable. You do not need to go from 40mg to 80mg as you can "mix 'n' match", e.g. 40mg + 10mg for 50mg dosage. My GP did this with my Lisinopril to avoid hypotension.

[Pitt12345]

under lipid specialist, he put me on rotuvastatin 20 mg and has added ezetimibe as he wanted mine down further as my lipoprotein a is high. My husband who has had 2 ha’s within 20 months has also now been put on ezetimibe to add to his 80mg atorvastatin as want ldl below 1,2. He also has high lipoprotein a , dont think this is routinely tested.

[istimewa in reply to Pitt12345]

Pitt12345 - is that Lipoprotein A that you mention being high in your case? Was it your cardiologist who got you tested for it, or did you have to see a lipid specialist in order to get tested for it please?

[tunybgur in reply to Pitt12345]

I think you're right, I don't know of anyone who has had their lipoprotein checked as a normal part of the screening process for cardio problems. I don't know much about it but I will do a bit of research....knowledge is power!

[JennyRx in reply to Pitt12345]

I had my lipoprotein(a) ( little a as there’s lipoprotein bigA apparently) tested. Referred to lipid clinic by GP. Mines very high so I’m on Atorvastatin 40mg and ezetimibe 10mg, plus other meds following CTO PCI and two stents in RCA . I was on Atorvastatin 80mg but my LDL didn’t shift and I was getting peripheral neuropathy so there was no point in staying on the higher dose. I have another follow up with lipid clinic to see how I’m doing. But I would have put my 100% blockage down to some lifestyle issues despite running, losing weight, eating healthily but it was the lp(a) that seems to have been the culprit. Apparently it can go up post menopausally in some women and there’s some correlation with breast cancer which I’ve had. But very little research.

[Pitt12345]

It was lipid specialist

[Greenfingers20]

Look up the BNF drug recommended doses. Or NICE.org.uk Search hypercholesterol

[timetabler]

Many doctors think that statins are a big 'con' by pharma companies...

[timetabler]

In looking at dosage, it's worthwhile thinking of bodyweight ...10mg of statin is not the same to someone weighing 15st as someone weighing just 10st.

[Greenfingers20 in reply to timetabler]

I'm 12st taking atorvastatin 20mg. Even though my ratio is fine!?

[Jay777]

Hi

Prescribing advice is 40mg for high cholesterol and 80mg post HA.

Advice I was given is the ratio is the most important factor and your HDL has increased so that’s a good thing.

[Bigrig]

A year after my CABGX3 having lost 3.5 stone & become a lot fitter, I was keen to reduce my pills etc - my last Cholesterol test was 3.1 (down from 7.4) my Gp said he would prefer it below 3 & if I reduced statin it may start going up again so advised to stay on 80mg Atorvastatin. Just on this & Aspirin now.

[tunybgur in reply to Bigrig]

First time I've heard of such a low target level, we do need Cholesterol, just not too much.Is there any particular reason why it should be so low?

[84green in reply to tunybgur]

My understanding from the reading I have done is that the best chance of achieving any plaque regression is to maintain LDL levels below 70mg/dl (approx 1.7 mmol/l). Obviously, some statins provide the opportunity to do this.

sciencedirect.com/science/a...

This is in addition to the need for tight control of any co-morbitities (eg diabetes, hypertension etc) as well as the usual diet and exercise regime. Medication alone won’t do it.

Best wishes

[fergusthegreat in reply to 84green]

I believe that this is correct. A study in 2011 on Korean patients by Dr Hoon found that plaque progression occurred in patients with an average ldl of 73 mg/dl.Interestingly these patients also had higher crp levels which would be consistent with the theory that increased imflammation is one of the main issues regarding heart disease

[Bigrig in reply to tunybgur]

My body produces excess Cholesterol apart from what I eat so I think GP being cautious- aim low then if it fluctuates between yearly blood tests there is a safety margin ? I get no side effects so am happy to follow his advice

[JennyRx in reply to tunybgur]

My target LDL is 1.7 or below due to high levels of lipoprotein (a). The target depends on individual circumstances. It’s also usually this low if you have FH

[ling in reply to Bigrig]

I believe there's truth in what your GP says. My mom's a case in point, though her cholesterol is nowhere as high.

She was on a low dose statin for years, when an inexperienced young GP suggested she reduced her statin dose by half as her levels were in range. When retested in 3 months, her levels shot up to 5 from around 3. My mother's never had a heart attack.

[tonylongman]

My cardiologist explained that the benefit of taking a higher level of cholesterol reduces as the dose increases, thus if you go from 40mg to 80mg you don't get twice the impact on reducing cholesterol. I believe that this is the reason that they don't prescribe 60mg because an increase of 20mg at this level is broadly ineffective.I started on 80mg post HA and CA but struggled with side effects, the statins combined with stannols and a better diet reduced cholesterol and I was able to convince cardiologist that reducing to 40mg was sensible, the side effects disappeared at 40mg. All very personal but this all worked for me.

My LDL is 2.07 with a ratio of 2.6 and I get the impression from my cardiologist that ideal figures don't really exist but that if you've knackered your heart and/or vascular system then the lower the LDL and the higher the HDL ratio the better!

I am fairly relaxed about my diet but avoid the obvious culprits (cheese, cream, puddings etc) using low fat alternatives where taste is ok (oat milk for example), seems to work for me and allows a decent lifestyle, eating out etc (when it was possible!)

[tunybgur in reply to tonylongman]

The law of diminishing returns....I found a graph for Atorvastatin showing the first 10mg gives a 40% reduction in LDL and 80mg gives 60%, unfortunately it won't cut and paste onto this page.

[Pollypuss]

There is a wonderful cardiologist from York on utube - all you have put in is : York cardiologist on cholesterol Dr Sanjay Gupta and he will give the best explanation on cholesterol I have seen . Before my bypass my cholesterol levels were always normal and my blood pressure also . I was fit . The cholesterol debate is like being in a jungle . I was told my heart problem was hereditary which to a certain extent it was. However I think it takes years for the plaque to build up . At 77 when I had my bypass there were years when I must have eaten sugar and fat etc in abundance , not knowing how bad they really were for me until modern medicine gave us the facts. After being in hospital my cholesterol level went up to a 7 because of the diet. After being home and back to eating my normal diet my last cholesterol test came back as “no further action” I cannot tolerate statins. Am back playing tennis and feel good

[Cruise1]

After being diagnosed with stable angina 3 months ago and prescribed statins (which I didn’t want to take) my wife modified our diet and today’s cholesterol result was 2.98 down from 6. Interestingly her level is 5.98 on exactly the same food and hasn’t changed over the years. Our exercise regime is unchanged as daily walks are essential after her recent hip replacement. I am not missing alcohol and my snacks have changed to fruit and nuts and have substituted a cholesterol drink for my original lunchtime dessert of yoghurt. Still have home made chips once a week with steak and all the trimmings , making sure the next day is a healthy vegetable bake with fish or chicken. We have reduced our meat intake by half by bulking up with lentils or beans. Thank goodness for our local Aldi which stocks all these at a reasonable price.