Friday, April 26, 2019

Retrospective #70: LDL Cholesterol and Statins (2012)

My doctor is hinting that I should start taking statins again. Knowing that I take a strong interest in the nitty-gritty of my own healthcare, and, like most people, have heard about the limited benefits and bad side effects of statins, I expect he knows he has to tread softly with me on the subject. He also knows, however, that I respect his knowledge – he is an internist and cardiologist – and he has worked well with me for over 20 years.
In August 2002, after failing to get me to lose weight on a balanced diet under his nutritionist’s supervision, my doctor suggested I try Very Low Carb (20g/d of carbs). It worked. In 9 months, I lost 60 pounds, and a few years later, after regaining 12, I started on Bernstein and lost 100 more in a year and then later another 22 (170 total).
Upon starting VLC, I immediately – in the first week – needed to greatly reduce and/or eliminate all three classes of oral diabetes medications I was taking. (I had upon beginning VLC been a Type 2 diabetic for 16 years.) Ten years later, after losing 170 pounds, my blood pressure had also gone down from 130/90 to 110/70 on the same meds.
In addition, my lipid health completely turned around. My HDL Cholesterol average more than doubled from 39 to 81, and my triglyceride average went from 137 to 49. (For details of my triglyceride and HDL story scroll down to Retrospectives #68 and #67, respectively.)
During this transformational period, how did my LDL Cholesterol fare? I’d say pretty well. Between 1992 and August 2002, when my doctor suggested I try eating VLC, my LDL had been tested 12 times. The average was 142mg/dl. For reference, from 130 to 159mg/dl LDL is considered “borderline high.” During the next 16 months, while I was eating VLC and losing weight, it was tested 16 more times, and the average was 125mg/dl.
The clinical guidelines consider LDL under 130 “near/above optimal.”  But, for patients who have either high blood pressure, Type 2 diabetes or are obese, the guidelines suggest <100, and if the patient presents with more than one of these conditions, the guidelines are <70mg/dl. And statin drugs lower LDL very effectively. How convenient.
So, since I was obese, hypertensive (on meds) and a Type2 diabetic, in December 2003 my doctor suggested I start on a statin: I started on 80mg of Lipitor, as I recall, and it definitely lowered my LDL Cholesterol. Over the next 5 years the average of 21 LDLs taken was 60mg/dl! I was lucky. I had no side effects that I recall. (However, maybe impaired cognition or memory loss were among them – LOL). Soon after starting them I switched to a generic, and over a period of time took less and less until my doctor finally took me off statins completely in December 2008.
Since that time my LDL has been tested 11 times for an average of 123mg/dl. This 123mg/dl LDL average is virtually the same as my first-year average on Very Low Carb (125mg/dl). It is also under the 130 “near/above optimal” LDL value, and despite significant weight regain, I still weigh today more than 100 pounds less than when I started VLC.
So, I find myself at a crossroads: Either I go back to strict adherence to my Very Low Carb diet, to lose weight, and improve my BP and A1c, or I start to take a low dose statin again (for the LDL only). My doctor wanted me to start with free samples that he had of a new statin, so I told him I would check it out. I did. It did well recently in a trial reported in PubMedCentral. I didn’t, however, notice a section on side effects or “adverse incidents.”
As the subject will arise at my next office visit, I think that my approach should be: So long as I am making improvements in my weight, blood pressure and A1c (glucose control), I will say “no” to starting on a statin again. If I can keep my LDL consistently between 100 and 130 without a statin, as I have for these last 4 years since I have been statin free, and I maintain low triglycerides and high HDLs by Very Low Carb alone, I’m sure I can keep the doctor off my back. He knows how important weight, BP, A1c and those two lipids are.
Besides, the medical literature, and the doctors who make the time to read it (instead of seeing attractive young saleswomen with free samples), know that the TG/HDL ratio (not TC/HDL ratio) …”is the strongest predictor of a heart attack” (See Retrospective #27.) Notice: Neither Total Cholesterol nor LDL cholesterol is mentioned.

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