Total Cholesteral Under 80 for Diabetics

[Gabby123]

How many others have been told by their Doctor to keep their TOTAL cholesteral under 80? Mine was 97 and the Doctor wants it under 80.At first I thought he meant HDL or Ldl but no he wants the main number under.This seems low doesn't it?

[cheryl]

Yes it does, and seems to be unrealistic unless you take med's....

I personally give up on that one....I don't want to give any advice but I will say it seems a little out there....to me that is..

Cheryl

[JediSkipdogg]

That would not be possible unless you eat no fats. Your HDL needs to be at least 40, so under 80 would mean an LDL of under 40 and that is nearly impossible unless you are on a no fat diet.

In all the research I've ever found for diabetics it says that LDL should be under 100 and HDL over 40.

[Cyborg]

My endocrinologist says non-diabetics should have an HDL under 130 and diabetics should have an HDL under 100.

[JediSkipdogg]

My endocrinologist says non-diabetics should have an HDL under 130 and diabetics should have an HDL under 100.

You mean LDL right? I thought HDL was the good and LDL was the bad.

[Dawn]

No...I've never heard of that as a total. I attended a heart health talk and they said that for a diabetic the LDL should be under around 75 but you want to be able to increase the HDL (for men over 40 and for women over 50).

I'm jealous....your total is 97!!! I personally think that is fabulous!!!

[LoDeSp]

My doctor said the diabetic target for LDL was 70 and for non-diabetics it was 100. He also said that 70 was very difficult to attain without medication.

[shockme]

that doesn't sound right-not for the total cholesterol......i thought the total should be under 200? trish

[Jules49]

My HDL is aLways over 80. My LDL is under 70 but I do take Vytorin 10/10. That was to lower the LDL. My HDL would be wrong for Gabby's doctor. My endo has told me it is normal for a thin Type 1 to have a high HDL. I was not always as thin as I am now but the HDL has been high since I first heard about cholestrol.

[Alice]

My most excellent, former endo from Philadelphia recommended that the levels be lower than non-diabetics. This is to prevent damage to tissue which typically occurs even with good control. He said the interior walls of the blood vessels get "scratched", so to speak in diabetics much faster than non-diabetics. This attracts plaque and contributes to hardening of the arteries, clots, etc.

I've been on Zocor as a preventative since I was 28 years old. This is recommended by most endo's.

Since that time, they've also recommended taking a minimum dose of blood pressure meds (Lisinopril, for me) for prevention of kidney damage.

[Penny]

My last tests had Total Cholesterol....139 (says it should be under 200)
LDL.......................29 ( should be less than 100mg/dl)
HDL.......................52 (should be greater than or equal to 40mg/dl)
All good according to doctors, but my Triglycerides were 289 (should be less than 150 mg/dl). I was told my Triglycerides could be a hereditary thing, but I still have been trying to reduce it. This was in May of this year, I am not due to be tested until 2008. I take 10 mg of Simvastatin a day.

[Gabby123]

Total cholesteral for a non diabetic not on any statins or other cholesteral meds is 200 I am told. But for a diabetic with cholesteral problems he told me the new guidlines were a TOTAl cholesteral count 80 or under not your HDL or LDL count. I thought I heard under 100 also .

[Cyborg]

You mean LDL right? I thought HDL was the good and LDL was the bad.

Oops... Yes, you are correct. ;)

[BlueSky]

The liver creates cholesterol for a number of very good reasons, and without it life is not possible. The obsesion with reducing cholesterol because it is found in plaque, and the suggestion that "cholesterol can't be too low" low, is a bit like saying that, because petrol is inflammable, you really shouldn't be carrying it around with you in your car .... :o .

[BlueSky]

Total cholesteral for a non diabetic not on any statins or other cholesteral meds is 200 I am told. But for a diabetic with cholesteral problems he told me the new guidlines were a TOTAl cholesteral count 80 or under not your HDL or LDL count. I thought I heard under 100 also .
So-called Cholesterol therapeutic targets have been set by the NCEP (National Cholesterol Education Program) based on risk categories. This has been written up in the ATP3 guidelines, which doctors use for guidance in making clinical judgements.

There are three 10 year heart attack risk categories. If your risk is <10% (no risk factors), the LDL target is <200mg/dl. If your risk is 10%-20% (2 or more risk factors), the LDL target comes down to <130 mg/dl. Risk factors include smoking, atherogenic diet, obesity, inactivity etc. The top level of risk is people who have had a heart attack or have other " CHD risk equivalents". For them, the LDL target is <100 mg/dl. Diabetes is considered a "CHD risk equivalent". So, in terms of the ATP 3 guidelines, we should all strive for LDL < 100 mg/dl.

But it doesn't end there. The ATP 3 guidelines were reviewed in 2004, based on clinical trials that had been recently completed. And it was suggested that lowering the LDL target level for the top level of risk to 70 mg/dl is a "therapeutic option". These targets apply to LDL, not total cholesterol. And I don't know where your doctor gets a target of 80mg/dl from.

The problem with all this is that the LDL targets are now well below "normal". Average LDL in the US is 130 mg/dl. And studies show that maximum longevity corresponds to an LDL level of 80-160 mg/dl. The ATP 3 guidelines have been pitched at a lower level to encourage intesive treatment of at-risk patients. But one has to wonder how healthy sustained abnormally low cholesterol levels can be. The rising incidence of nasty statin complications suggests that this might not be such a good idea.

The doctors are always giving me a hard time over this. I am a diabetic, I am over the age of 45, and I am on what is considered to be an "atherogenic diet". But as long as my LDL is in that 80-160 range and there is no evidence of heart disease, I am happy and won't take a statin. Especially since my triglycerides are low (101 mg/dl) and my HDL is high (82 mg/dl).

[georgepds]

Medscape has article on this issue which indicateds benefits at even lower LDL levels.

The doctor must have mispoke. If optimal HDL is >60 and LDL ~40 there is no way optimum total cholesterol is <100

www . medscape . com/viewarticle/551989_4

"What about the safety of achieving ultra-low LDL levels? An analysis by Wiviott and colleagues[17] looked carefully at the results of liver function enzyme tests, creatinine kinase elevations, and other side effects among patients who achieved very low LDL levels (ie, < 40 mg/dL or in the range 40 to 60 mg/dL) and found no differences in any of these adverse safety events.[17] Intriguingly, as the achieved LDL reached this new ultra-low range, the rate of death or cardiovascular events continued to drop lower and lower, suggesting that a target LDL of < 70 mg/dL might not be the lowest target to achieve in order to get maximum benefit. However, the important take-home message from this safety analysis is that if a patient is on a high-dose statin, and his or her LDL comes back at 42 mg/dL, there is no need to reduce the dose."

[BlueSky]

... Intriguingly, as the achieved LDL reached this new ultra-low range, the rate of death or cardiovascular events continued to drop lower and lower, suggesting that a target LDL of < 70 mg/dL might not be the lowest target to achieve in order to get maximum benefit. However, the important take-home message from this safety analysis is that if a patient is on a high-dose statin, and his or her LDL comes back at 42 mg/dL, there is no need to reduce the dose."
This is just playing with numbers. They analyse stats on people who have died of heart attacks and then relate this to their cholesterol levels. The lower below average cholesterol you go, of course the fewer people die from heart attacks, simply because they die from something else. If you take this to the extreme, you will find that nobody with zero cholesterol dies of heart disease. It is a bit like saying that you can eliminate your risk of diabetic complications completely if you reduce your HBA1c to, say 3%. This statement is both ridiculous and technically correct at the same time.

Optimal levels of LDL for longevity are 80-160 mg/dl. So reducing your LDL below 80 increases your risk of dying young. In fact the stats show that, in terms of longevity, women don't benefit from reducing cholesterol at all, regardless of their their age and whether or not they have had a heart attack.

On the liver enzyme issue, levels only rise when rhabdomyolysis sets in. But failure of this to happen doesn't mean that the body is happily functioning with adequate cholesterol. Most statin users who get muscle pain, low libido, peripheral neuropathy, memory loss etc, don't have elevated liver enzymes anyway. It can also take many years for adverse effects of reducing cholesterol to manifest, and these studies are done over relatively short periods of time. Statins were only invented in 1987 and some long term users are only now beginning experience adverse effects.

Cholesterol is used to make sex hormones, create new cells and maintain the nervous system, among numerous other good things. It seems totally inconceivable that apparently intelligent researchers and doctors can promote something so obviously fallacious. With all other blood tests, a problem is identified when the result is outside the normal range. But with cholesterol, we are told that our LDL should be 46% below normal. There is some seriously faulty logic going on there. Bearing in mind that normal LDL is about 130mg/dl, I can't see how LDL of 42mg/dl can possibly be good for you.

[georgepds]

This is just playing with numbers. ...There is some seriously faulty logic going on there. Bearing in mind that normal LDL is about 130mg/dl, I can't see how LDL of 42mg/dl can possibly be good for you.

Maybe

A least some research indicates the benefit is from the statins, LDL level be ****ed. The reference below suggests, take the statin, but don't try to go lower still by taking other meds.

How low should we go? Researchers find no clear evidence for ultra-low cholesterol targets (http://www.eurekalert.org/pub_releases/2006-10/uomh-hls100206.php)

"n fact, he says, the evidence strongly suggests that a high dose of a statin produces the same benefit in a person who has an LDL level of 100 mg/dL as it does in a person with an LDL level of 200 mg/dL if the two have the same overall heart attack risk."

[tanyatype1]

How many others have been told by their Doctor to keep their TOTAL cholesteral under 80? Mine was 97 and the Doctor wants it under 80.At first I thought he meant HDL or Ldl but no he wants the main number under.This seems low doesn't it?

Reading this thread was really interesting. I went and dug out last years bloodwork and it says that my total cholesterol was 4 mmol/l. So I figure that to be 72 mg/dl right? I'm so happy because I guess that's a nice low number! I'm not on any cholesterol lowering meds either.:thumbsup:

[georgepds]

Reading this thread was really interesting. I went and dug out last years bloodwork and it says that my total cholesterol was 4 mmol/l. So I figure that to be 72 mg/dl right? I'm so happy because I guess that's a nice low number! ...

Thwack... (sound of the other shoe dropping)

Not quite, Michael Eades, author of protein power, has a diagram called the mortality bucket . On the horizontal axis is total cholesterol, on the vertical mortality (all causes). IIRC, the lowest mortality rate is ~160 , drop too low or go to high and mortality increases.

I'm not really sure how to interpret this, most people distinguish between the types of cholesterol and their ratios as indicators of cardiac risk.

--G ( the party pooper)

[georgepds]

That and the conversion between mmol/l and mg/dl is different for blood lipids than for blood glucose. The reason is mmol/l measures number of particles per unit volume and mg/dl measures weight of particles per unit volume. to convert from one to the other you need to know the weight of a particle, and the fats weigh differently

[tanyatype1]

Okayyyyyyy.(?) Soooooo, that meeeeeaaaaans........:)LOL! I'm not as healthy as I thought I was this morning!:dontknow:

[BlueSky]

...

How low should we go? Researchers find no clear evidence for ultra-low cholesterol targets (http://www.eurekalert.org/pub_releases/2006-10/uomh-hls100206.php)

"n fact, he says, the evidence strongly suggests that a high dose of a statin produces the same benefit in a person who has an LDL level of 100 mg/dL as it does in a person with an LDL level of 200 mg/dL if the two have the same overall heart attack risk."
Interesting article. This bit says it all (my bolding)

"Our review suggests that we in the medical community have misunderstood the scientific evidence on whether very low LDL is important, or whether adequate doses of statins are what is really important," says lead author Rodney Hayward, M.D., director of the VA Center for Health Services Research and Development and professor of internal medicine at the U-M Medical School. "Current practice guidelines and recommendations often focus on getting LDL as low as possible, but the literature to date doesn't demonstrate that low LDL is what is truly important – but it does show that statins save lives in high cardiac risk patients regardless of a person's LDL level."

In fact, Hayward and his colleagues say, it may be that the other effects of statin drugs help reduce the risk of heart disease and heart attacks as much or more than the drugs' LDL-lowering power does. Statins inhibit inflammation and clotting, as well as reduce cholesterol, attributes that can be important for preventing heart attacks. ...
If reducing cholesterol treats a symptom of heart disease and not the cause, it could be that the medical profession has become obsessed with a totally inappropriate treatment target. The focus really needs to be on preventing the inflammation that attracts cholesterol in the first place. Stuff like burned foods, damaged oils, pollution, high stress hormone and insulin levels etc. The problem is that there is no pill that can be taken for these things. Cholesterol, on the other hand, can be measured and the number can be managed with statins. So that is what the money is most likely to continue chasing.

[Alice]

There is a (fairly) new test that should be done now...I had my first cardiac test this year and it was ordered by my office. Sorry, I can't remember the name of the test but it does measure the size of the particles which other tests do not do...this is the warning sign of problems.

Mine came out excellent...they said it was very good for one with diabetes for 41 years. So, I was thankful. The test take about two weeks for the results. Seems like they come from California, but I'm not sure. I just moved and my report is buried somewhere in my office.

[georgepds]

There is a (fairly) new test that should be done now....

perhaps VLDL (very low density lipo protein)?

[BlueSky]

There is a (fairly) new test that should be done now...I had my first cardiac test this year and it was ordered by my office. Sorry, I can't remember the name of the test but it does measure the size of the particles which other tests do not do...this is the warning sign of problems.....
There are a number of tests that do lipid subfraction analysis - was it VAP, Lipoprint or Lipoprofile? The idea is that small LDL particles are more hazardous as they can fit through holes in the porous blood vessel lining and be used to make plaque. Here is an article about it : Low-Density Cholesterol Subfractions: Not all LDL-C Particles are Created Equal - Diagnostics Technology Spotlight - Medcompare (http://www.medcompare.com/spotlight.asp?spotlightid=201)

[Alice]

It might have been the Nuclear Magnetic Resonance test. (bigger particles are better)...here's a Mayo summary of numbers which I find helpful. Read all the way to the bottom for the brief info on NMR. If I find the actual report from my cardiologist, I'll post later. I want to say it was a "Stanford test..." but that doesn't sound right.

Cholesterol test: Sorting out the lipids - MayoClinic.com (http://www.mayoclinic.com/health/cholesterol-test/CL00033)

Sorry, I'm a little link challenged on this forum, but I'll learn someday.

[Wildbill]

Bearing in mind that normal LDL is about 130mg/dl, I can't see how LDL of 42mg/dl can possibly be good for you.

One of my cardiologists told me that rat studies showed that it is impossible to clog coronary arteries with a total cholesterol <100. My internist agreed, and then he said that it was a trade off. Very low cholesterol and a liver transplant or cholesterol a little higher and reasonable chances at avoiding serious arteriosclerosis.