[gigiwong]

I got my blood test report last week, and my doctor said my LDL level is slightly increased, from 2.6mmol/L (100mg/dL) to 2.9mmol/L (111mg/dL). He said though it's still within an acceptable range, it's no harm to make it a bit lower. So he has prescribed a low-dose Simvastatin (10mg) to me.

When I was first diagnosed with T1, my LDL level shot up to 6.6mmol/L (254mg/dL) coz of the mild DKA effect. At that time I was prescribed with Crestor (20mg) until I suggested to my doctor to stop it after a year. My LDL level was 2mmol/L (77mg/dL) and that's why now my doctor thinks that my cholesterol gradually increases without the drug.

I think I will take that Simvastatin for some time and see if it helps, but I don't want to have unnecessary drug on me, when my situation is not that bad. Should I suggest to stop the drug again once I got a stable low LDL level?

[BlueSky]

I won't ever take any drug that messes with my cholesterol levels. Your body knows how much cholesterol it needs for producing hormones, making cell membranes, maintaining your nervous system etc. And it tells your liver to make it. Taking a drug that interferes with this doesn't make sense.

My cholesterol is much higher than yours, but if it were me, I really wouldn't take the drug .

[REDLAN]

Bluesky's view is somewhat controversial....

however I don't think arguing about it is really very important.

Is Cholesterol and in particular LDL a risk factor for heart disease? Well according to the Framingham Heart study it is. Is it the elevated level that causes heart disease or is it another unknown factor that raises LDL AND causes heart disease? Not known for sure. The latest hypothesis is that the damage that leads to atherosclerosis is caused by oxidised LDL, which damages arterial walls, and leads to the changes that cause atherosclerosis. Is it the only factor? Naturally not, the simple truth is that heart disease is multifactoral - many things are responsible.

what you need to know is whether statins are a benefit to you, and this is where it gets controversial, and I think that statins are being over-prescribed.

In Secondary prevention (i.e. given to prevent you having a second heart attack) they have a clear clinical benefit. They improve outcomes. I would argue that the benefit is fairly small (Number Needed to Treat is around 50 i.e. you need to treat 50 patients to save 1 person), but they do work.

In primary prevention (i.e. before you have had a heart attack, but are at high risk for one) they show no overall mortality benefit. Statins still reduce your risk of dying from a heart attack, but your other risks appear to increase. It is not known what this is caused by (statin studies do not break down overall mortality causes, and the only one that did had an increased risk of accidental/violent death). And now we come to the issue of side effects - statins do have side effects, quite a lot of side effects and it is likely that these may be responsible for the lack of benefit on overall mortality. Some of these side effects can affect brain function - affecting muscle control, numbness/tingling, forgetfulness and so forth are commonly reported as side effects of statins. They can also cause muscle damage.

Nobody has studied young healthy type 1's in primary prevention to see whether aggressive treatment does improve outcomes. Aggressive treatment in diabetes has become however standard treatment. Will it make you healthier? If you are like the primary prevention arms (50+ and at high risk of heart attack) then the answer is no.