Cholesterol high with large fluffy pieces. Would you take a statin?!

[ToStatinOrNotToStatin]

My LDL cholesterol came back high. HDL good, triglycerides good. According to some doctors the composition of the LDL is important too so I did in depth testing.

It turns out that my LDL is composed of large, fluffy pieces, which is a good sign. However, there are a really high number of them! So now I don't know what to do about taking a statin?

My ratios were all good because of the decent other numbers the proportions worked out. But as this deep dive blood test shows, there is just a high amount of LDL pieces in there

Would you take a statin in my shoes?

I started on stations years ago. I've never had any side effects, so yes I would.

Can you link to the deep dive test you had?
My understanding was that the ratios are more important than numbers... I don't know about lots of large fluffy pieces test though.

I'd be taking advice from my gp first rather than asking on here tbh. Having said that I have them because I'm diabetic and yes, they work for me.

I'd be taking advice from my gp first rather than asking on here tbh.

The GP has a pretty basic understanding of cholesterol tbh. At my GP you can't even access the in depth cholesterol testing, so the GP is not interpreting this data regularly...

Don't underestimate the knowledge base of patients who are dealing with their conditions - that's why I asked here, in case anyone has had a similar situation.

Thank you, I'm tempted to try a low dose.

I'll see if I can find the numbers from the test.

The thinking is generally that the large fluffy pieces are not the type that embed in the arterial wall and do damage. Which is fine in theory, but I have so bloody many of them!

Yes, I'd start the statin, to prevent problems in the future

Hi medic here,
It would be really helpful to know your levels. However, the LDL is known as the 'bad cholesterol' so the lower the number better ideally under 4. What is also really important is the ratios as HDL - 'the good cholesterol' takes LDL to the liver to be broken down. So if you have a good ratio (normally 6 or under) it should mean that you have enough HDL to remove the LDL.
I haven't heard much about large fluffy pieces.
Overall, I would follow whatever your GP says and remember that statins are there to help and with a few lifestyle changes you can reduce the dose in the future.

Where did you get your cholesterol deep dive testing done? Did they not provide any further info?

I'm thinking about this with my drs at the moment. It's a big decision to start a life long drug. I'm going to wait for the outcome of a CT scan to see if that changes my stats any, but as it stands currently I'm v low risk so I'm not likely to start statins but I've been given the option. GP recommend benecol saying there was an evidence basis to that, and she also said there's a lot of new thinking about alternatives to statins. Its a 6 wk wait for my CT scan, so I'm going to take benecol in the meantime (my diet is otherwise v cholesterol friendly) and then do a blood test at the CT scan. I'll be curious to see what info pops up on your thread, i agree with you that there's some useful info amongst the patient population.

According to some doctors the composition of the LDL is important too so I did in depth testing.

GP here. The in-depth testing was likely designed to lighten your wallet and nothing else................

Try to include the triglyceride numbers when you post.
Do as you please, statins are super low risk medication.

But am still suspecting you basically lower risk for CVD harms.

Is that a heart CT scan?

I have done a cardiac calcium score, which uses a CT scanner. Results showed no calcification and definitely factoring this into my statin decision.

Interesting perspective.

I'm not in UK so my insurance covered it after the cardiologist offered the testing to help inform my decision.

I didn't pay anything extra.

ah, you're in the USA presumably, where over-investigation is rife!

It is, for other reasons, before my cholesterol jumped up quite quickly, i was already starting down this road to see if my heart is ok as I've been having chest pain. In the UK they have a scoring system for predicting risk of heart issues, called the Q something, and I'm v low even with the significantly raised cholesterol.

What's your Q risk?

*ah, you're in the USA presumably, where over-investigation is rife!8

I am 38 and wanted more information before committing long term to a drug so asked my doctor for more tests.

My LDL has been high for years and no NHS doctor has said I need to take them.

On the basis of the cardiac calcium score my cardiologist is happy if I wait a couple of years before starting statins, do more blood tests once I'm 40 and re assess.

Equally he's said he'd be happy to prescribe them now for preventative measures as so low risk as a drug.

Both are valid ways to approach it, my gut feeling is 38 is on the young side to start statins, but at the same time I'm tempted to start a low dose as mentioned upthread.

It's simply not as black and white as you're making out. I just want to make the best choice for myself rather than just doing whatever the NHS would do or whatever my American doctor would do automatically.

Have they done anything as basic and evidence-based as a QRisk3 score?
https://qrisk.org/
And have they discussed the numbers needed to treat? For primary prevention with a statin you have to treat 200 - 300 people per year to prevent one vascular event. Probably a higher number at your age.

Thanks to all of you commenting about the Q Risk. I haven't done that recently but pretty sure my doctor in London did use that and it was all totally ok a few years ago.

So I should have a look at that now.

The measurements are different hence not posted the numbers yet - I used a conversion chart but it seems suspiciously low in UK number so think that's wrong.

If you're 38, normal BMI, non smoker, no relevant FH/diabetic etc then a total/HDL cholesterol of 7 = 0.9% Qrisk i.e. less than one vascular event in 100 people over ten years. Bringing the cholesterol down to 4 reduces the QRisk to 0.5% i.e. you'd need to treat 250 people for 10 years to prevent one event.

I'm sure your cardiologist is thrilled that you've had the scan/an appointment - they have to pay their kids school fees somehow - but NHS GPs are not in fact unknowledgeable about statins, they know enough to realise that you have been hugely over-investigated and now over-treatment is being suggested. In fact it's arguable that the tiny increase in lifetime cancer risk from the CT scan might be more than the benefits that you would get from statins at the moment.......

@mycoffeecup

I have type 1 diabetes since I was a child. Hba1c is 5 but decades of diabetes are a risk factor. My best friend from childhood, with type 1 diabetes also, has had a heart attack in her thirties.

I see a cardiologist because of autonomic neuropathy that is low level for now, thank goodness and I hope it stays that way. It causes POTS like symptoms.

So no, I am not being "over investigated".

But thank you for your patronising, sneery attitude and for throwing in that little nugget about exposure to CT scans adding to my cancer risk - and yes, I did know that and consider it before my cardiac calcium scoring.

Unfortunately I have to say you are quite representative of a lot of NHS gps in general. You assume the patient is thick and gullible, incapable of reading academic research.

Also, you are fairly ill-informed if you honestly believe that reputable, highly sought after US specialists view their patients as cash cows and clap their hands with glee as they send us off for batches of tests. It just doesn't work like that when you have access to the networks of doctors that I do in my city.

Conversely my old NHS gps flatly refused to investigate what turned out to be two serious chronic health issues I now have managed/ have a plan for.

I have never met a gp (anywhere) with a comprehensive working knowledge of type 1 diabetes. So why should I assume they have a comprehensive and up to date knowledge of statins?

There are some great NHS gps, obviously.

The NHS is brilliant at some things. Women's healthcare and chronic health conditions are not things they excel at imo.

Have you tried reducing your cholesterol through lifestyle changes first?

My cholesterol is slightly high. my GP recommended lifestyle changes, and they'll retest and see if it's reduced.

I had a heart attack in 2019. Previous numbers similar to yours, I’m not diabetic.

Statins not only reduce your levels, they stabilise any plaques you have. It’s bits chipping off that start the chain of events for a heart attack.

My cardiologist (writes books on heart stuff for Oxford/Cambridge) has never mentioned fluffy, non fluffy or in the middle fluffy cholesterol. He most certainly doesn’t talk down to me and answers anything I ask. Such as how Lisinopril protects the left ventricle.

Never had side effects and cannot see the problem taking a drug if it is safe and stops bad stuff happening. ‘On medication for life’ - and?!

I hope you are recovering well from your heart attack, that must have been scary as hell. Can I ask, what age group are you in?

Medication for life - not a problem in and of itself, I am obviously on insulin and will be forever as a type 1 diabetic. I'm also on thyroid medication, again forever.

I'm weary of having so many medical issues and so many parts of my daily medical regimen, I suppose that's why really. I have been chronically ill for a long time, and there are a lot of moving parts already so I suppose a part of me would hope to avoid more ongoing drugs.

But like I say, I'm tempted by the low dose for the protective benefit.