(C) Daily Kos This story was originally published by Daily Kos and is unaltered. . . . . . . . . . . On Cholesterol, Statins, and PSA tests [1] ['This Content Is Not Subject To Review Daily Kos Staff Prior To Publication.', 'Backgroundurl Avatar_Large', 'Nickname', 'Joined', 'Created_At', 'Story Count', 'N_Stories', 'Comment Count', 'N_Comments', 'Popular Tags'] Date: 2023-03-07 My Cholesterol Lipid Blood Labs I had lunch with some friends on Sunday. The conversation turned to cholesterol. My friend said he remembered the days when a cholesterol of 250 was considered acceptable, and now they will put you on a statin at that level. He believed the guidelines were reduced to 200 because “big pharma wanted it there.” I’ve never had an opinion on that topic. I know statin drugs were huge money makers for big pharma in the 1990’s and early 2000’s, but they are all available in generics now. I do know that cholesterol guidelines have changed over the decades. In 1970, it seems the cut-off was 300. I remember when the first statin was approved in 1987 it seemed to change to 200. In recent years, these guidelines have been changed so that anyone age 40 to 75 who has a 10 year risk of a heart attack or stroke of 7.5% or more should be placed on a statin — link — even if their cholesterol isn’t elevated. It seems all risk factors are considered including diabetes, blood pressure, smoking, etc. The online test I took calculated my 10 year risk of a heart attack or stroke at 9.4% is above the 7.5% threshold. My current lipid profile didn’t seem to help. Also, I take blood pressure pills and while my blood pressure is controlled that worked against me. I input my best lipid profile of the past 10 years with a total cholesterol of 168 and an LDL of 109 and I still had a 7.6% 10 year risk. According to this, I should be prescribed a statin even with a total cholesterol of 168? That doesn’t make sense to me. Why wouldn’t we just treat the risk factors people have? In my case, that would be treating my high blood pressure and eating a healthy diet to lower my A1C? Heart disease doesn’t run in my family. I’ve never had a blood relative have coronary artery disease. However, T2 diabetes runs on both sides of my family. High blood pressure doesn’t run in my family. I developed hypertension in my teen years. I was put on blood pressure medicine at age 24. I am not sure why I’m the only blood relative who has high blood pressure. I think it’s because I was born with my right kidney being half the size of a normal kidney. When I was 24 years old, the doctor ordered a renal angiogram to rule out renal artery stenosis — I didn’t have it the arteries and blood flow into that kidney were all normal. My doctor didn’t bring up statins. But I don’t think statin therapy would be beneficial to me. I’ve read statins double your risk of T2 diabetes (the CNN article linked above implies that risk is overstated). Heart disease doesn’t run in my family, but T2D does. I’ve had prediabetes for many years, and I fell off the wagon with my eating habits after my dad died and my A1C has increased just to the T2D range. Given my health history and family history, I wouldn’t think statin therapy makes sense. I found a couple excellent diaries on this topic here and here. I wrote a diary about my recent physical exam here. My doctor seemed far more concerned about my A1C of 6.7% than she was about my lipid profile (see above), but she wants to recheck both labs in May. She had no problem letting me try getting my A1C down by diet changes first, but if I come back with an A1C of 6.7% I suspect I would be prescribed Metformin. I have been eating a lot healthier, but my primary focus has been on eating fewer and healthier carbohydrates rather than on cholesterol. That means more fruits and vegetables and very few starchy carbohydrates. My blood sugar readings are pretty decent. It’s usually in the upper 90’s to low 100’s in the morning. I seem to have this "dawn effect." I’ve focused more on blood sugar since I’m not as knowledgeable about what raises cholesterol and one dietary change is hard enough. I’ve been tracking what I eat on My Fitness Pal. I’ve been eating around 75-100 carbs a day. That’s not a lot when you consider that a banana is 27 carbs, an orange is 22 carbs, and so on. But I’ve read on some “keto diets” people consume as few as 30 carbs a day. I wonder if someday we won’t find out there’s a health drawback to that, such as high cholesterol or something else? As far as snacking goes, I no longer snack on Frito’s or ice cream. I’ve been eating frozen blueberries and I eat those frozen (they also don’t spoil). I also keep cashews and almonds on hand. The only other topic from the physical exam was whether to have a PSA test to screen for prostate cancer. I had one in November 2014, and it was 0.5 which was well within the normal range of 0-4.0. After that, the doctor didn’t bring it up again for a couple years. When she did, she would say it can be a little unreliable and she didn’t push me so I declined. But this year she did push it more because it has been so long. Why did I decline? The test isn’t reliable. The research says that 70% to 80% of men with an elevated PSA do not have prostate cancer. I have an anxiety disorder and my anxiety level would go sky high if I was referred to a urologist due to an elevated PSA. She did a DRE and found nothing concerning not enlarged and no nodules. Also, prostate cancer and prostate problems do not run in my family. I’m just wondering what other people’s doctors tell them with regard to the PSA test? Do you have this done? I could change my mind and have the PSA test done when she rechecks my other labs. [END] --- [1] Url: https://www.dailykos.com/stories/2023/3/7/2156700/-On-Cholesterol-Statins-and-PSA-tests Published and (C) by Daily Kos Content appears here under this condition or license: Site content may be used for any purpose without permission unless otherwise specified. via Magical.Fish Gopher News Feeds: gopher://magical.fish/1/feeds/news/dailykos/