Comment by DanBC | Hacker News Reader

Comment by DanBC | Hacker News Reader

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The NICE evidence, which your NHS GP should be following, is here: http://www.nice.org.uk/guidance/cg181/evidence

The NICE guidance, which your NHS GP should be following, is here: http://www.nice.org.uk/guidance/cg181

Your GP should have used more information than just your non-HDL results; they should have given you a standardised risk assessment call QRISK2.

http://www.nhs.uk/news/2014/02February/Pages/NICE-publishes-...

That risk assessment needs to know your age, sex, BMI, ethnicity, family history, your blood pressure, your blood cholesterol levels, and whether you have history of diabetes, high blood pressure, atrial fibrillation, or rheumatoid arthritis.

Your GP should have most of that, and if you think they don't it's probably a good idea to let them know.

You've said that you think the "eating saturated fat leads to high blood cholesterol" thing is wrong, and that the NHS seems to push this, but you also say that your GP didn't ask you what you eat, so it seems your GP isn't pushing that hypothesis. Your GP (from what you've said) didn't say "stop eating animal fat and take this medication", your GP said "take this medication".

Thank you for those links!

I should have been clearer: what bugged me about my interaction with the GP was that he didn't ask about anything to do with lifestyle/diet. When I went looking on my own - everything I seemed to find from the NHS/Heart UK suggested that cutting saturated fat was essential, leading to my conclusion that this is what the mainstream medical establishment still believes.

As somebody in the same situation (same age, otherwise healthy, high cholesterol, regular exercise) my read is that trying to influence ldl in a meaningful way through diet alone is essentially pointless.

You can knock off a few points, and you can raise HDL a bit, but the likelihood of a dramatic reduction is essentially nil. Going right for the statins kind of makes sense beyond a certain point.

That said, I opted out. My gp showed me the risk in the calculator mentioned above and the difference statins made was not large enough for me to justify it.

Could you define "dramatic reduction"?

Based on information I found using clinical resources which I have access to via my employer (I work at a University with a medical school and have access to their tools, although I am not a medical professional) I found this useful note:

> The United Kingdom Lipid Clinics Programme study of 2508 subjects found that, with diet alone, 60 percent of subjects had a mean reduction in body weight of 1.8 percent, which was associated with 5 to 7 percent reductions in serum total and LDL-C.

Key thing here: when I mentioned "otherwise healthy" above that includes "not overweight and exercises." Lifestyle interventions for people with hypercholesterolemia are most effective on people who are both sedentary and overweight (or obese) who have really poor diets. None of that applies to me.

The conclusion that I ultimately came to is that, if your diet isn't awful, your BMI is normal, and you exercise every now and then, there's no dietary change that's likely to benefit by more than 5%, not enough in my case to reach normal levels. This is my "gut" assessment based on personal research and I urge you to do your own research on this matter before making any decisions.

To further complicate all of this and bring things back to the topic of this article: statins seem to reduce the risk of CVD through some means other than simply lowering cholesterol levels. There's a school of thought that even people with normal cholesterol who have other risk factors for CVD should be on statins.

So really, the question of "should I take statins" may end up being less about cholesterol specifically, and more about overall risk of CVD. This is why in my own decision making process I opted not to pursue treatment (yet) since my overall health otherwise is sound.

If your triglyceride levels are too high you're eating too many carbs and not enough fish. If they're not, there is not as much evidence you really have a problem.

Having skimmed over, one indication that my GP isn't up to date is that the lipid test is no longer required to be a fasted test, whereas mine was. Interestingly the specialist lipid clinic has also asked for a fasting test.

I'm coming from the US, but the tests that are run by a doctor are often constrained by what the nearby laboratories offer. New, validated tests may be delayed until the relevant laboratories deem them to be cost-effective.

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