Prednisone and cholesterol levels

My GP had me on a statin from the very beginning after prednisone was started. As far as I recall, my cholesterol numbers were never elevated before being on prednisone. I took a statin for at least 10 years while being treated with prednisone for PMR.

My cholesterol numbers were all over the place while I took the statin. In general, my numbers were borderline high most of time. Stopping the statin was never considered until I came off prednisone.

When I was off prednisone, my rheumatologist was worried that my CK level was too high in conjunction with my total cholesterol level being too low. My rheumatologist was concerned about statin induced myopathy.

"Statin-Associated Muscle Symptoms
SAMSs are by far the most prevalent and important adverse event, with up to 72% of all statin adverse events being muscle related. These can present as myalgia, myopathy, myositis with elevated CK (creatinine kinase)."

My rheumatologist stopped the statin but my GP restarted the statin when my cholesterol level got too high. This went back and forth a couple of times until my rhematologist deferred to my GP to manage of my cholesterol level. My CK level remained elevated but showed a slight improvement when the stain was stopped.

My GP eventually reduced my statin dose to next to nothing. The conclusion being that I was very sensitive to statins so I didn't need much.

My HbA1c was borderline while on prednisone. My GP didn't think it needed to be treated but considered starting Metformin once or twice. My GP just encouraged me to exercise more and watch what I eat.

An endocrinologist intervened after I got off prednisone when I was being evaluated for adrenal insufficiency caused by long term prednisone use. My endocrinologist checked my insulin level and it was very high. My endocrinologist said I should have been on Metformin the entire time I was taking prednisone because it helps to prevent insulin resistance. Overall, my endocrinologist was worried about prednisone induced metabolic syndrome. My endocrinologist stressed that diet and exercise will help the most.

"Clinical observations have linked excess glucocorticoid levels with profound metabolic disturbances of intermediate metabolism resulting in abdominal obesity, insulin resistance and dyslipidaemia."

The following link discusses this topic.
https://www.frontiersin.org/articles/10.3389/fendo.2020.00059/full
Maybe just read the discussion at the end of the link.

Yes, 3 different type of my Cholesterols went way up since I started taking Prednisone. Cholesterol went from 161 to a 255 LDL went from 71 to a 146 and non HDL went from 89 to a 158. Also my Glucose went from a 70 to a 124.