Statins

Statins are medications that reduce cholesterol synthesis in the liver by inhibiting the enzyme HMG-CoA reductase. They are used to lower LDL levels and reduce cardiovascular risk in individuals for whom such therapy is indicated.

What it is

Statins include atorvastatin, rosuvastatin, simvastatin, pravastatin, fluvastatin, pitavastatin, and lovastatin. They decrease cholesterol production in the liver and enhance the uptake of LDL from the blood.

The main goal of therapy is not just to change the numbers in the analysis but to reduce the likelihood of heart attack, stroke, and other complications of atherosclerosis in individuals at increased risk.

How it relates to metabolism and health

Statins primarily affect LDL and apolipoprotein B, which are associated with the number of atherogenic particles in the blood. They may also moderately reduce inflammatory markers related to the vascular wall:

• indications depend on cardiovascular risk, age, blood pressure, smoking, diabetes, family history, and existing vascular events;
• in secondary prevention after a heart attack, stroke, or established atherosclerosis, the benefits are usually greater;
• in primary prevention, the decision depends on individual risk and additional markers;
• during therapy, it is important to monitor tolerability and not discontinue the medication without consulting a doctor.

Statins are important when discussing high LDL, high ApoB, familial hypercholesterolemia, coronary artery calcium, history of heart attack or stroke, diabetes, and overall cardiovascular risk.

What may affect tolerability

Side effects do not occur in everyone. Possible side effects include muscle pain, elevated liver enzymes, changes in glucose metabolism in predisposed individuals, and drug interactions. Tolerability is influenced by dosage, specific medication, liver disease, hypothyroidism, vitamin D deficiency, intense exercise, and combinations with other medications.

Practical significance for keto and LCHF

In keto and LCHF, it is important to look not only at total cholesterol but also at triglycerides, HDL, LDL, ApoB, non-HDL, lipoprotein(a), glucose, insulin resistance, blood pressure, and family history.

If LDL sharply increases on a very high-fat version of keto, the diet composition, amount of saturated fats, body weight, thyroid function, and overall risk are sometimes assessed first, and only then a decision about therapy is made.