Cholesterol and Statins

Statins are among the most widely prescribed medications for managing cholesterol. However, from a functional health perspective, it is essential to understand how these medications influence your overall wellness, energy levels, and the natural biological shifts that occur with age.

Key Facts About Statins

Statins work by inhibiting an enzyme called HMG-CoA reductase to lower cholesterol production. Because this same pathway produces geranylgeraniol (GG) and Coenzyme Q10 (CoQ10), statins can inadvertently lower CoQ10 levels in the body amongst other substances including Heme A, vitamin K2, and certain cellular proteins.1

CoQ10 is a vital nutrient located in your mitochondria—the "power plants" of your cells. When CoQ10 levels drop, mitochondrial function can worsen, leading to:

• Reduced Energy Production: Mitochondria generate the energy (ATP) your body needs to function.

• Oxidative Stress: Lower CoQ10 reduces your body’s natural antioxidant defenses.

Common Adverse Effects

While some patients tolerate statins, many experience side effects that impact physical activity and quality of life:

• Muscle Pain and Myopathy: This can manifest as muscle soreness, weakness, or cramping and affects nearly ¼ of patients.

• Fatigue: This is often linked to reduced mitochondrial energy output.

• Cognitive Shifts: Some individuals experience "mental fuzziness" or memory loss. It remains less widely known that the brain contains about 20-25 percent of whole body cholesterol.3

• Hormone Disruption: Cholesterol is required to produce essential hormones (e.g., estrogen, progesterone, testosterone, and cortisol). If cholesterol levels are aggressively lowered, the body may lack the raw materials necessary to synthesize these hormones effectively.

The "Cholesterol Paradox" in Post-Menopausal Wellness

For women in the post-menopausal stage of life, the conversation around cholesterol is evolving. While standard guidelines encourage keeping total cholesterol below 200 mg/dL, research suggests that higher levels may serve a protective biological role as we age.

• Reduced Mortality Risk: A sex-stratified cohort study found that in older adults, particularly women, total cholesterol levels above 200 mg/dL were associated with a lower mortality risk compared to lower levels.6

• A Marker of Resilience: In advanced age, lower cholesterol can at times be a marker of vulnerability. Conversely, higher levels are often linked to better cognitive function and a reduced risk of frailty.5

• Hormonal Health: As cholesterol is a precursor to essential hormones, after menopause, a natural rise in cholesterol may be the body’s way of maintaining neuronal integrity and hormonal balance.2

  
  

The Benefits of High Cholesterol

Emerging literature suggests high cholesterol alone does not cause cardiovascular disease. Instead, researchers point to various sources of vascular injury, including: mechanical stress, exposure to tobacco fumes, oxidized cholesterol, homocysteine, metabolic consequences of diabetes, deficiencies of vitamins A and D, consumption of trans fatty acids, and microorganisms. Furthermore, evidence indicates cholesterol may provide a protective effect against infections.

• Cholesterol and Mortality: This protective association is supported by clinical data. A UCLA study of over 200 patients by Dr. Donna Vredevoe identified higher mortality rates in individuals with the lowest lipid values (including total cholesterol, LDL-c, HDL-c, and triglycerides).4 Similarly, Professor Gregg C. Fonorow and his team at the UCLA Department of Medicine evaluated over 1,000 severe heart failure patients over five years. They discovered that the majority of patients with low cholesterol levels (below 129 mg/dL) had died, compared to only half as many among those with higher levels (greater than 233 mg/dL).

• LDL and Immunity: Laboratory evidence has identified that LDL may not only bind to and inactivate dangerous bacterial toxins but it also seems to have immune-supporting properties. A study at the University of Pittsburgh demonstrated that the total count of white blood cells were notably lower in men with LDL-c below 160 mg/dl than in those with LDL-c above 160 mg/dl.

  
  

Patient Recommendations

• CoQ10 Supplementation: A 2024 systematic review published in Cureus found that CoQ10 supplementation significantly ameliorates statin-induced musculoskeletal symptoms, including muscle pain, weakness, and cramp.1

• Contextual Labs: View your lipid panel through the lens of your specific life stage. For post-menopausal women, a total cholesterol level over 200 mg/dL may be a sign of biological resilience rather than a primary risk factor.

• Consult Your Provider: Always discuss symptoms like fatigue or muscle aching with your doctor. Never stop or change your medication dosage without consulting your prescribing physician.

  
  

Older women exercising outside

References

1. Ahmad K, Ali S, Baig M, et al. Effectiveness of Coenzyme Q10 supplementation in statin-induced myopathy: a systematic review. Cureus. 2024 Aug;16(8):e67301.

2. Arnautovic J. Cholesterol levels increase after menopause. Henry Ford Health. 2026 Feb 12 [cited 2026 May 6]. Available from: https://www.henryford.com/blog/2026/02/cholesterol-menopause

3. Jin U, Park SJ, Park SM. Cholesterol Metabolism in the Brain and Its Association with Parkinson's Disease. Exp Neurobiol. 2019 Oct 31;28(5):554-567. doi: 10.5607/en.2019.28.5.554. PMID: 31698548; PMCID: PMC6844833.

4. Ravnvskov U. The Cholesterol Myths: Exposing the Fallacy that Saturated Fat and Cholesterol Cause Heart Disease. NewTrends Publishing; 2000.

5. Schupf N, Costa R, Luchsinger J, Tang MX, Lee JH, Mayeux R. Relationship between plasma lipids and all-cause mortality in nondemented elderly. J Am Geriatr Soc. 2005 Feb;53(2):219-26.

6. Yi SW, Yi JJ, Ohrr H. Total cholesterol and mortality in older adults: a sex-stratified cohort study. J Pers Med. 2022 Jan;12(1):100.