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Coenzyme Q10 and statin myopathy

For some time there has been a view that the muscle pains associated with statins may be reversed by taking coenzyme Q10. The argument is that statins inhibit the biosynthesis of both cholesterol and ubiquinone (fancy name for coenzyme Q10), with resultant lowering of cholesterol and ubiquinone in blood, ubiquinone in muscle, and, as ubiquinone is involved in electron transport and ATP formation, fatigue and muscle pain.

Whether taking coenzyme Q10 helps overcome that muscle pain is another matter, but there are a few straws in the wind.

Systematic review

A systematic review [1] sought all the evidence linking coenzyme Q10 with statin-associated myopathy, searching for English language articles in a PubMed search to August 2006, together with examination of reference lists. While it examines animal and human studies, only the human studies are mentioned here.

Results

Circulating coenzyme Q10

The review found nine randomised trials and nine observational studies looking at effects of statins on circulating levels of coenzyme Q10. Most of these were of a few weeks duration, and involved fewer than 50 patients. The two studies with at least 100 patients, both randomised, observed reductions in circulating coenzyme Q10 of 22% and 27-38% in 120 and 1,049 people respectively at 12 weeks and one year.

Most of the reduction in circulating coenzyme Q10 is related to lower levels of LDL-cholesterol, and some studies suggest that absolute changes are less relevant than the coenzyme Q10/cholesterol ratio [2].

Muscle coenzyme Q10

Five studies looked at muscle levels, one finding and increase, one a decrease, and three no difference.

Mitochondrial function

There is no consistent message of impairment to muscle metabolism with statins, or any suggestion that coenzyme Q10 is related to any changes.

Clinical studies

There is a dearth of clinical studies of coenzyme Q10 supplementation in statin-associated myopathy. None was published in full at the time of the systematic review. Two subsequent reports of randomised trials are too small to be conclusive.

One [3] compared daily coenzyme Q10 100 mg with vitamin E at 400 IU daily in 32 patients with myopathic symptoms on statins. After 30 days overall pain severity decreased, and pain interfered less with activities of daily living, but most patients taking coenzyme Q10 still had some pain.

A second report [4] records a randomised trial that managed to recruit only three patients with statin-associated myopathy in 1.5 years, because patients stopped the statin, or were already taking coenzyme Q10. All three had low initial circulating coenzyme Q10 levels, and two had significant improvements in mobility and energy levels together with increased circulating levels on blind or open challenge.

Comment

There really is not much evidence that coenzyme Q10 is effective in combating fatigue and muscle pain with statins. For some patients it does make a difference, though. A number of randomised trials are ongoing, so perhaps this is a space worth watching. At least one more moderate sized trial is ongoing, completing by the end of 2007.

References:

  1. L Marcoff, PD Thompson. The role of coenzyme Q10 in statin-associated myopathy. Journal of the American College of Cardiology 2007 49: 2231-2237.
  2. AD Hershey et al. Coenzyme Q10 deficiency and response to supplementation in pediatric and adolescent migraine. Headache 2007 47: 73-80.
  3. G Caso et al. Effect of coenzyme Q10 on myopathic symptoms in patients treated with statins. American Journal of Cardiology 2007 99: 1409-1412.
  4. MM Reidenberg. Statins, lack of energy and ubiquinone. British Journal of Clinical Pharmacology 2005 59: 606-607.

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