From the Guidelines
Coenzyme Q10 (CoQ10) is not recommended for routine use in patients treated with statins or for the treatment of statin-associated muscle symptoms (SAMS). According to the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol 1, the use of CoQ10 is not supported for alleviating statin-induced myalgia. The guideline recommends reassessing and rechallenging patients with statin-associated side effects to achieve maximal LDL-C lowering by modified dosing regimen, an alternate statin, or in combination with nonstatin therapy.
Key points to consider:
- Statin-associated muscle symptoms (SAMS) can be managed through modified dosing regimens, alternate statins, or nonstatin therapy 1
- CoQ10 plays a role in cellular energy production, but its use is not recommended for routine treatment of SAMS 1
- Patients experiencing muscle pain from statins should discuss alternative approaches with their doctor, such as switching statins, adjusting dosage, or trying different medication schedules 1
It is essential to prioritize the cardiovascular benefits of statin therapy and discuss any concerns or side effects with a healthcare provider to determine the best course of action. The guideline emphasizes the importance of continuing statin therapy in patients with increased diabetes mellitus risk or new-onset diabetes mellitus, while also promoting adherence to core principles of regular moderate-intensity physical activity, maintaining a healthy dietary pattern, and sustaining modest weight loss 1.
From the Research
Coenzyme Q10 and Statin-Induced Myalgia
- The relationship between Coenzyme Q10 (CoQ10) supplementation and statin-induced myalgia has been investigated in several studies 2, 3, 4, 5, 6.
- A 2014 study found that CoQ10 supplementation decreased statin-related mild-to-moderate muscle symptoms in 75% of patients, with significant reductions in Pain Severity Score (PSS) and Pain Interference Score (PIS) 2.
- In contrast, a 2015 study found that CoQ10 supplementation did not reduce muscle pain in patients with statin myalgia, with no significant differences in Brief Pain Inventory (BPI) pain severity and interference scores between the CoQ10 and placebo groups 3.
- A 2018 meta-analysis of 12 randomized controlled trials found that CoQ10 supplementation ameliorated statin-associated muscle symptoms, including muscle pain, weakness, cramp, and tiredness, but did not reduce plasma creatine kinase levels 4.
- Another study published in 2020 found that CoQ10 supplementation did not demonstrate any benefit in improving myalgia symptoms or improving adherence to statin therapy, with a meta-analysis of 7 studies showing no significant difference in weighted mean difference or risk ratio between CoQ10 and placebo groups 6.
- The evidence suggests that the effectiveness of CoQ10 supplementation in alleviating statin-induced myalgia is inconsistent, with some studies showing positive effects and others showing no benefit 2, 3, 4, 6.