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) 1. The interaction between CoQ10 and statins is complex, and while some patients may experience muscle pain or weakness due to statin use, the evidence does not support the use of CoQ10 supplementation as a routine treatment for SAMS.
Key Points to Consider
- Statins work by blocking an enzyme involved in cholesterol production, which also produces CoQ10, essential for cellular energy production, particularly in muscle cells.
- Some people develop myalgia (muscle pain) as a side effect of statin use due to reduced CoQ10 levels.
- However, available evidence does not support the use of CoQ10 supplementation for routine use in patients treated with statins or for the treatment of SAMS 1.
- The clinical diagnosis of SAMS remains challenging, given that the majority of symptoms are subjective and definitive diagnostic criteria do not exist 1.
- Multiple potential mechanisms have been suggested to contribute to SAMS, including depletion of ubiquinone or coenzyme Q10, but the evidence does not support CoQ10 supplementation as a treatment 1.
Recommendations for Clinical Practice
- In patients with statin-associated side effects, it is recommended to reassess and rechallenge with a modified dosing regimen, an alternate statin, or in combination with nonstatin therapy to achieve maximal LDL-C lowering 1.
- In patients with severe statin-associated muscle symptoms or recurrent SAMS, nonstatin therapy should be considered when there is net clinical benefit 1.
- CoQ10 supplementation is not recommended as a routine treatment for SAMS, and patients should consult their healthcare provider before starting any supplement, especially if they are taking other medications.
From the Research
Interaction between Coenzyme Q10 (CoQ10) and Statins
The interaction between CoQ10 and statins has been studied in various research papers. The key findings are:
- Statins reduce circulating levels of CoQ10 2
- CoQ10 supplementation can raise the circulating levels of CoQ10, but data on the effect of CoQ10 supplementation on myopathic symptoms are scarce and contradictory 2
- Some studies suggest that CoQ10 supplementation can improve statin-associated myopathy, with a significant relationship between statin intake and decreased serum levels of CoQ10 3, 4
- CoQ10 supplementation has been shown to decrease statin-related mild-to-moderate muscle symptoms in some patients 5
Effects of CoQ10 Supplementation on Statin-Induced Myopathy
The effects of CoQ10 supplementation on statin-induced myopathy are:
- Improvement in statin-associated myopathy with CoQ10 supplementation, along with or without a reduced dosage of statins, without any notable side effects of CoQ10 3
- Decrease in statin-related muscle symptoms in 75% of patients with CoQ10 supplementation 5
- Reduction in the intensity of muscle pain and pain interference score with CoQ10 supplementation 5
Biochemical and Clinical Implications
The biochemical and clinical implications of the interaction between CoQ10 and statins are:
- Plasma levels of CoQ10 are lowered in the course of statin treatment, which could be related to the fact that statins lower plasma LDL levels, and CoQ10 is mainly transported by LDL 6
- Statin treatment affects muscle ubiquinone levels, although it is not yet clear to which extent this depends on some effect on mitochondrial biogenesis 6
- CoQ10 depletion during statin therapy might be associated with subclinical cardiomyopathy, and this situation is reversed upon CoQ10 treatment 6