From the Guidelines
Coenzyme Q10 is not recommended for routine use in patients treated with statins or for the treatment of statin-associated muscle symptoms (SAMS) 1. This recommendation is based on the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol, which emphasizes the importance of continuing statin therapy in patients with increased diabetes mellitus risk or new-onset diabetes mellitus, while also considering the potential side effects of statin therapy.
However, some studies suggest that CoQ10 supplementation may be beneficial in reducing blood pressure in patients with cardiometabolic disorders, particularly those with diabetes or dyslipidemia 1. The optimal intake of CoQ10 for blood pressure regulation is estimated to be around 100-200 mg/d, with a U-shaped dose-response relation observed between CoQ10 supplementation and systolic blood pressure level 1. It is essential to note that the quality of evidence for CoQ10 supplementation is rated as moderate for systolic blood pressure, low for diastolic blood pressure, and very low for circulating CoQ10 levels according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach 1.
In clinical practice, the decision to recommend CoQ10 supplementation should be made on a case-by-case basis, taking into account the individual patient's risk factors, medical history, and potential benefits and harms of supplementation. Key considerations include:
- The patient's cardiovascular risk profile and potential benefits of CoQ10 supplementation on blood pressure reduction
- The presence of statin-associated muscle symptoms or other potential side effects of statin therapy
- The patient's overall health status and potential interactions with other medications or supplements
- The importance of informing the patient's doctor before starting any supplement, including CoQ10.
Ultimately, the most recent and highest-quality study 1 suggests that CoQ10 supplementation may be beneficial in reducing blood pressure in patients with cardiometabolic disorders, but the evidence is not strong enough to support routine use in patients treated with statins or for the treatment of SAMS.
From the Research
Statins and CoQ10 Relationship
- Statins have been shown to decrease plasma levels of CoQ10, with studies suggesting a significant relationship between statin intake and decreased serum levels of CoQ10 2.
- The reduction in CoQ10 levels has been proposed as a mechanism for statin-associated muscle symptoms (SAMS), such as muscle pain, cramping, and weakness 3.
CoQ10 Supplementation and Statin-Induced Myopathy
- Some studies have found that CoQ10 supplementation can ameliorate statin-associated muscle symptoms, such as muscle pain, weakness, and cramp 4.
- CoQ10 supplementation has been shown to improve symptoms of myalgia or increase serum levels of CoQ10 in patients taking statins, with beneficial effects seen at doses of 30-200 mg daily 2.
- However, not all studies have found a benefit of CoQ10 supplementation, with some showing no reduction in muscle symptoms or plasma creatine kinase levels 3, 4.
Potential Benefits of CoQ10 Supplementation
- Combining ubiquinol (the active reduced form of CoQ10) with a statin may be beneficial for patients with hypercholesterolaemia and chronic heart failure, potentially decreasing skeletal muscle injury and improving myocardial function 5.
- CoQ10 supplementation may be a complementary approach to manage statin-induced myopathy, although further research is necessary to fully understand its effects 2, 4.
Methodological Considerations
- Methodological and pharmacological issues may confound interpretation of data on the efficacy of CoQ10 supplements in preventing and treating SAMS, such as the effectiveness of oral CoQ10 supplementation in increasing mitochondrial CoQ10 in human skeletal muscle 3.
- The quality of studies on CoQ10 supplementation and statin-induced myopathy can vary, with some studies having methodological limitations or biases 4.