Q. Does coenzyme Q10 help to reduce muscular issues and other negative side effects associated with statins? And if so, should doctors give this information to patients when statins are prescribed?
A. Coenzyme Q10, a popular dietary supplement marketed as CoQ10 “to promote heart health,” probably does not reduce statin-induced muscle problems.
In 1957, researchers at the University of Wisconsin discovered a molecule that helps muscle cells generate energy. Today, that molecule is commonly known as coenzyme Q10.
In 1978, investigators, including Dr. Michael Brown and Dr. Joseph Goldstein, who would go on to win the Nobel Prize, noted that cholesterol and coenzyme Q10 are synthesized by the same biochemical pathway. As a result, statins not only lower cholesterol levels, they also deplete the body’s stores of coenzyme Q10
This finding renewed interest in coenzyme Q10. Was its depletion the cause of statin-induced muscle aches? If so, could restoring coenzyme Q10 to normal levels with supplements counteract these problems? This theory attracted many proponents, including Dr. Brown, who in 1989 filed a patent on coenzyme Q10 as a treatment for statin-induced muscle problems.
In the ensuing years, coenzyme Q10 was studied extensively as a treatment for statin-induced muscle problems. But the studies yielded conflicting results.
In 2015, the Lipid and Blood Pressure Meta-analysis Collaboration Group combined data from six randomized controlled trials of coenzyme Q10 as a treatment for statin-induced muscle problems. Their meta-analysis of 302 patients concluded that coenzyme Q10 was not beneficial. A subsequent randomized controlled trial of coenzyme Q10 in 41 patients with proven statin-induced muscle problems reached the same conclusion.
Rigorous studies of coenzyme Q10 for other medical conditions — such as heart failure, Parkinson’s disease and Huntington’s disease — have also found it to be ineffective.
Some argue, with some justification, that the studies of coenzyme Q10 were not large enough, or were not long enough, or used various preparations and doses of coenzyme Q10. Still, considering the preponderance of evidence, there is no proof coenzyme Q10 helps prevent statin-induced muscle problems.
Like all dietary supplements, coenzyme Q10 is not regulated as a drug by the Food and Drug Administration, so there may be important differences between different manufacturer’s products. Side effects may also occur, including insomnia and upset stomach, and it may interact with drugs such as blood thinners, insulin and certain chemotherapies. If you do take coenzyme Q10, seek your doctor’s advice.
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CoQ10 works for a lot of people. Not for everyone, nothing does. But the science showing that statins reduce CoQ10 levels is solid, and even this NYT hit piece didn't question that.
A meta analysis with only 300 patients? Those were 6 tiny trials! Meta analysis are notorious for bogus results, especially with such small numbers. It's nearly certain that those 6 trials used different doses, probably different measurements, different inclusion criteria, etc.
If this "study" had come up with strong support for CoQ10, it would never have seen the light of day. It shouldn't, no matter what the outcome. Bogus.
I was a little surprised at the results myself, given the known connection between cholesterol and CoQ10. That's why I posted it. Keep in mind that it's not only meta data, they have a 41-person RCT as well. It may not be conclusive, but certainly suggestive. I have been taking 100mg of CoQ10 on a daily basis for a couple of months now. Is it helping? Honestly I cannot tell because I did not have strong symptoms to begin with, and I'm taking it as a preventive measure.
notes that twice as many patients experienced an INCREASE in muscle pain when on both simvastin and CoQ10. The numbers were 14 of 20 vs 7 of 18. While that sounds like a lot, the population is so small that the p-value is 0.05, meaning there is a 5% chance that this is due to random fluctuations. I'm somewhat surprised that the authors didn't emphasize this result, as it was among the most significant of the study.
To its credit, the RCT did measure changes in muscle strength. Myopathy is a disease of the muscle in which the muscle fibers do not function properly. This results in muscular weakness. The RCT relied on a single before and after test; once again only very large effects could have been observed. The meta analysis did not include any such measure, but relied on proxies like muscle pain, which has many causes.
What the RCT actually tested was whether patients who had already developed significant myopathy due to treatment with simvastin were able to reverse that condition with a 600 mg dose of some unnamed brand of CoQ10. There was no effort to determine dose response.
It's also worth noting that the RCT excluded 2/3 of patients treated with simvastin and complaining of muscle pain, because the pain did not vanish when a placebo was substituted for the statin. Patients were taken off simvastin for 4 weeks. If, hypothetically, it takes some patients 1 year without statins to return to no muscle pain, this study would have excluded them.
There are many statins, atorvastatin, cerivastatin, fluvastatin, lovastatin, pravastatin to name a few. The study didn't address those.
So what the RCT actually showed was that a 600 mg dose of CoQ10 failed to resolve symptoms of myopathy in those patients most severely affected by simvastin. That's it. The study was so lacking in statistical power and time that only truly dramatic effects could have been demonstrated. That is by design; one could predict this when the study was proposed.
I'm not convinced that CoQ10 supplementation will prevent or treat statin-induced myopathy. I'm quite convinced that these studies offer little useful data on that point.
I have heart disease, high cholesterol, diabetes, Prostate cancer, kidney disease, and I am on two blood thinners. I take coenzyme Q10 100mg twice a day. I have much less muscle aches and pains when I take it. I take Livalo for cholesterol because it has less side effects. The Q10 helps my heart as well. When the article says it does not work probably they used the wrong dosage.
Exactly. It works for you. What's the harm? That balance of risk and rewards is almost never discussed in research, but an integral part of day to day living.
The RCT used 600 mg of an unknown brand. That's a very large dose and might explain why the patients getting CoQ10 were slightly more likely to report pain. Most drugs and supplements have a therapeutic window. Too much is rarely better.
do your research, statins are the biggest money makers for big pharma, ever....cholesterol and heart disease correlation, do your research, there is none, in fact negative correlation.
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