Should You Take CoQ10 with Statins?

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Question: Should You Take CoQ10 with Statins?

My doctor has put me on generic simvastatin to lower my cholesterol. I seem to be tolerating it OK, but I've heard that if you are taking a statin drug, you should also take CoQ10 to prevent muscle problems. Is that true? Should I be taking CoQ10?

Answer: Unfortunately, there is no definitive answer to this question. However, the clinical evidence we have to date suggests that CoQ10 does not help much, if at all, to prevent or treat muscle problems with statins.

What Is CoQ10?

CoQ10 - also known as ubiquinone - is a coenzyme that helps muscles produce the energy they need to do their work. Some studies suggest that statins can reduce the amount of CoQ10 in muscle tissue, but other studies have not found a decrease in CoQ10 with statins. In any case, some have speculated that reduced levels of CoQ10 might contribute to the muscle injury that can be associated with statins. So, some doctors recommend CoQ10 supplementation with statin therapy.

What Is the Evidence On CoQ10? 

The medical literature is mixed on the CoQ10 question, and for two reasons. First, as mentioned, not all studies show that statins affect CoQ10 levels in muscle tissue itself. 

And second, studies with CoQ10 in patients taking statins have been very limited. Only a few, small studies have been completed, and the results of these few studies are disappointing.

 

The studies that have been done have examined the ability of CoQ10 to treat statin-induced muscle pain. The purpose of these studies was to determine whether taking CoQ10 would allow patients with statin-induced muscle pain to continue taking statins. This is an important matter, because when it comes to reducing cardiac risk due to cholesterol levels, there is as yet no good substitute for the statins.

These studies have yielded conflicting results. For instance, a 30-day trial in 32 patients with muscle pain on statins suggested that CoQ10 produced a significant reduction in pain. Critics have pointed out, however, that such short-term administration of CoQ10 would not be expected to affect the amount of CoQ10 in the muscles themselves. And several other longer-term trials with CoQ10 showed no improvement in muscle pain on statins.

To attempt to settle the issue, a meta-analysis was performed in 2015 looking at the available randomized trials. This analysis showed no significant benefit when CoQ10 is used to treat statin myopathy.  However, larger, longer-term randomized trials would be necessary to really get a handle on this issue.

None of this, however, really gets to your question, which is, should a person taking statins also take CoQ10 to preventstatin myopathy? The reason I have talked about using CoQ10 to treat statin-induced muscle pain is that there is at least some data available that addresses this question (as paltry as that data may be).

When it comes to using CoQ10 as a preventive measure, the only evidence available is entirely anecdotal. There are no published randomized controlled trials that address this question.

CoQ10 and Statins - The Bottom Line

The bottom line is that no good, objective evidence from clinical trials is available showing that CoQ10 either prevents or effectively treats statin-induced muscle pain. At the same time, the theory that CoQ10 might help remains admittedly intriguing, and the studies that have been done are quite limited in their scope and duration. Furthermore, CoQ10 (as far as anyone knows) is harmless. So if you are interested in trying it, and can afford it, most doctors would voice no strong objection to the idea.

If you are having muscle pain while on statins, you should talk to your doctor about trying one of the statin drugs that are especially unlikely to produce muscle problems, namely, Lescol (fluvastatin) or Pravachol (pravastatin).  Also, make sure your doctor checks your thyroid function and your vitamin D levels, since either hypothyroidism or low vitamin D will make statin myopathy more likely.

Sources:

Rosenson RS, Baker SK. Muscle injury associated with lipid lowering drugs. UpToDate. Accessed: August 30,2015

Caso G, Kelly P, McNurlan MA, Lawson WE. Effect of coenzyme q10 on myopathic symptoms in patients treated with statins. Am J Cardiol 2007; 99:1409.

Young JM, Florkowski CM, Molyneux SL, et al. Effect of coenzyme Q(10) supplementation on simvastatin-induced myalgia. Am J Cardiol 2007; 100:1400.

Bookstaver DA, Burkhalter NA, Hatzigeorgiou C. Effect of coenzyme Q10 supplementation on statin-induced myalgias. Am J Cardiol 2012; 110:526.

Taylor BA, Lorson L, White CM, Thompson PD. A randomized trial of coenzyme Q10 in patients with confirmed statin myopathy. Atherosclerosis 2015; 238:329.

Banach M, Serban C, Sahebkar A, et al. Effects of coenzyme Q10 on statin-induced myopathy: a meta-analysis of randomized controlled trials. Mayo Clin Proc 2015; 90:24.

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