Does Coenzyme Q10 Supplementation Mitigate Statin-Associated Muscle Symptoms? Pharmacological and Methodological Considerations
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Statin drugs markedly reduce low-density lipoprotein cholesterol and consequently the incidence of cardiac events. In approximately 5–10% of adults, these drugs are associated with a range of muscle side effects such as muscle pain, cramping and weakness. Reduction in mitochondrial coenzyme Q10 (CoQ10), or ubiquinone, has been proposed as a mechanism for these statin-associated muscle symptoms (SAMS), and thus various formulations of CoQ10 are marketed and consumed for the prevention and treatment of SAMS. However, data supporting the efficacy of CoQ10 are equivocal, with some studies showing that CoQ10 supplementation reduces the incidence and severity of SAMS and others finding no beneficial effects of supplementation. Methodological and pharmacological issues may confound interpretation of data on this topic. For example, many patients who report SAMS, such as those who have been enrolled in previous CoQ10 studies, may be experiencing non-specific (non-statin-associated) muscle pain. In addition, the effectiveness of oral CoQ10 supplementation to increase mitochondrial CoQ10 in human skeletal muscle is not well established. This manuscript will critically evaluate the published data on the efficacy of CoQ10 supplements in the prevention and treatment of SAMS.
Compliance with Ethical Standards
Dr. Taylor received research support from Regeneron, Inc. and served on the Amgen Pharmacovigilance Monitoring Board.
No external funding was used in the preparation of this manuscript.
- 1.Prescription cholesterol-lowering drug use in adults. https://www.cdc.gov/nchs/data/databriefs/db177.pdf. Accessed July 2017.
- 3.Downs JR, Clearfield M, Weis S, Whitney E, Shapiro DR, Beere PA, et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA. 1998;279:1615–22.CrossRefPubMedGoogle Scholar
- 10.Rosenson RS, Baker SK, Jacobson TA, Kopecky SL, Parker BA, The National Lipid Association’s Muscle Safety Expert Panel. An assessment by the Statin Muscle Safety Task Force. update. J Clin Lipidol. 2014;2014(8):S58–71.Google Scholar
- 18.Bouitbir J, Charles AL, Rasseneur L, Dufour S, Piquard F, Geny B, et al. Atorvastatin treatment reduces exercise capacities in rats: involvement of mitochondrial impairments and oxidative stress. J Appl Physiol. 1985;2011(111):1477–83.Google Scholar
- 20.Mallinson JE, Marimuthu K, Murton A, Selby A, Smith K, Constantin-Teodosiu D, et al. Statin myalgia is not associated with reduced muscle strength, mass or protein turnover in older male volunteers, but is allied with a slowing of time to peak power output, insulin resistance and differential muscle mRNA expression. J Physiol. 2015;593:1239–57.CrossRefPubMedPubMedCentralGoogle Scholar
- 44.Clarke TC, Black LI, Stussman BJ, Barnes PM, Nahin RL. Trends in the use of complementary health approaches among adults: United States, 2002-2012. Natl Health Stat Report. 2015;79:1–16.Google Scholar
- 45.Coenzyme Q10 market size to reach $1bn by 2024, to witness gain above 10% CAGR: Global Market Insights Inc. https://globenewswire.com/news-release/2016/09/01/868768/0/en/Coenzyme-Q10-Market-size-to-reach-1bn-by-2024-to-witness-gain-above-10-CAGR-Global-Market-Insights-Inc.html. Accessed July 2017.
- 49.Sever P, Gupta A, Thompson D, Whitehouse A, Collier T, Dahlof B, et al. Lbos 01-04 the true incidence of statin-related adverse events in hypertensive patients revealed by comparison of blinded and un-blinded use of statin in the Anglo-Scandinavian Cardiac Outcomes Trial (Ascot). J Hypertens. 2016;34:e547–8.CrossRefGoogle Scholar
- 50.Rosenson RS, Miller K, Bayliss M, Sanchez RJ, Baccara-Dinet MT, Chibedi-De-Roche D, et al. The Statin-Associated Muscle Symptom Clinical Index (SAMS-CI): revision for clinical use, content validation, and inter-rater reliability. Cardiovasc Drugs Ther. 2017;31:179–86.CrossRefPubMedPubMedCentralGoogle Scholar
- 64.Muraki A, Miyashita K, Mitsuishi M, Tamaki M, Tanaka K, Itoh H. Coenzyme Q10 reverses mitochondrial dysfunction in atorvastatin-treated mice and increases exercise endurance. J Appl Physiol. 1985;2012(113):479–86.Google Scholar
- 70.Michalska-Kasiczak M, Sahebkar A, Mikhailidis DP, Rysz J, Muntner P, Toth PP, et al. Analysis of vitamin D levels in patients with and without statin-associated myalgia - a systematic review and meta-analysis of 7 studies with 2420 patients. Int J Cardiol. 2015;178:111–6.CrossRefPubMedGoogle Scholar