Of the 26% of American adults aged 40+ taking statins in 2012, as many as 10.5% have reported symptoms of muscular myopathy, such as muscle pain, cramps, spasms, or weakness as a result of treatment [1,2]. You may have heard of coenzyme Q10 (CoQ10) as a potential option to counteract these muscle-related symptoms, and your doctor may have even suggested it with your statin prescription as a preventative measure. Here, we’ll show you what the research says.
What’s the link between CoQ10 and statins?
Although statins are relatively safe for long-term use, they can have the unfortunate side effect of causing muscle pain and deterioration (myopathy). Rates of these symptoms seem to increase with statin dosage. In recent years, researchers have also identified that patients who take any form of a statin, including Lipitor, Crestor, Zocor, and Zetia, can experience a decrease in CoQ10 levels .
CoQ10 is a naturally occurring enzyme found in many foods and is active in every cell in your body. It’s no wonder why; CoQ10 is necessary for aerobic cellular respiration - the process that turns food you eat and oxygen you breathe into the energy that keeps you running . People with CoQ10 deficiencies will feel tired or easily fatigued and may have low metabolism if there isn’t enough of the enzyme to process energy in their cells.
Statins have been found to interact with CoQ10 in two possible ways. First, statins reduce your LDL cholesterol by inhibiting HMG-CoA reductase, a natural enzyme necessary for cholesterol production. It just so happens that HMG-CoA reductase is a critical step in creating CoQ10 as well. Inhibiting HMG-CoA reductase means that production of CoQ10 will decrease too. Secondly, CoQ10 is fat soluble and any CoQ10 you ingest is carried and absorbed from the bloodstream with the same LDL cholesterol that you’re trying to reduce . Lower cholesterol levels equate to lower levels of CoQ10 being absorbed from your diet.
What we’ve learned from animal studies
In seven rodent studies, researchers have demonstrated that regular CoQ10 supplementation for overweight statin-treated rats improved measures of mitochondria, bone, liver, and heart function, as well as indicators of myopathy [13,14,15,16,17,18,19]. This research has led to suggestions that we should consider regularly supplementing CoQ10 in adults who use statins as well.
The effects of CoQ10 supplementation in clinical trials
Since 1987, six randomized controlled trials have been conducted to specifically examine the effect of CoQ10 supplementation on myopathy in human statin patients, and in 2015 a team from the Mayo Clinic conducted a detailed meta-analysis of all six trials. Their conclusion was that CoQ10 had a promising yet not-statistically significant impact on muscle pain and myopathy .
The results of these studies point in the direction of reduced muscle pain, but there’s too much variation to say conclusively if CoQ10 will decrease myopathy in the average statin user. For example, in one study of 32 subjects, patients experienced a statistically significant decrease in pain by up to 40% compared with placebo, but in a more recent study of 43 subjects, no significant improvement in pain was reported [10,11]. All of these studies used different methods for selecting patients and measuring pain and myopathy symptoms, so it’s not easy to compare them directly. It’s clear that further testing of larger groups will be necessary to elucidate the real value of CoQ10 supplementation in statin patients as whole.
What this means for you
On top of these positive-to-mixed results, we know that CoQ10 levels are reduced to below-normal levels in statin users, and that consuming over-the-counter CoQ10 supplements has been shown in repeated studies to normalize CoQ10 levels in these patients . We also know that CoQ10 presents a very low risk of side effects when taken in marketed over-the-counter dosages . Overall, it would seem as though CoQ10 could help you, and likely won’t hurt.
A conversation with your doctor might be worth having if you take a statin and begin to feel fatigued or weak. Consult your doctor especially if you are on warfarin, chemotherapy, antihypertensive drugs, or are breastfeeding or pregnant as CoQ10 may cause complications under these conditions . If your doctor suggests that you supplement your statin treatment with CoQ10, know that it’s unlikely to do harm and will likely restore balance to the natural Q10 coenzyme levels in your body.
Related article: The Beginners Guide to CoQ10 (Coenzyme Q10)
- NCHS. Prescription Cholesterol-lowering Medication Use in Adults Aged 40 and Over: United States, 2003–2012. (2014). [source link]
- Bruckert, E., et al. (2005). Mild to Moderate Muscular Symptoms with High-Dosage Statin Therapy in Hyperlipidemic Patients —The PRIMO Study. Cardiovasc Drugs Ther Cardiovascular Drugs and Therapy, 19(6), 403-414. [source link]
- Ernster, L. & Dallner, G. (1995). "Biochemical, physiological and medical aspects of ubiquinone function". Biochimica et Biophysica Acta 1271 (1): 195–204. [source link]
- Banach, M., et al. (2015). Statin therapy and plasma coenzyme Q10 concentrations—A systematic review and meta-analysis of placebo-controlled trials. Pharmacological Research, 99, 329-336. [source link]
- Littarru, G. P. & Langsjoen, P. (2007). Coenzyme Q10 and statins: Biochemical and clinical implications. Mitochondrion, 7. [source link]
- Mabuchi, H., et al. (2007). Effects of CoQ10 supplementation on plasma lipoprotein lipid, CoQ10 and liver and muscle enzyme levels in hypercholesterolemic patients treated with atorvastatin: A randomized double-blind study. Atherosclerosis, 195(2). [source link]
- Pourmoghaddas, M., et al. (2014). Combination of atorvastatin/coenzyme Q10 as adjunctive treatment in congestive heart failure: A double-blind randomized placebo-controlled clinical trial. ARYA Atherosclerosis, 10(1):1-5. [source link]
- Silver, M. A., et al. (2004). Effect of atorvastatin on left ventricular diastolic function and ability of coenzyme Q10 to reverse that dysfunction. The American Journal of Cardiology, 94(10), 1306-1310. [source link]
- Banach, M., et al. (2015). Effects of Coenzyme Q10 on Statin-Induced Myopathy: a meta-analysis of randomized controlled trials. Mayo Clinic Proceedings, 90(1), 24-34. [source link]
- Caso, G., et al. (2007). Effect of Coenzyme Q10 on Myopathic Symptoms in Patients Treated With Statins. The American Journal of Cardiology, 99(10), 1409-1412. [source link]
- Bogsrud, M. P., et al. (2013). No effect of combined coenzyme Q10 and selenium supplementation on atorvastatin-induced myopathy. Scandinavian Cardiovascular Journal, 47(2), 80-87. [source link]
- Mayo Clinic. Coenzyme Q10 Safety. (2016). Retrieved July 06, 2016, from [source link]
- Choi, H., et al. (2016). Effect of Coenzyme Q10Supplementation in Statin-Treated Obese Rats. Biomolecules & Therapeutics, 24(2), 171-177. [source link]
- Murad, H. A. (2016). L-Carnitine, but not coenzyme Q10, enhances the anti-osteoporotic effect of atorvastatin in ovariectomized rats. J. Zhejiang Univ. Sci. B Journal of Zhejiang University SCIENCE B, 17(1), 43-53. [source link]
- Mohammadi-Bardbori, A., et al. (2015). Coenzyme Q10 remarkably improves the bio-energetic function of rat liver mitochondria treated with statins. European Journal of Pharmacology, 762, 270-274. [source link]
- Khalil, MS., et al. (2015) Does coenzyme-Q have a protective effect against atorvastatin induced myopathy? A histopathological and immunohistochemical study in albino rats. Histol Histopathol. 30(3):383-90. [source link]
- Jiménez-Santos, M. A., et al. (2014). Coenzyme Q10 supplementation improves metabolic parameters, liver function and mitochondrial respiration in rats with high doses of atorvastatin and a cholesterol-rich diet. Lipids Health Dis Lipids in Health and Disease, 13(1), 22. [source link]
- Muraki, A., et al. (2012). Coenzyme Q10 reverses mitochondrial dysfunction in atorvastatin-treated mice and increases exercise endurance. Journal of Applied Physiology, 113(3), 479-486. [source link]
- Garjani, A., et al. (2011). Combined atorvastatin and coenzyme Q10 improve the left ventricular function in isoproterenol-induced heart failure in rat. European Journal of Pharmacology, 666(1-3), 135-141. [source link]
- Lee, B. (2016). The Beginners Guide to CoQ10 (Coenzyme Q10). Labdoor Magazine. [source link]
- Co-author: Benita Lee