By Duane Graveline, M.D., M.P.H.
Caso G and others recently published (Am J Cardiol. 2007 May 15; 99(10):1409-12) on the effects of CoQ10 on statin treated patients. Excerpts from this paper follow:
"Treatment of hypercholesterolemia with Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) is effective in the primary and secondary prevention of cardiovascular disease. However, statin use is often associated with a variety of muscle-related symptoms or myopathies. Myopathy may be related in part to statin inhibition of the endogenous synthesis of coenzyme Q10, an essential cofactor for mitochondrial energy production."Statin drugs are reductase inhibitors with site of action being the mevalonate to mevalonic acid step of the mevalonate pathway. For your information, this is the very beginning of the mevalonate pathway, the trunk of the tree, so to speak. As Caso suggests, "inhibition of the endogenous synthesis of CoQ10 may result from statin use."
What Caso could have said is that inhibition of CoQ10 synthesis is inevitable with reductase inhibitors along with dolichol synthesis and selenoprotein synthesis and it is the inhibition of the normal glyyl-glyceryl phosphorylation by reductase inhibitors that enhances tau protein production, the stuff of neurofibrillatory tangles (see Meske J Europcerean Neuroscience, 2003). All of this from reductase inhibition at that vital step of our mevalonate tree. Think about it!
The aim of this study was to determine whether coenzyme Q10 supplementation would reduce the degree of muscle pain associated with statin treatment.
"Patients with myopathic symptoms were randomly assigned in a double-blinded protocol to treatment with coenzyme Q10 (100 mg/day, n = 18) or vitamin E (400 IU/day, n = 14) for 30 days. Muscle pain and pain interference with daily activities were assessed before and after treatment."
"After a 30-day intervention, pain severity decreased by 40% (p <0.001) and pain interference with daily activities decreased by 38% (p <0.02) in the group treated with coenzyme Q10. In contrast, no changes in pain severity (+9%, p = NS) or pain interference with daily activities (-11%, p = NS) was observed in the group treated with vitamin E."
This positive response has been known for at least 15 years, prompting Merck to patent but not market the combination CoQ10 / lovastatin. Canada has warned that CoQ10 should be supplemented with statin use. Somehow the U.S. government failed to catch this.
Actually, I fail to see any justification for the study of Caso and the rest of his group for this benefit has always been known. I estimate that some 40% of statin side effects are CoQ10 related and could in my opinion be prevented by concurrent supplementation.
Unfortunately, preventing side effects due to dolichol inhibition and tau protein formation does not lend itself to easy solutions. Dolichols play a key role in peptide formation dealing with the attachment of necessary sugars and vital to cell signaling and immunodefence. But that is another story.
"In conclusion, results suggest that coenzyme Q10 supplementation may decrease muscle pain associated with statin treatment," say the authors of this paper. I shake my head sadly at the frustration of it all.
Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor