Pneumonitis and Statin Therapy

Dr. Golomb of the UCSD statin study recently has commented on chronic interstitial pneumonitis (primary symptoms are cough and shortness of breath) as a quite common statin side effect, usually recognized very late in the course of the patient's disease.

Most doctors are unaware of this relationship and spend a great deal of time in considering other more familiar causes of this chronic process including allergy and autoimmune mechanisms. The drug Amiodarone, commonly used as an anti-arrthymic, also is known to cause this reaction, believed now to be due to the induction of mitochondrial mutations. Dr. Golomb points at this same mechanism of mitochondrial mutation as the most likely mechanism involved in statin effect as well.

As a recap on statin side effect causality we have to remember that statin drugs, as reductase inhibitors, exert their effect at the beginning of the mevalonate pathway, which is shared by several other biochemical processes including the vital CoQ10 synthesis function. It is this CoQ10 inhibition that is likely to be the cause of mitochondrial mutations. CoQ10 has many important function in our bodies of which the most important are cell wall stabilization, production of ATP derived energy and as a powerful anti-oxidant tothe mitochondria in the walls of each of our cells. It is the anti-oxidant function that is vital here.

Mitochondria are our ultimate source of energy and play the role of front-line warriors in this never ending task of extracting the oxygen necessary for survival while at the same time attempting to exist unharmed in the highly oxidative danger zone where blood oxygen is transferred from the blood stream and utilized for physiological purposes.

Without sufficient CoQ10 the rapid oxidation and free radical production cause serious mutations of the mitochondria in a relatively short time. A number of carefully done studies have shown that shortly after statin therapy has begun, there occurs a rapid fall-off in CoQ10 levels in both tissue and blood. Deprived of their CoQ10 protection, these mitochondria rapidly change their character and often become the enemy as in chronic interstitial pneumonitis.

Interesting that the drug Amiodarone, widely used to help control irregular heart beats, can cause this same effect, illustrating the immense complexity of our body systems and how little even the most diligent researchers really know about the full effect on the body when therapeutic drugs are first used.

Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor

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