Atorvastatin Reduces Blood CoQ10 Levels

Laurie Barclay, MD

June 22, 2004

June 22, 2004 — Atorvastatin substantially reduces blood coenzyme Q10 (CoQ10) levels, according to the results of a prospective blinded study published in the June issue of the Archives of Neurology. The investigators speculate that this may underlie some of the adverse effects, and they suggest that supplements may be appropriate.

"Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) are widely used for the treatment of hypercholesterolemia and coronary heart disease and for the prevention of stroke," write Tatjana Rundek, MD, from Columbia University College of Physicians & Surgeons in New York City, and colleagues. "There have been various adverse effects, most commonly affecting muscle and ranging from myalgia to rhabdomyolysis. These adverse effects may be due to a [CoQ10] deficiency because inhibition of cholesterol biosynthesis also inhibits the synthesis of CoQ10."

At the stroke center of an academic tertiary care hospital, the investigators enrolled 34 subjects eligible for statin treatment according to National Cholesterol Education Program: Adult Treatment Panel III criteria.

At baseline, mean blood concentration of CoQ10 was 1.26 ± 0.47 µg/mL. This decreased to 0.62 ± 0.39 µg/mL after 30 days of atorvastatin therapy ( P < .001). A significant decrease was already detectable after 14 days of treatment ( P < .001).

The most common adverse effects were flatulence and constipation, which were usually transient. There were no complaints of myalgia, weakness, or other severe adverse effects. One subject experienced weakness and tingling in the legs, which disappeared two days after reducing the dose of atorvastatin calcium to 40 mg per day.

"Even brief exposure to atorvastatin causes a marked decrease in blood CoQ10 concentration," the authors write. "Widespread inhibition of CoQ10 synthesis could explain the most commonly reported adverse effects of statins, especially exercise intolerance, myalgia, and myoglobinuria."

The authors note that this study did not evaluate tissue levels of CoQ10. "Despite this limitation, our findings raise the possibility of a widespread inhibition of CoQ10 synthesis in patients treated with atorvastatin," the authors write. "Given the many patients exposed to relatively high doses of this drug and the persistent occurrence of adverse effects related to statins, it may be reasonable to add CoQ10 in patients receiving long-term treatment with statins in general, and atorvastatin in particular. This recommendation is strengthened by the general experience that oral CoQ10 — even in high doses — is well tolerated by patients."

Pfizer Inc., the Hazel K. Goddess Fund, and the Muscular Dystrophy Association supported this study. One of the authors has received honoraria for lecturing and consulting from Pfizer Inc.

Arch Neurol. 2004;61:889-892

Reviewed by Gary D. Vogin, MD

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