Does Coenzyme Q10 Supplementation Mitigate Statin-Associated Muscle Symptoms?

Pharmacological and Methodological Considerations

Beth A. Taylor

Disclosures

Am J Cardiovasc Drugs. 2018;18(2):75-82. 

In This Article

CoQ10 in the Treatment of SAMS

Multiple trials have evaluated the impact of CoQ10 supplementation on SAMS, with approximately half showing a benefit and the other half showing no effect.[33–42] Placebo-controlled trials involving patients with a history of SAMS are presented in Table 1. The variability of these findings is well illustrated by two of the earliest publications on the topic. Caso et al. randomly assigned patients with prior SAMS and currently on statin treatment varying from 10–80 mg to low-dose CoQ10 (100 mg/day, n = 18) or vitamin E (400 IU/day, n = 14) for 30 days.[33] Pain severity decreased by 40% and pain interference with daily activities decreased by 38% in the group treated with CoQ10, but neither pain severity (? 9%) nor pain interference with daily activities (-11%) changed with vitamin E. Young et al. randomized 44 patients with SAMS to CoQ10 200 mg/day or placebo during upward dose titration of simvastatin from 10 to 40 mg/day, but found no difference in myalgia score, adherence to simvastatin treatment or the number of patients tolerating the highest simvastatin dose.[34] More recent results are similarly equivocal. Skarlovnik et al. reported that CoQ10 supplementation decreased muscle pain severity by approximately 25% and decreased statin-related muscle symptoms in 75% of patients with self-reported mild-to-moderate statin myalgia treated with CoQ10 supplementation (n = 25) relative to placebo (n = 25) for 30 days.[39] By contrast, we placed subjects with confirmed SAMS (using a confirmation cross-over phase with placebo or statin) on simvastatin 20 mg daily (in order to exactly replicate the regimen that evoked SAMS in the confirmation phase) plus either CoQ10 or placebo for 8 weeks.[40] CoQ10 supplementation had no effect on the incidence and severity of SAMS, time to onset of pain, muscle strength, or aerobic performance. These negative results occurred despite elevated serum concentrations of CoQ10 in the treatment group (from 1.3 ± 0.4 to 5.2 ± 2.3 ng/mL) relative to the placebo group (from 1.3 ± 0.3 to 0.8 ± 0.2 ng/mL). Similarly, a recent meta-analysis of five CoQ10 supplementation trials with 253 participants found no significant effect of CoQ10 on SAMS despite a small, non-significant trend (p = 0.20) toward a decrease in muscle pain,[24] and a study investigating the effect of CoQ10 supplementation on phosphocreatine (PCr) recovery kinetics (a more direct assessment of muscle mitochondrial function) found no impact of CoQ10 on PCr kinetics relative to statin therapy alone.[41]

Nonetheless, CoQ10 administration remains a popular therapy for treatment of SAMS among both physicians and the lay public.[10,25,43] According to the National Health Industry Survey, 1.3% of US adults (or 3.3 million) reported use of CoQ10 supplements in 2012 (albeit not all for the treatment of SAMS), and this represents a half million increase in users since 2007.[44] Consequently, North American and global market sizes for CoQ10 supplements are expected to exceed 550 million and 1 billion US dollars, respectively, by 2024.[45]

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