madman
Super Moderator
Abstract
Background Statins can trigger a series of muscle-related adverse events, commonly referred to collectively as statin-induced myopathy. Although coenzyme Q10 (CoQ10) is widely used as a supplement in statin therapy, there is little clinical evidence for this practice.
Aim This study aims to assess the effect of adding CoQ10 on statin-induced myopathy.
Methods Searching the PubMed, EMBASE, and the Cochrane Library databases to identify randomized controlled trials investigating the effect of adding CoQ10 on creatine kinase (CK) activity and degree of muscle pain as two indicators of statin-induced myopathy. Two reviewers will independently extract data from the included articles.
Results Study screening included a randomized controlled trial of oral CoQ10 versus placebo in patients with statin-induced myopathy. We had a total of 8 studies in which 472 patients were treated with statins: 6 studies with 281 participants assessed the impact of adding CoQ10 on CK activity, and 4 studies with 220 participants were included to evaluate the impacts of CoQ10 addition on muscle pain. Compared with the controls, CK activity increased after adding CoQ10, but the change was not significant (mean difference, 3.29 U/L; 95% CI,−29.58 to 36.17 U/L; P=0.84). Similarly, the meta-analysis did not benefit CoQ10 over placebo in improving muscle pain (standardized mean difference,−0.59; 95% CI,−1.54 to 0.36; P=0.22).
Conclusion The outcomes of this meta-analysis of existing randomized controlled trials showed that supplementation with CoQ10 did not have any significant benefit in improving statin-induced myopathy.
Background
Low-density lipoprotein (LDL) hypercholesterolemia is the major risk factor for coronary artery disease (CAD), and a large number of epidemiological and clinical data have indicated that the higher serum LDL-cholesterol (LDL-C) level, the more likely to coronary heart disease (CHD) [1]. Among the drugs to reduce LDL-C, HMG-CoA reductase inhibitors (statins) are widely used drugs. The most common side effects of statins are elevated liver transaminase and myopathy [2]. The mechanisms of statin-associated myopathy are not well understood but may include a reduction in sarcolemmal cholesterol, a reduction in small guanosine triphosphate (GTP)-binding proteins, an increase in intracellular lipid production and lipid myopathy, an increase in cardiomyocyte phytosterols, last but not least, a possible decrease in CoQ10 (ubiquinone) (in mitochondria) [3]. The one hypothesized mechanism of statin-induced myopathy is mitochondrial dysfunction due to CoQ10 deletion [4].
CoQ10 is one of the key substances in the energy metabolism of the heart and also plays an important role in cell membrane stability. Without CoQ10, muscle cells may develop destructive myopathy or rhabdomyolytic myositis [5]. Most studies have shown a decrease in serum CoQ10 concentrations (from 16 to 49%) in patients treated with statins [6–11]. In addition, CoQ10 supplementation has been shown to prevent or reverse this reduction [7, 9, 11, 12]. The impacts of CoQ10 addition on statin myalgia have not been widely studied, and the studies available have yielded conflicting results [13, 14]. However, despite the lack of definitive outcomes, CoQ10 is recommended by many clinicians and used by many patients.
*The purpose of this article is to investigate whether the addition of CoQ10 can improve muscle symptoms. We systematically reviewed all published trials supplementing CoQ10 and evaluated its overall efficacy as a statin-induced myopathy treatment for increased CK activity and statin myalgia. This article seeks to be a reference and update of the field, as well as to provide a review of the current clinical effects of CoQ10 addition.
Conclusion
Based on this meta-analysis, there is no evidence that the addition of CoQ10 is beneficial in the treatment of statin-induced myopathy. Now, the European atherosclerosis society (EAS) consensus panel does not recommend supplementation with either CoQ10 or vitamin D to treat or prevent statin-associated muscle symptoms [26]. But this is inconsistent with clinical practice. We look forward to more high-quality RCTs in the future to further study the effects of coenzyme Q10 supplementation on statin-induced myopathy.
Background Statins can trigger a series of muscle-related adverse events, commonly referred to collectively as statin-induced myopathy. Although coenzyme Q10 (CoQ10) is widely used as a supplement in statin therapy, there is little clinical evidence for this practice.
Aim This study aims to assess the effect of adding CoQ10 on statin-induced myopathy.
Methods Searching the PubMed, EMBASE, and the Cochrane Library databases to identify randomized controlled trials investigating the effect of adding CoQ10 on creatine kinase (CK) activity and degree of muscle pain as two indicators of statin-induced myopathy. Two reviewers will independently extract data from the included articles.
Results Study screening included a randomized controlled trial of oral CoQ10 versus placebo in patients with statin-induced myopathy. We had a total of 8 studies in which 472 patients were treated with statins: 6 studies with 281 participants assessed the impact of adding CoQ10 on CK activity, and 4 studies with 220 participants were included to evaluate the impacts of CoQ10 addition on muscle pain. Compared with the controls, CK activity increased after adding CoQ10, but the change was not significant (mean difference, 3.29 U/L; 95% CI,−29.58 to 36.17 U/L; P=0.84). Similarly, the meta-analysis did not benefit CoQ10 over placebo in improving muscle pain (standardized mean difference,−0.59; 95% CI,−1.54 to 0.36; P=0.22).
Conclusion The outcomes of this meta-analysis of existing randomized controlled trials showed that supplementation with CoQ10 did not have any significant benefit in improving statin-induced myopathy.
Background
Low-density lipoprotein (LDL) hypercholesterolemia is the major risk factor for coronary artery disease (CAD), and a large number of epidemiological and clinical data have indicated that the higher serum LDL-cholesterol (LDL-C) level, the more likely to coronary heart disease (CHD) [1]. Among the drugs to reduce LDL-C, HMG-CoA reductase inhibitors (statins) are widely used drugs. The most common side effects of statins are elevated liver transaminase and myopathy [2]. The mechanisms of statin-associated myopathy are not well understood but may include a reduction in sarcolemmal cholesterol, a reduction in small guanosine triphosphate (GTP)-binding proteins, an increase in intracellular lipid production and lipid myopathy, an increase in cardiomyocyte phytosterols, last but not least, a possible decrease in CoQ10 (ubiquinone) (in mitochondria) [3]. The one hypothesized mechanism of statin-induced myopathy is mitochondrial dysfunction due to CoQ10 deletion [4].
CoQ10 is one of the key substances in the energy metabolism of the heart and also plays an important role in cell membrane stability. Without CoQ10, muscle cells may develop destructive myopathy or rhabdomyolytic myositis [5]. Most studies have shown a decrease in serum CoQ10 concentrations (from 16 to 49%) in patients treated with statins [6–11]. In addition, CoQ10 supplementation has been shown to prevent or reverse this reduction [7, 9, 11, 12]. The impacts of CoQ10 addition on statin myalgia have not been widely studied, and the studies available have yielded conflicting results [13, 14]. However, despite the lack of definitive outcomes, CoQ10 is recommended by many clinicians and used by many patients.
*The purpose of this article is to investigate whether the addition of CoQ10 can improve muscle symptoms. We systematically reviewed all published trials supplementing CoQ10 and evaluated its overall efficacy as a statin-induced myopathy treatment for increased CK activity and statin myalgia. This article seeks to be a reference and update of the field, as well as to provide a review of the current clinical effects of CoQ10 addition.
Conclusion
Based on this meta-analysis, there is no evidence that the addition of CoQ10 is beneficial in the treatment of statin-induced myopathy. Now, the European atherosclerosis society (EAS) consensus panel does not recommend supplementation with either CoQ10 or vitamin D to treat or prevent statin-associated muscle symptoms [26]. But this is inconsistent with clinical practice. We look forward to more high-quality RCTs in the future to further study the effects of coenzyme Q10 supplementation on statin-induced myopathy.
