Effect of coenzyme Q10 supplementation on simvastatin-induced myalgia
Abstract
Myalgia is the most frequently reported adverse side effect associated with statin therapy and often necessitates reduction in dose, or the cessation of therapy, compromising cardiovascular risk management. One postulated mechanism for statin-related myalgia is mitochondrial dysfunction through the depletion of coenzyme Q(10), a key component of the mitochondrial electron transport chain. This pilot study evaluated the effect of coenzyme Q(10) supplementation on statin tolerance and myalgia in patients with previous statin-related myalgia. Forty-four patients were randomized to coenzyme Q(10) (200 mg/day) or placebo for 12 weeks in combination with upward dose titration of simvastatin from 10 mg/day, doubling every 4 weeks if tolerated to a maximum of 40 mg/day. Patients experiencing significant myalgia reduced their statin dose or discontinued treatment. Myalgia was assessed using a visual analogue scale. There was no difference between combined therapy and statin alone in the myalgia score change (median 6.0 [interquartile range 2.1 to 8.8] vs 2.3 [0 to 12.8], p = 0.63), in the number of patients tolerating simvastatin 40 mg/day (16 of 22 [73%] with coenzyme Q(10) vs 13 of 22 [59%] with placebo, p = 0.34), or in the number of patients remaining on therapy (16 of 22 [73%] with coenzyme Q(10) vs 18 of 22 [82%] with placebo, p = 0.47). In conclusion, coenzyme Q(10) supplementation did not improve statin tolerance or myalgia, although further studies are warranted.
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Seven studies with 321 patients were included in the pooled analysis, of which 165 were treated with CoQ10 and 156 with placebo.
“Seven studies with 321 patients were included in the pooled analysis, of which 165 were treated with CoQ10 and 156 with placebo [5,6,8,9,11,12,17].”
From Effect of Coenzyme Q10 on statin-associated myalgia and adherence to statin therapy: A systematic review and meta-analysis (2020) · cites this paper as [8]
Three trials assessed statin continuation at the end of the study period.
“Three trials assessed statin continuation at the end of the study period [8,9,11].”
From Effect of Coenzyme Q10 on statin-associated myalgia and adherence to statin therapy: A systematic review and meta-analysis (2020) · cites this paper as [8]
Five included studies did not report a washout period and statin rechallenge necessary to confirm that myalgia was related to statin treatment.
“Importantly, five studies did not report a washout period and statin rechallenge necessary to confirm that myalgia was related to statin treatment [5,6,8,9,17].”
From Effect of Coenzyme Q10 on statin-associated myalgia and adherence to statin therapy: A systematic review and meta-analysis (2020) · cites this paper as [8]
For the second outcome of interest, three studies with 79 CoQ10-treated patients and 78 placebo-controlled comparators were included.
“For the second outcome of interest, three studies with 79 CoQ10 treated patients and 78 placebo controlled comparators were included [8,9,11].”
From Effect of Coenzyme Q10 on statin-associated myalgia and adherence to statin therapy: A systematic review and meta-analysis (2020) · cites this paper as [8]
A number of randomised controlled trials have reported that CoQ10 reduces statin-associated muscle symptoms, while others have failed to demonstrate a benefit.
“A number of these RCTs have reported that CoQ10 reduces SAMS [4-7], while other have failed to demonstrate a benefit [8-12].”
From Effect of Coenzyme Q10 on statin-associated myalgia and adherence to statin therapy: A systematic review and meta-analysis (2020) · cites this paper as [8]
A number of included studies reported attrition of patients but did not describe baseline characteristics or interval outcomes.
“A number of studies reported the attrition of patients but did not describe their baseline characteristics or interval outcomes [8,9,11,12].”
From Effect of Coenzyme Q10 on statin-associated myalgia and adherence to statin therapy: A systematic review and meta-analysis (2020) · cites this paper as [8]
All included studies were randomised controlled trials designed as parallel-group studies with a placebo arm.
“All included studies were RCTs designed as parallel-group studies with a placebo arm [5,6,8,9,11,12,17].”
From Effect of Coenzyme Q10 on statin-associated myalgia and adherence to statin therapy: A systematic review and meta-analysis (2020) · cites this paper as [8]
Qu et al. appears to have misinterpreted the direction of the change in pain score for two included studies.
“Qu et al., appears to have misinterpreted the direction of the change in pain score for two included studies [8,12].”
From Effect of Coenzyme Q10 on statin-associated myalgia and adherence to statin therapy: A systematic review and meta-analysis (2020) · cites this paper as [8]
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- Authors
- Young, J. M., Florkowski, C. M., Molyneux, S. L., McEwan, R. G., Frampton, C. M., George, P. M., & Scott, R. S.
- Affiliations
- Christchurch Hospital (NZ)
- Canterbury Health Laboratories (NZ)
- Corresponding author
- Young, Joanna M.
- ORCID
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2007-11
- Volume
- 100
- Issue
- 9
- Pages
- 1400-1403
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W1993325964
- Cited by
- 185
- References
- 21
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 2 · 2023: 1 · 2022: 5 · 2021: 3 · 2020: 5 · 2019: 3 · 2018: 13 · 2017: 11 · 2016: 8 · 2015: 11 · 2014: 16 · 2013: 19 · 2012: 22
- FWCI
- 5.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Coenzyme Q10 studies and effects
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
- Keywords
- coenzyme Q10, simvastatin, statin-induced myalgia, statin intolerance, mitochondrial dysfunction, statin dose titration, statin adverse effects
- MeSH terms
- Coenzymes, Double-Blind Method, Drug Tolerance, Female, Humans, Male, Middle Aged, Muscular Diseases, Pilot Projects, Ubiquinone, Vitamins, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Simvastatin
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