Effect of Coenzyme Q10 supplementation on statin-induced myalgias
Open accessAbstract
Coenzyme Q10 (CoQ10) deficiency has been proposed to be causal in 3-hydroxy-3-methyl-glutaryl coenzyme A reductase inhibitor (statin)-induced myopathies. However, the clinical benefit of supplementation is unproved. The purpose of the present study was to assess the effect of CoQ10 supplementation on myalgias presumed to be caused by statins. Patients currently receiving a statin who developed new-onset myalgias in ≥ 2 extremities within 60 days of initiation or a dosage increase were eligible. Patients continued statin therapy and were randomized using a matched design to either CoQ10 60 mg twice daily or matching placebo. Double-blind treatment continued for 3 months, and patients completed a 10-cm visual analog scale (VAS) and the Short-Form McGill Pain Questionnaire at baseline and at each monthly visit. The primary end point was the comparison of the VAS score at 1 month. A total of 76 patients were enrolled (40 in the CoQ10 arm and 36 in the placebo arm). The mean VAS score was 6 cm at baseline in both groups. At 1 month, no difference was seen in the mean VAS score between the 2 groups (3.9 cm in the CoQ10 group and 4 cm in the placebo group; p = 0.97). However, 5 patients in the CoQ10 group and 3 in the placebo group discontinued therapy during the first month because of myalgias. The baseline median score on the Sensory Pain Rating Index subscale was 10 in the CoQ10 group and 11.5 in the placebo group. At 1 month, these scores had decreased to 6.5 and 7.5, respectively, with no statistically significant difference (p = 0.34). In conclusion, CoQ10 did not produce a greater response than placebo in the treatment of presumed statin-induced myalgias.
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Six out of seven studies administered CoQ10 in the intervention group and placebo in the control group; one trial compared CoQ10 plus n-3 fatty acids to n-3 fatty acids only.
“Six out of seven studies administer CoQ10 supplements in the intervention group and a placebo supplement in the control group.(34,39–43) One trial compares the supplementation of CoQ10 in combination with n-3-fatty acids (n-3 FA) in the intervention group to a control group taking n-3 FA only.(33)”
From Effects of coenzyme Q10 supplementation on myopathy in statin-treated patients: a systematic review and meta-analysis (2025) · cites this paper as [43]
Split into 2 atoms — 1 confirmed, 0 partially supported, 1 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredExclusion of patients without statin-induced pain was performed in only four studies, and among those only one confirmed SAMS by having a wash-out period.
“Further, an exclusion of patients without statin-induced pain was performed only in four studies(34,41–43) and among those only one confirmed SAMS by having a wash-out period.(41)”
From Effects of coenzyme Q10 supplementation on myopathy in statin-treated patients: a systematic review and meta-analysis (2025) · cites this paper as [43]
The citation attached to the wash-out claim identifies this study as the one that confirmed statin-associated muscle symptoms. Its Methods state that participants continued statin therapy at their current dosage, and its Discussion says the cause of their myalgias could not definitely be determined. The paper does not establish the citing sentence’s count of four studies. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredOnly two included studies reported an intention-to-treat analysis.
“Only two studies reported an intention to treat analysis and this had to be assumed for the other studies when using the RoB2tool [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 [9]
The Methods section states that this trial’s analyses followed the intention-to-treat principle. The paper does not establish that only two studies in the citing document’s set reported such an analysis, or that it had to be assumed for the others when using RoB2. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPrevious meta-analyses of CoQ10 supplementation on SAMS have shown contradictory results: one demonstrated a beneficial effect and three indicated no effect.
“Previous meta-analyses have shown contradicting results, with one meta-analysis demonstrating a beneficial effect(26) and three meta-analyses indicating no effect of a CoQ10 supplementation on SAMS.(24,25,27)”
From Effects of coenzyme Q10 supplementation on myopathy in statin-treated patients: a systematic review and meta-analysis (2025) · cites this paper as [27]
The Abstract describes a randomized, double-blind trial of 76 patients, not a meta-analysis. The Discussion reports that CoQ10 was no more effective than placebo for presumed statin-induced muscle pain, supporting the no-effect finding but not the claim that this source is one of three meta-analyses. (LLM, conf=0.88)
Experimental — accuracy not yet measuredFive 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 [9]
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 [9]
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 [9]
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 [9]
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 [9]
Only three included studies described the randomisation/allocation process in full.
“While all studies were randomised, double blinded and had allocation concealment, only three studies described the process in full [6,9,12].”
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 [9]
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 [9]
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 [9]
Risk of bias assessment shows an overall low risk of bias in four included studies and moderate to high risk in three studies.
“The risk of bias assessment shows an overall low risk of bias in four of the included studies with no considerable bias in all five underlying domains,(34,39,40,43) whereas the remaining three studies show an overall moderate to high risk of bias (Figure 2).(33,41,42)”
From Effects of coenzyme Q10 supplementation on myopathy in statin-treated patients: a systematic review and meta-analysis (2025) · cites this paper as [43]
Results from randomised controlled trials and previous meta-analyses show contradictory effects of CoQ10 supplementation on SAMS.
“Although CoQ10 supplementation seems to be a plausible strategy to prevent SAMS,(13,19) results from randomised controlled trials (RCTs) and previous meta-analyses show contradictory effects of CoQ10 supplementation on SAMS.(24–27)”
From Effects of coenzyme Q10 supplementation on myopathy in statin-treated patients: a systematic review and meta-analysis (2025) · cites this paper as [27]
Four out of seven included studies show a significant reduction of muscle pain intensity after CoQ10 supplementation compared to control, while three studies do not show a significant change.
“Four out of seven studies show a significant reduction of muscle pain intensity after CoQ10 supplementation compared to the control group,(33,39,40,42) while three studies do not show a significant change of muscle pain intensity(34,41,43) (Table 2).”
From Effects of coenzyme Q10 supplementation on myopathy in statin-treated patients: a systematic review and meta-analysis (2025) · cites this paper as [43]
Four studies stated SAMS as inclusion criterion, while three studies included patients with and without SAMS besides other side effects.
“Four studies stated SAMS as inclusion criterion,(34,41–43) while three studies included patients with and without SAMS besides other side effects.(33,39,40)”
From Effects of coenzyme Q10 supplementation on myopathy in statin-treated patients: a systematic review and meta-analysis (2025) · cites this paper as [43]
Evidence for the effectiveness of vitamin D in SAMS is controversial.
“Evidence for the effectiveness of vitamin D is also controversial,57–60”
Many patients with SAMS are found to have low blood levels of vitamin D.
“although many patients with SAMS are found to have low blood levels of vitamin D.”
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- Authors
- Bookstaver, D. A., Burkhalter, N. A., & Hatzigeorgiou, C.
- Affiliations
- United States Army (US)
- Corresponding author
- Bookstaver, David A.
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2012-08
- Volume
- 110
- Issue
- 4
- Pages
- 526-529
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2017157616
- Cited by
- 89
- References
- 25
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 3 · 2023: 2 · 2022: 6 · 2021: 6 · 2020: 6 · 2019: 3 · 2018: 5 · 2017: 5 · 2016: 8 · 2015: 13 · 2014: 15 · 2013: 9
- FWCI
- 4.75
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- 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, statin-induced myalgia, statin-induced myopathy, statin intolerance, statins, coenzyme Q10 supplementation, sensory pain
- MeSH terms
- Double-Blind Method, Female, Follow-Up Studies, Georgia, Hospitals, Military, Humans, Male, Middle Aged, Muscular Diseases, Pain Measurement, Ubiquinone, Vitamins, Treatment Outcome, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Musculoskeletal Pain
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