Coenzyme Q10and selenium in statin-associated myopathy treatment
Abstract
The objective of this study was to evaluate the possible benefits of coenzyme Q10 and selenium supplementation administered to patients with statin-associated myopathy (SAM). Sixty eligible patients entered the pilot study. Laboratory examination (CoQ10, selenium, creatin kinase) and intensity of SAM (visual scale) were performed at baseline, after 1 month, and at the end of study at month 3. Plasma levels of CoQ10 increased from 0.81 ± 0.39 to 3.31 ± 1.72 μmol/L in the active group of patients treated by CoQ10, compared with the placebo (p = 0.001). Also, the symptoms of SAM significantly improved in the active group (p < 0.001): the intensity of muscle pain decreased from 6.7 ± 1.72 to 3.2 ± 2.1 (p < 0.01, -53.4 ± 28.2%); muscle weakness decreased from 7.0 ± 1.63 to 2.8 ± 2.34 (p < 0.01, -60 ± 24.0%); muscle cramps decreased from 5.33 ± 2.06 to 1.86 ± 2.42, p < 0.01, -65 ± 28%); tiredness decreased from the initial 6.7 ± 1.34 to 1.2 ± 1.32 (p < 0.01, -82 ± 22%). We did not observe any significant changes in the placebo group. In conclusion, supplementation of statin-treated patients with CoQ10 resulted in a decrease in the symptoms of SAM, both in absolute numbers and intensity. Additional selenium supplementation was not associated with any statistically significant decrease of SAM. However, it is not possible to draw any definite conclusions, even though this study was carried out in double-blind fashion, because it involved a small number of patients.
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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 [5]
Two included studies reported a significant reduction in muscle pain in the CoQ10 treated group compared to placebo, while the remaining six did not find a significant reduction.
“A significant reduction in muscle pain in the CoQ10 treated group compared to placebo was reported in two studies, while the remaining six studies did not find a significant reduction in pain score [5,6].”
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 [5]
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 [5]
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 [5]
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 [5]
Only two included studies had a prospective study protocol identified.
“No deviations from the study protocol were reported, though only two studies had a perspective study protocol identified (both at ClinicalTrial.gov) [5,12].”
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 [5]
Only two of the seven included studies disagree with this result in their conclusions, and the eighth study in the qualitative review did not favour CoQ10 treatment.
“Only two of the seven included studies disagree with this result in their conclusions [5,6], and the eighth study in the qualitative review did not favour CoQ10 treatment [18].”
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 [5]
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 [42]
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 [42]
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 [42]
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 [42]
Exclusion 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 [42]
Whether CoQ10 supplementation ameliorates statin-induced myopathy remains controversial.
“whether CoQ10 supplementation ameliorates statin‐induced myopathy remains controversial.”
From Effects of Coenzyme Q10 on Statin‐Induced Myopathy: An Updated Meta‐Analysis of Randomized Controlled Trials (2018) · cites this paper as [8]
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Statin-Induced Mitochondrial Damage
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Diabetes Risks of Statin Therapy—Coenzyme Q10 May Help
Han, X., Liu, J., Gu, Y., Li, Y., Zhang, W., Lv, N., & Dang, A. (2025) · Reviews in Cardiovascular Medicine · doi:10.31083/rcm26437 · Cited by 2 · see citing works
Ubiquinol (Reduced CoQ10): A novel yet ubiquitous nutrient for heart disease
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Lipid Lowering Therapy and Endothelial Function in Patients with Metabolic Syndrome
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- Authors
- Fedacko, J., Pella, D., Fedackova, P., Hänninen, O., Tuomainen, P., Jarcuska, P., Lopuchovsky, T., Jedlickova, L., Merkovska, L., & Littarru, G. P.
- Affiliations
- Pavol Jozef Safarik University, 1st Department of Internal Medicine, Centre of Excellency for Atherosclerosis Research, Trieda SNP 1, 041 90 Kosice, Slovakia.
- University of Pavol Jozef Šafárik (SK)
- University of Kuopio, Department of Physiology, Kuopio, Finland.
- University of Eastern Finland (FI)
- Marche Polytechnic University (IT)
- Venue
- Canadian Journal of Physiology and Pharmacology
- Publisher
- Canadian Science Publishing
- Published
- 2013-02
- Volume
- 91
- Issue
- 2
- Pages
- 165-170
- ISSN
- 0008-4212 (ISSN-L)
- 1205-7541
- OpenAlex
- W2127440367
- Cited by
- 76
- References
- 20
- Citations by year
- 2025: 6 · 2024: 1 · 2022: 6 · 2021: 4 · 2020: 2 · 2019: 5 · 2018: 9 · 2017: 4 · 2016: 8 · 2015: 14 · 2014: 14 · 2013: 3
- FWCI
- 3.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Canadian Journal of Physiology and Pharmacology (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
- statin-induced myopathy, coenzyme Q10, selenium supplementation, myalgia, muscle weakness, muscle cramps, creatine kinase, statin adverse effects
- MeSH terms
- Analysis of Variance, Double-Blind Method, Drug Therapy, Combination, Female, Humans, Male, Middle Aged, Muscular Diseases, Pilot Projects, Prospective Studies, Selenium, Ubiquinone, Treatment Outcome, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Dietary Supplements
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