Coenzyme Q10 supplementation decreases statin-related mild-to-moderate muscle symptoms: a randomized clinical study
Open accessAbstract
BACKGROUND: Statin use is frequently associated with muscle-related symptoms. Coenzyme Q10 supplementation has yielded conflicting results in decreasing statin myopathy. Herein, we tested whether coenzyme Q10 supplementation could decrease statin-associated muscular pain in a specific group of patients with mild-to-moderate muscle symptoms. MATERIAL/METHODS: Fifty patients treated with statins and reporting muscle pain were recruited. The Q10 group (n=25) received coenzyme Q10 supplementation over a period of 30 days (50 mg twice daily), and the control group (n=25) received placebo. The Brief Pain Inventory (BPI) questionnaire was used and blood testing was performed at inclusion in the study and after 30 days of supplementation. RESULTS: The intensity of muscle pain, measured as the Pain Severity Score (PSS), in the Q10 group was reduced from 3.9±0.4 to 2.9±0.4 (P<0.001). The Pain Interference Score (PIS) after Q10 supplementation was reduced from 4.0±0.4 to 2.6±0.4 (P<0.001). In the placebo group, PSS and PIS did not change. Coenzyme Q10 supplementation decreased statin-related muscle symptoms in 75% of patients. The relative values of PSS and PIS significantly decreased (-33.1% and -40.3%, respectively) in the Q10 group compared to placebo group (both P<0.05). From baseline, no differences in liver and muscle enzymes or cholesterol values were found. CONCLUSIONS: The present results show that coenzyme Q10 supplementation (50 mg twice daily) effectively reduced statin-related mild-to-moderate muscular symptoms, causing lower interference of statin-related muscular symptoms with daily activities.
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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 [6]
The Methods (Patients; page not available) explicitly report statin de-challenge and re-challenge before enrollment, with symptoms recurring afterward. The Results (Patient characteristics; page not available) also report that statin discontinuation lasted no more than two weeks in a subgroup. Thus, this study did report the rechallenge that the citing sentence says was absent. (LLM, conf=0.91)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredOnly 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 [6]
The citation [18] is attached to the claim that the eighth study did not favour CoQ10 treatment. This paper’s Conclusions (page unavailable) say the opposite: CoQ10 supplementation significantly reduced statin-associated muscle pain in patients with mild-to-moderate symptoms. (LLM, conf=0.95)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredTwo 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 [6]
The Results (‘Intensity of myopathic pain’; page not supplied) report significantly less muscle pain in the CoQ10 group than in the placebo group, so this paper supports one positive-study result. Its Discussion describes conflicting findings in earlier studies but does not establish the claimed tally of two positive and six negative studies. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThree studies reported a run-in period in which patients stopped statin intake prior to trial start to assure that myopathic pain and other side effects were caused by statin intake.
“Of all seven studies, three studies reported a run-in period in which patients were asked to stop statin intake prior to the start of the trial to assure that the myopathic pain and other side effects are caused by the statin-intake.(34,40,41)”
From Effects of coenzyme Q10 supplementation on myopathy in statin-treated patients: a systematic review and meta-analysis (2025) · cites this paper as [34]
The Material and Methods > Patients section says patients underwent statin de-challenge and re-challenge before enrollment to establish the association with muscle symptoms. The Results > Patient characteristics section also reports a brief statin discontinuation for some patients. The paper does not describe this as a formal run-in period or say that the procedure established the cause of other side effects; it cannot establish the count of three studies. (LLM, conf=0.85)
Experimental — accuracy not yet measuredA 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 [6]
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 [6]
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 [6]
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 [6]
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 [34]
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 [34]
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 [34]
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 [34]
Intake of medication affecting study outcomes was considered in eligibility criteria in four trials and led to exclusion of participants.
“The intake of medication affecting the study outcomes, including pain medication, was considered in the eligibility criteria in four of the selected trials and led to exclusion of participants.(34,39–41)”
From Effects of coenzyme Q10 supplementation on myopathy in statin-treated patients: a systematic review and meta-analysis (2025) · cites this paper as [34]
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 [34]
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 [9]
Only two included studies declared no funding from industry.
“only two declared no funding from industry [6,12]”
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 [6]
The Methods and Discussion passages describe this trial but do not state whether it received industry funding. Searches for funding, financial support, sponsorship, and a no-industry-funding declaration found no such statement in our copy. The paper also cannot establish the citing document’s count of two included studies. (LLM, conf=0.73)
Experimental — accuracy not yet measuredIn one study the baseline myalgia scores varied by almost 25%, and by 5-10% in two others.
“In one study the baseline scores varied by almost 25% [24] and by 5-10% in two others [6,11].”
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 [6]
The Results section (‘Intensity of myopathic pain’; page unavailable) says baseline Pain Severity Scores were similar in the Q10 and placebo groups, but does not quantify their difference or report that baseline scores varied by almost 25%. A change from 3.9 to 2.9 is reported for the Q10 group after treatment, not as variation between baseline scores. The 5–10% figures are attached to other citations in the citing sentence and are not assessed here. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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- Authors
- Šabovič, M.
- Affiliations
- Department of Vascular Diseases, University of Ljubljana Medical Centre, Ljubljana, Slovenia
- Venue
- Medical Science Monitor
- Published
- 2014
- Volume
- 20
- Pages
- 2183-2188
- ISSN
- 1234-1010 (ISSN-L)
- 1643-3750
- PMC
- PMC4226312
- OpenAlex
- W2167715213
- Cited by
- 75
- References
- 15
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 5 · 2023: 4 · 2022: 7 · 2021: 4 · 2020: 4 · 2019: 5 · 2018: 10 · 2017: 7 · 2016: 7 · 2015: 6 · 2014: 1
- FWCI
- 2.87
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Medical Science Monitor (publishedVersion, cc-by-nc-nd)
- PubMed Central (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 myopathy, statin adverse effects, pain interference, muscle enzymes, cholesterol, lipid-lowering therapy
- MeSH terms
- Activities of Daily Living, Adult, Aged, Female, Humans, Male, Middle Aged, Muscles, Pain Measurement, Placebos, Ubiquinone, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Dietary Supplements, Myalgia
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