The health care industry and the government in the United States has been engaged in a highly significant ‘war’ against fat and cholesterol, a perspective that has been the subject of significant controversy in recent years (1).
The most common approach to decreasing the risk of heart disease is the prescription of statins (2).
Statins follow the common concept that reducing LDL cholesterol (the ‘bad’ cholesterol) will decrease the risk of heart disease. This concept is covered in considerable depth in another post.
Yet, at the same time, statins are associated with significant side effects. For some people, the side effects can be strong enough to cause them to stop taking the medication (3). One problem is that statins deplete CoQ10, which may be a very significant outcome.
One example of side effects from statins is muscle symptoms, which can often arise in patients receiving statins. Estimates of the number of patients experiencing some form of muscle symptom ranges from 7% to 29% depending on the source (4).
This is a concerning level of side effects, especially given the large number of people on statins at any given time.
A major challenge with statins is that by inhibiting the cholesterol synthesis pathway, statins also have similar effects on other compounds. In particular, by inhibiting this pathway, statins also act to inhibit the synthesis of CoQ10 (5,6).
The way that statins do this isn’t a side effect exactly, instead it’s the result of the way that statins work.
Statins decrease the production of cholesterol by blocking the enzyme HMG/CoA Reductase (7). This is an effective way of reducing cholesterol production.
However, the human body consists of a large number of different systems and they connect with one another.
So, it isn’t really possible to simply inhibit a pathway and expect it to only affect the one particular chemical that you are interested in.
In particular, part the pathway that is used to produce cholesterol is also involved in the production of CoQ10. So, when a person is taking statin medication, their cholesterol and their CoQ10 production is inhibited (8).
This is a concerning impact, because CoQ10 is an essential nutrient for human health, and dramatically decreasing its level may have significant and unintended impacts on health.
In fact, the process will invariably affect other processes in the body, often in unexpected ways.
The Use of Statins
Statins are already very commonly prescribed, and recently, new guidelines have been developed that significantly alter the situations where statins should be prescribed (10).
Traditionally, statins have been prescribed to people who had a certain level of LDL cholesterol, which resulted in a large number of people being prescribed the medication.
However, the changes to cholesterol guidelines suggest that a much greater number of people will be prescribed with statins, particularly as doctors are being told not to prescribe other types of medication for blood cholesterol (11).
Research indicates that around 17% of patients experience an adverse event as the result of statin use, with many patients discontinuing statin use at least temporarily because of the event (12).
One of the reasons that side effects from statin use occur is that statins decrease the level of CoQ10 that is present in the body.
This is a significant problem, and this has led to the discussion of CoQ10 supplementation as a way of significantly reducing the side effects associated with statin use.
Research into CoQ10 Supplementation
While there is certainly some evidence for using CoQ10 along with statin treatment, the evidence is far from conclusive.
For example, one review noted a few studies that showed a benefit in muscle symptoms or CoQ10 levels as the result of supplementation with CoQ10. However, the review also noted one study that showed no effect of the CoQ10 supplementation (16).
However, the authors of that analysis did note that larger well-designed trials are needed to provide sufficient evidence.
Despite this, CoQ10 supplementation is a commonly used treatment for statin side effects among patients and physicians (18).
It is likely that the effectiveness of CoQ10 supplementation depends on the CoQ10 status of the people receiving the supplements.
In particular, statins block CoQ10 synthesis in the body, but it can still be sourced through the diet. The site Superfoodly has an extensive list of foods that can provide the nutrient.
As such, it is likely that some people receiving statins are deficient in CoQ10 while others are not. It is feasible that only those actually deficient in CoQ10 will experience benefits from CoQ10 supplementation.