Evidence for using Co-enzyme Q10 with statins

Evidence does not support the use of Co-enzyme Q10 to prevent myalgia (muscle pain) during treatment with a statin.

No clear evidence of benefit

No trials have shown that taking a Co-enzyme Q10 supplement with a statin prevents myalgia. Randomised controlled trials of Co-enzyme Q10 to manage statin-associated myalgia have conflicting results and do not support routine use with statin therapy.

Two randomised controlled trials have investigated Co-enzyme Q10 for statin-associated myalgia, but they have conflicting results. One trial found that Co-enzyme Q10 (100mg daily for 30 days) improved pain scores for people with statin-associated myalgia more than vitamin E (400 IU daily).1 The other trial involving people who previously had statin-associated myalgia found no difference between Co-enzyme Q10 (200mg daily for 12 weeks) and placebo in myalgia scores or in the number of people who tolerated a higher dose of a statin.2

A systematic review concluded that there is insufficient evidence for using Co-enzyme Q10 in statin-associated myopathy and its use with statins cannot be routinely recommended.3

Evidence for using vitamin D3 with statins

Evidence does not support use of vitamin D3 to prevent myalgia (muscle pain) during treatment with a statin, or for the sole purpose  of improving cardiovascular health.

No clear evidence of benefit

Until randomised controlled trials designed to investigate cardiovascular outcomes are undertaken, the importance of vitamin D in cardiovascular health remains unproven. Most of the positive results come from observational studies which may be prone to bias.

Results from uncontrolled studies suggest that vitamin D deficiency may play a part in statin-associated myalgia. No randomised controlled trials have investigated this association. Trials have not investigated vitamin D supplementation to prevent statin-associated myalgia, or to treat it in people who are not low in vitamin D.

Results of some observational studies suggest there may be an association between lower vitamin D levels and a higher risk of cardiovascular disease.4,5 However one large randomised trial6 and meta-analyses of randomised trials4,7,8 have been unable to find any significant differences in cardiovascular outcomes (including death, heart attack or stroke) among people taking vitamin D supplements and people who are not. Meta-analyses also found no significant changes in lipid levels (e.g. cholesterol), blood sugar (glucose) levels or blood pressure.4,7

Two uncontrolled studies found that vitamin D supplementation may improve myalgia in people who are taking a statin and have low vitamin D.9,10 Some uncontrolled studies also suggest that taking a statin may actually increase levels of vitamin D.11,12

People with myalgia who are taking a statin should see their doctor first

A doctor will need to review other possible causes of muscle pain (e.g. increased physical activity, infections) and do tests if necessary. If someone has statin-associated myalgia, management options include reducing the statin dose or switching to a different statin (if symptoms are mild), stopping the statin and/or trying another type of medicine.13,14 If these options are not suitable, a doctor may suggest trying a Co-enzyme Q10 supplement.

A doctor can also advise on a suitable vitamin D product if this is needed. The amount of vitamin D3 in Blackmores STAT Companion (1000 IU) is not enough to treat moderate to severe vitamin D deficiency (25-OHD level < 25 nmol/L). These people should be treated with 3000 to 5000 IU of vitamin D3 per day for 6 to 12 weeks.15

If you suspect someone may be vitamin D deficient they should see their doctor for investigation and appropriate management.

Some people more at risk of vitamin D deficiency than others may be advised to see their GP. These include people who:

  • are housebound, particularly those aged over 65 years or resident in aged care facilities
  • have naturally dark skin
  • cover themselves for religious or cultural reasons
  • use medicines that interfere with vitamin D metabolism
  • have a malabsorption syndrome
  • have limited access to sunlight because of a chronic illness or disability, or because of working conditions such as shift work
  • avoid the sun as they are at increased risk of skin cancers.

Supplements can have side effects and interactions

Co-enzyme Q10 may affect the liver if used in high doses (> 300 mg per day) for long periods.16 It may interact with some medicines, including warfarin, blood pressure lowering medicines and medicines for diabetes.16

If Blackmores STAT Companion is used, the amount of vitamin D3 in this product is unlikely to cause toxicity, but it may interact with thiazide diuretics to raise calcium levels in the blood.

References
  • Caso G, Kelly P, McNurlan MA, et al. Effect of coenzyme q10 on myopathic symptoms in patients treated with statins. The American journal of cardiology 2007;99:1409-12. www.ncbi.nlm.nih.gov/pubmed/17493470
  • Young JM, Florkowski CM, Molyneux SL, et al. Effect of coenzyme Q(10) supplementation on simvastatin-induced myalgia. The American journal of cardiology 2007;100:1400-3. www.ncbi.nlm.nih.gov/pubmed/17950797
  • Marcoff L, Thompson PD. The role of coenzyme Q10 in statin-associated myopathy: a systematic review. Journal of the American College of Cardiology 2007;49:2231-7. www.ncbi.nlm.nih.gov/pubmed/17560286
  • Pittas AG, Chung M, Trikalinos T, et al. Systematic review: Vitamin D and cardiometabolic outcomes. Ann Intern Med 2010;152:307-14. www.ncbi.nlm.nih.gov/pubmed/20194237
  • Parker J, Hashmi O, Dutton D, et al. Levels of vitamin D and cardiometabolic disorders: systematic review and meta-analysis. Maturitas 2010;65:225-36. www.ncbi.nlm.nih.gov/pubmed/20031348
  • Hsia J, Heiss G, Ren H, et al. Calcium/vitamin D supplementation and cardiovascular events. Circulation 2007;115:846-54. www.ncbi.nlm.nih.gov/pubmed/17309935
  • Elamin MB, Abu Elnour NO, Elamin KB, et al. Vitamin D and cardiovascular outcomes: a systematic review and meta-analysis. The Journal of clinical endocrinology and metabolism 2011;96:1931-42. www.ncbi.nlm.nih.gov/pubmed/21677037
  • Wang L, Manson JE, Song Y, et al. Systematic review: Vitamin D and calcium supplementation in prevention of cardiovascular events. Ann Intern Med 2010;152:315-23. www.ncbi.nlm.nih.gov/pubmed/20194238
  • Glueck CJ, Budhani SB, Masineni SS, et al. Vitamin D deficiency, myositis–myalgia, and reversible statin intolerance. Current Medical Research and Opinion 2011;27:1683-90. www.ncbi.nlm.nih.gov/pubmed/21728907
  • Ahmed W, Khan N, Glueck CJ, et al. Low serum 25 (OH) vitamin D levels (<32 ng/mL) are associated with reversible myositis-myalgia in statin-treated patients. Transl Res 2009;153:11-6. www.ncbi.nlm.nih.gov/pubmed/19100953
  • Yavuz B, Ertugrul DT, Cil H, et al. Increased levels of 25 hydroxyvitamin D and 1,25-dihydroxyvitamin D after rosuvastatin treatment: a novel pleiotropic effect of statins? Cardiovasc Drugs Ther 2009;23:295-9. www.ncbi.nlm.nih.gov/pubmed/19543962
  • Perez-Castrillon JL, Vega G, Abad L, et al. Effects of Atorvastatin on vitamin D levels in patients with acute ischemic heart disease. Am J Cardiol 2007;99:903-5. www.ncbi.nlm.nih.gov/pubmed/17398180
  • Rossi S, ed. Australian Medicines Handbook. Adelaide, 2011.
  • McKenney JM, Davidson MH, Jacobson TA, et al. Final conclusions and recommendations of the National Lipid Association Statin Safety Assessment Task Force. Am J Cardiol 2006;97:89C-94C. www.ncbi.nlm.nih.gov/pubmed/16581336?dopt=Citation
  • Vitamin D and adult bone health in Australia and New Zealand: a position statement. The Medical journal of Australia 2005;182:281-5. www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15777143
  • Natural Standard. Somerville, MA, USA: 2011. naturalstandard.com (accessed 27 September 2011).