ORLANDO, FLA. — Coenzyme Q10 markedly improved statin-induced myopathic pain in a randomized, double-blind controlled trial with 41 patients.
“I was surprised at the strength of the outcome; I'd been skeptical,” Patricia Kelly, D.O., told this newspaper at the annual meeting of the American College of Cardiology.
Dr. Kelly reported on 41 statin-treated patients who had myopathic pain and whose creatine phosphokinase (CPK) levels were normal or minimally elevated. The patients were randomized to 400 IU vitamin E (control group) or 100 mg coenzyme Q10 daily for 30 days.
On a validated pain scale of 0–10, self-rated muscle pain fell from a mean of 6.2 to 3.1 in the group taking coenzyme Q10 but remained unchanged in controls. Pain improved in 18 of 21 patients treated with coenzyme Q10, compared with 3 of the 20 taking vitamin E, said Dr. Kelly, a cardiology fellow at Stony Brook (N.Y.) University Hospital.
Severity of muscle pain was unrelated to CPK level, which didn't change significantly in either study arm. LDL cholesterol concentrations and liver function tests also remained unchanged. Both treatments were well tolerated and free of side effects.
Based on these findings, Dr. Kelly concluded that coenzyme Q10 may provide an alternative to halting statins in patients with muscle pain. Although the incidence of myopathic pain in clinical trials sponsored by drug companies is often as low as 5%, the experience of Dr. Kelly and her colleagues has been that it's more like 25%, or even higher, in clinical practice.
The rationale for studying coenzyme Q10 stems from the fact that all statins not only reduce production of cholesterol but also reduce the biosynthesis of coenzyme Q10, or ubiquinone, a component of the electron transport system and a key early player in mitochondrial ATP production. Other investigators have previously documented 25%–40% reductions in serum and plasma coenzyme Q10 levels in statin-treated patients.
Oral coenzyme Q10 supplementation therefore seemed like a potential way to boost skeletal muscle high-energy phosphate metabolism—and thereby reduce myopathic pain symptoms—without interfering with the potent LDL cholesterol-lowering ability of statins, she explained.
A month's supply of coenzyme Q10 costs at least $30 in health food stores. Based upon the encouraging results of this unsponsored randomized pilot study, Dr. Kelly and her coinvestigators have applied to the National Institutes of Health for a grant to conduct a larger, definitive study.