Abstract 343: Coenzyme Q10 does not Improve Simvastatin Tolerability in Dyslipidemic Patients with Prior Statin-Induced Myalgia
Introduction. Myalgia is the most common adverse effect associated with statin therapy, often necessitating reduction in statin dose, leaving an unfavourably high CV risk status. Statins inhibit synthesis of mevalonate, a precursor of coenzyme Q10 (CoQ) that is an essential mitochondrial redox-component, resulting in a decrease in plasma CoQ. The mechanism for statin-induced myalgia remains unclear, but may be linked to CoQ depletion and there are anecdotal reports of improved statin tolerance with CoQ supplementation. This has not been tested, however, in a randomised placebo controlled trial. We therefore studied whether supplementation with CoQ ameliorates myalgia during statin therapy in a double blind placebo controlled study.
Methods. Forty-four dyslipidemic patients with prior statin-induced myalgia were randomised to 12 weeks treatment with increasing doses of simvastatin (10mg/d −40mg/d) in combination with: CoQ (Q-Gel) 200mg/d (SIMV+COQ) or placebo (SIMV), after a 2-week wash out of lipid lowering therapies. Patients experiencing significant myalgia dropped down a dose level of simvastatin or discontinued the study. Plasma CoQ and lipids were measured at baseline and end of treatment. Myalgic symptoms were evaluated using a myopathic pain score.
Results. Baseline profile (mean ± SEM): age 59 ± 2 yrs, LDL-C 178 ± 3 mg/dL, TG 97 ± 18 mg/dL, and plasma CoQ 1.4 ± 0.1 μmol/L. SIMV+COQ and SIMV produced comparable reductions (medians) in LDL-C (−30% vs −36%) and TG (−17% vs −17%), p<0.001 from baseline. CoQ levels and CoQ/LDL ratio were increased with SIMV+COQ (+131%, + 230%, p<0.001), conversely CoQ levels were decreased with SIMV (−35%, p<0.001). However, no differences were observed between SIMV+COQ and SIMV in the number of patients who tolerated 40mg/d simvastatin (p=0.34), or in the total number of standard 10mg simvastatin doses tolerated (p=0.35). Furthermore, the change in myalgia scores did not differ between treatments (p=0.63).
Conclusion. Despite achieving a significant increase in CoQ levels with SIMV+COQ, CoQ supplementation was not associated with improved statin tolerability. Our findings do not support the concomitant use of CoQ in statin-treated patients who experience myalgic symptoms, however larger studies are warranted.