Q: Crazy Conspiracy Theory or Useful Supplement?

Over the past several months, the news has been reporting about a shadowy figure named “Q”, who has promulgated many baseless and false theories over a wide range of subjects, mostly about politicians and elections. Similarly, the body has a shadowy “Q”, coenzyme Q, which is ubiquitous and is involved in multiple metabolic pathways. Since the election is over, we will tackle questions about the body’s Q.

 

Coenzyme Q10 (CoQ10) is a naturally occurring substance produced by the body. It plays an essential role in generating energy for the cell. CoQ10 is found in abundance in tissues with high-energy requirements, such as the heart or skeletal muscle. CoQ10 is made in all tissues of the body and the pathway that produces it also produces cholesterol. In general, the body produces as much CoQ10 as it needs, but with aging, the levels of CoQ10 can diminish. Also, importantly, statin use can decrease CoQ10 levels.  CoQ10 is also available as a nutritional supplement with a global market estimated at $600 million. The supplement has been studied extensively and is safe with mild adverse reactions such as dizziness, insomnia, nausea and diarrhea. CoQ10 supplementation may play a role in statin associated muscle pain and in congestive heart failure.

 

Statin associated muscle problems can occur in 10 to 20% of patients who take statins to lower cholesterol. It is one of the major reasons why patients stop taking statins.  Symptoms range from minor muscle aches, to severe muscle pain, cramps and weakness, to muscle breakdown and toxicity (called rhabdomyolysis, a serious condition that can lead to hospitalization, kidney failure and even death).  Unfortunately, there is no objective test to determine statin associated muscle pain. A lab test, creatine kinase or CPK, can be elevated if there is muscle damage, but the test isn’t always reliable. The diagnosis is made by clinical symptoms and stopping the statin (if symptoms improve, they may have been due to the statin). No one knows the cause of statin associated muscle pain, but it has been hypothesized that depletion of CoQ10 may play a role. As such, many trials have been conducted to see if supplementation with CoQ10 would be beneficial. Unfortunately, the trials have been inconclusive and contradictory; some trials show that CoQ10 is beneficial while others do not.  One trial reported more muscle pain in patients who took a statin plus CoQ10 compared to statin plus placebo; a finding known as the nocebo effect. Even though benefit is questionable, there is no harm in taking CoQ10 supplements. Therefore, there may be a role. For patients with statin associated muscle pain the following may be an approach:

1)  Stop the statin for 1 or 2 months

2)  If symptoms improve, restart the same statin at a lower dose or try a different statin 

(if symptoms don’t improve, the muscle pains may be due to something else)

3)  If symptoms return at a low dose or on a different statin, a trial of CoQ10 may be used at a dose of 200 to 400 mg per day

 

Congestive heart failure (CHF) occurs when the heart weakens and cannot pump blood effectively. Fluid builds up in the lungs (causing shortness of breath) or throughout the body (causing swelling in the legs and abdomen).  CHF is the number one cause for hospitalization in the US. CoQ10 is involved with the production of energy in cells, especially heart cells. If CoQ10 is depleted, the heart cells will have reduced energy leading to the weakening of the pumping function of the heart. It has been shown that there are reduced levels of CoQ10 in the blood and in the heart tissue of CHF patients. It has been theorized that supplementation of CoQ10 might improve CHF.  Studies have shown that CoQ10 supplementation does improve symptoms, reduces hospitalizations and decreases cardiac death in chronic CHF patients.  It may also improve the ejection fraction (a measure of the heart’s pumping function). It must be noted that these studies are preliminary and that CoQ10 should only be used in the context of a clinical trial, and not for routine use as yet.

 

CoQ10 is emerging from the shadows and being extensively studied in heart disease.  Depletion of CoQ10 may play a role in statin associated muscle pain and in congestive heart failure.  While awaiting definitive data from future research, nutritional supplementation with CoQ10 may be beneficial in these conditions. It must be noted that CoQ10 is not approved for any medical condition by the Food and Drug Administration (FDA).  In addition, routine us of CoQ10 is not needed in cardiac patients as the body manufactures the amount of CoQ10 that it requires.