COENZYME Q10

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Statins are a type of cholesterol medication. At the moment they are the most effective medications we have to reduce LDL or bad cholesterol. If we reduce a patient’s LDL they are less likely to die of a heart attack or a stroke. Statins are usually considered very safe in most people. However, a small number of people on statins get muscle pain. The other day I was explaining to a customer how coenzyme Q10 may prevent or treat this statin related muscle pain. I also said co-enzyme Q10 was a B vitamin. Ever say something and then immediately wonder if what you said was right? Let’s do some fact checking.

Coenzyme Q10 was discovered in 1957. It is a naturally occurring fat soluble compound that is structurally similar to Vitamin K. So I was wrong about it being a B Vitamin. About half of the body’s coenzyme Q10 is obtained through the diet and the rest the body produces itself. It does many things in the body including acting as an antioxidant and helping the cell burn carbohydrates and fats to get energy.

So why should we care about coenzyme Q10? Well, there isn’t a definite answer yet, but it does seem to show some interesting properties. Coenzyme Q10 levels are highest during the first 20 years of life and then decline. At age 80 the levels may be lower than when you were born. If you give Q10 to certain bacteria, you can make them live longer. However, if you give Q10 to rodents for their whole lives, they don't live any longer. Since we are closer relatives to rats than bacteria, that probably means Q10 isn't a fountain of youth. Coenzyme Q10 does have some promise, though. It may help patients with early stage Parkinson's disease not deteriorate as fast and may help people with HIV/AID’s improve their immune function. When some peopled added Q10 to their other blood pressure pills, their blood pressure went down further than with their usual blood pressure pills alone. Coenzyme Q10 may help reduce the number of migraine headaches in some people.

What about statins, coenzyme Q10 and muscle pain? I’m getting to that. Statins are more properly called 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, but statins is way shorter to say. The point of the long name to remind us that statins block an enzyme. That enzyme creates something called mevalonate. Melvalonate is a key building block to make cholesterol. So statins stop a key building block of cholesterol from being formed and thus reduce cholesterol levels. This is good. However, melvalonate is also a key building block for making coenzyme Q10. So statins also reduce the blood levels of conenzyme Q10. This may be bad.

Remember I said coenzyme Q10 helps the cell get energy from burning carbohydrates and fats? This happens in the powerhouses of the cell called the mitochondria. Well, the theory says that statins reduce the coenzyme Q10 in the mitochondria of the muscles. The muscle mitochondria can’t burn carbohydrates and fats as well so they get damaged and cause pain. It’s a good theory! The problem is that the evidence is conflicting. When the scientists look at the muscles of animals and people, statins don’t always make the conenzyme Q10 levels in the muscles go down. Sometimes the muscles even seem to get damaged while having their Q10 levels stay high. On the plus side there were studies that showed a decrease in muscle pain caused by statins in patient who took coenzyme Q10.

So should people take coenzyme Q10 to prevent or treat statin related muscle pain? A 2007 review article in the Journal of the American College of Cardiology said although routine use of Q10 can’t be recommended as the evidence is conflicting, as there are no known risks to Q10 and there might be some benefit, it can be worth a try in individual patients even if it is just a placebo effect.

Who shouldn’t take coenzyme Q10? It is generally considered safe, but as it is chemically similar to Vitamin K, people on warfarin should be careful as it may make warfarin not thin their blood as well.

As always if you have any questions or concerns about these or other products, ask your pharmacist.