Let’s face it: few of us likes taking prescription drugs. But, unfortunately, taking drugs sometimes becomes a way of life when dealing with heart disease.
If you have heart disease, there is a good chance you were prescribed a statin drug if diet, exercise, and supplements were no longer capable of keeping your cholesterol under control.
We have certainly come a long way since the first statin drug lovastatin (Mevacor), which was derived from oyster mushrooms and red yeast rice and FDA approved in 1987. It was followed shortly thereafter by pravastatin (Pravachol) and simvastatin (Zocor). Next, came the more powerful “second generation” statins like atorvastatin (Lipitor) and rosuvastatin (Crestor), which allowed many of us to lower our dose. The newest statin, pitavastatin (Livalo), not only reduces LDL cholesterol but also has been shown to significantly – as much as 40 percent – increase HDL cholesterol and is purported to have fewer side effects.
Yet, for all the advancements in statin drug development, muscle pain remains one of the major reasons patients discontinue statin treatment. Drug manufacturers tell us that the likelihood of side effects from statin agents is low, approximately one to two percent for serious muscle damage and liver dysfunction (which is the reason most doctors routinely test their patients on statins for elevated liver enzymes). These percentages are based on the frequency of side effects observed in formal clinical trials.
However, many physicians will tell you the incidence is higher. Some suggest muscle aches and weakness occur in approximately 30 percent of people taking statin agents. Others maintain that, given enough time, virtually every one of their patients seem to develop muscle aches. This is certainly subject to much debate since statin use is a long-term prospect and most people eventually develop muscle aches as they age, but the observation of muscle aches while on statins cannot be ignored.
Are the symptoms progressive and will they lead to irreversible damage of some sort? The existing experience dating back over twenty years suggest that mild muscle aches or weakness are not progressive and do not result in any long-term damaging effects. Thankfully, serious muscle side effects like rhabdomyolysis, a life-threatening breakdown of muscle tissue, are rare.
In terms of lowering cholesterol, statins are pretty good drugs, considering that they’re intended for long-term use. Imagine taking an antibiotic for 10 or 20 years! Even 10 days of antibiotic treatment can leave you with an stomach upset, diarrhea and opportunistic infections that emerge after elimination of the original infection. Given this perspective, the majority of people taking statin drugs year after year really do pretty well.
Statins block the production of cholesterol and CoQ10
All current statins work by inhibiting the production of HMG-CoA reductase, an enzyme used by the body to produce mevalonate, a key building block in the production of cholesterol. Unfortunately, mevalonate is also used by the body to produce C0Q10. Blocking mevalonate to reduce cholesterol production also reduces production of CoQ10. But, CoQ10 is a participant in energy production in muscle tissue throughout the body, including skeletal muscle in your arms and legs as well as heart muscle.
An early observation in a handful of patients on lovastatin (the only statin available at the time) from the University of Texas suggested a dramatic reduction of CoQ10 blood levels. They also showed that CoQ10 administration corrected blood levels and all adverse effects. Another Columbia University study demonstrated that the blood levels of people taking atorvastatin dropped by 50 percent within four weeks. These findings have been confirmed by several other centers.
Another study conducted at the Neuromuscular Science Center of the University of Milan revealed that people suffering from muscle weakness and aches while on atorvastatin showed distortions in muscle cell structure when biopsied. It seems inarguable that statin drugs significantly reduce CoQ10 levels in the body, especially in muscle tissue, and this may be the cause for many of the side-effects.
Replacing what is lost
If statin drugs deplete blood and muscle CoQ10, can we replace it by taking supplemental CoQ10? It is certainly an imperfect situation to treat the side-effect of one drug with another agent. But, for many people, statins are an important part of their program to reduce heart disease risk. People with very high LDL cholesterols, for instance, of 200 or greater, typically are unable to substantially reduce LDL with diet or nutritional supplements. In this situation, a statin drug really provides substantial advantage.
If a statin drug is an important part of your overall program, then CoQ10 can be a real lifesaver. CoQ10 supplementation may be indispensable for muscle ache symptoms. I take CoQ10 to relieve muscle aches related to my statin use (5mg Crestor). My personal experience is that oil-based preparations of CoQ10 are more effective than powdered preparations. Oil-based capsules are generally opaque and the product label will say something like, “Each capsules contains 100 mg of coenzyme Q10 in a base of soybean oil (or rice bran oil or some other vegetable oil).”
Of course, everyone is different but a common effective dose is 100 mg per day (my dose). Ask your doctor what is right for you. Trial and error will help guide you and your doctor on what dose is required. Please keep in mind that, if you experience muscle aches or weakness on any of the statin drugs, you should first inform you doctor before you embark on a CoQ10 replacement program. Is CoQ10 supplementation 100% percent effective in sparing you from muscle aches and weakness, or in providing relief once you develop them? Some anecdotal observations suggest that 80 to 90 percent of people realize substantial relief of symptoms on CoQ10.
CoQ10 does more than relieve muscle aches
CoQ10 may provide benefits beyond relief of statin-related muscle aches. Numerous clinical studies have examined CoQ10’s effects on blood pressure. The pooled data reveal an impressive drop of 16 mg Hg in systolic pressure, 10 mg drop in diastolic pressure with CoQ10.
Many people with high blood pressure develop abnormally thickened heart muscle (“left ventricular hypertrophy”). Reduction of abnormal heart muscle thickening (measured by ultrasound, or echocardiography), may also be a benefit of CoQ10 replacement. Interesting data from the University of Texas-Austin suggests that abnormal hypertrophy resulting from high blood pressure can be substantially reversed with CoQ10 treatment.
If muscle tissue in arms and legs are affected by statin therapy, what about the heart muscle? This question has been raised, with some authorities proposing that statin therapy may increase the likelihood of congestive heart failure by inadvertently impairing the strength of heart muscle. This issue remains largely unsettled, though the implications are considerable. A significant body of scientific literature already exists documenting the beneficial effects of CoQ10 supplementation for heart failure. However, it is not yet clear whether CoQ10 depletion by statin drugs impairs heart muscle, and whether CoQ10 supplementation will block this effect.
If you need to take a statin drug
If you’re among the people like me who truly require a statin drug to reduce LDL, then you should be aware of the CoQ10 issue. In my experience, the likelihood of muscle aches and weakness is so high that, given sufficient time, it will eventually affect you.
If you develop muscle aches or weakness while taking a statin, first inform your doctor so that he/she can help you decide if the statin drug is to blame and if real muscle injury is occurring. If no real injury is occurring and the statin drug is truly the culprit, you might consider taking supplemental CoQ10 after approval by your doctor.
What if you don’t have any symptoms yet? Should you take CoQ10 preventively? Because the symptoms are so common and predictable, and because CoQ10 is virtually side-effect free, taking it to prevent muscle symptoms (with the approval of your doctor) seems like a safe bet. The only drawback is cost. CoQ10 supplements tend to be very pricey, as much as $40-$50 per bottle. But you’ll also obtain the other benefits of CoQ10 such as blood pressure reduction, improved energy, and possible protection against the heart muscle-impairing effects.
As always, I must caution that we are all different and you should never start a new therapy without consulting your doctor. My personal experience with CoQ10 is very positive and the same is true of the many people on statins I routinely talk with!
Looking out for your heart health,