Statins are drugs that reduce cholesterol by inhibiting an enzyme in the liver known as ‘HMG-CoA reductase’. This enzyme ‘drives’ cholesterol production. HMG-CoA reductase also participates in the formation of a substance known as ‘coenzyme Q10,’ which is involved in energy production in the body. Specifically, coenzyme Q10 (or CoQ10 for short) helps in the production of what is known as ‘adenosine triphosphate’ (ATP) – the most basic unit of energy ‘fuel’ in the body. The major process which drives ATP production in the body utilising CoQ10 is known as ‘oxidative phosphorylation’.
Now we’ve got the biochemistry out of the way, it becomes clear that one potential risk of taking statins is to hinder oxidative phosphorylation and ATP production in the muscles, which may then lead to symptoms such as fatigue and muscle pain.
In a study published this week in the Journal of the American College of Cardiology (JACC), researchers based in Denmark measured CoQ10 levels in individuals taking simvastatin (a commonly-prescribed statin), and compared them with individuals not taking statins . The levels in those taking the statin were significantly lower.
Now, a study of this nature is what is termed ‘epidemiological’, which means it looks at associations between things but cannot prove that one thing is causing another. However, of relevance here is other evidence which finds that administration of statins can lower levels of CoQ10 in the body . In other words, statins do indeed have the capacity to deplete the body of CoQ10, strengthening the results of this latest study.
Depleting CoQ10 may be hazardous for cardiac health
What was also interesting about the JACC study is that it found that those treated with statins had lower levels of oxidative phosphorylation than those not taking them. They also had reduced ‘insulin sensitivity’. This is relevant for a number of reasons, including the fact that insulin facilitates the uptake of nutrients such as glucose into the cells. Lowered insulin sensitivity can therefore ‘starve’ the cells of essential nutrients. Reduced insulin sensitivity is also the underlying fault in type 2 diabetes. It is perhaps worth bearing in mind that statin use has been proven to increase the risk of type 2 diabetes.
The authors of the study conclude that: “It is plausible that [their] finding partly explains the muscle pain and exercise intolerance that many patients experience with their statin treatment.”
Another thing worth bearing in mind here, I think, is the fact that the heart is a muscle, and depleting it of CoQ10 may be hazardous for cardiac health. Specifically, it may weaken the heart and lead to what is known as ‘heart failure’.
In researching this article, I came across an interesting review of the evidence for statin-induced CoQ10 depletion in both humans and animals . The authors raise the alarm regarding real and increasing problems here, and conclude: “Statin-induced CoQ10 deficiency is completely preventable with supplemental CoQ10 with no adverse impact on the cholesterol lowering or anti-inflammatory properties of the statin drugs. We are currently in the midst of a congestive heart failure epidemic in the United States, the cause or causes of which are unclear. As physicians, it is our duty to be absolutely certain that we are not inadvertently doing harm to our patients by creating a wide-spread deficiency of a nutrient critically important for normal heart function.”
Here’s to a healthy heart
Dr John Briffa
for The Cholesterol Truth
Bear in mind we are not addressing anyone’s personal situation and you should rely on this for informational purposes only. Please consult with your own physician before acting on any recommendations contained herein.
1. Larsen S, et al. Simvastatin Effects on Skeletal Muscle – Relation to Decreased Mitochondrial Function and Glucose Intolerance. J Am Coll Cardiol. 2013;61(1):44-53
2. Passi S, et al. Statins lower plasma and lymphocyte ubiquinol/ubiquinone without affecting other antioxidants and PUFA. Biofactors 2003;18(1-4):113-24.
3. Langsjoen PH, et al. The clinical use of HMG CoA-reductase inhibitors and the associated depletion of coenzyme Q10. A review of animal and human publications. Biofactors 2003;18(1-4):101-11.
Category: Statin Drugs Side Effects