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The specifics of the chosen group represent one of the most frequent clinical scenarios in statin-related adverse effects.įifty patients of both sexes, aged between 40 and 65 years, with statin-related muscle pain were recruited in this study. Therefore, the aim of the present study was to test whether coenzyme Q10 supplementation could decrease mild-to-moderate statin-associated muscle pain. Several previous studies have reported conflicting results regarding decrease of statin-related muscle pain by coenzyme Q10 supplementation in different study populations. If the proposed mechanism of statin-related muscle pain is at least partially correct, coenzyme Q10 supplementation seems a logical step in its reduction. Therefore, a deficiency of coenzyme Q10 is the most probable mechanism of statin-related myopathy. Deficiency of coenzyme Q10 affects oxidative phosphorylation and mitochondrial adenosine triphosphate (ATP) production, and consequently impairs muscle energy metabolism.

Coenzyme Q10, also known as ubiquinone, is localized in cellular membranes and participates in electron transport, and during oxidative phosphorylation in mitochondria, protects against oxidative stress and regenerates active forms of the antioxidant vitamin E.

Statins were shown to reduce serum/plasma levels of coenzyme Q10 by 16–54% and coenzyme Q10 supplementation was reported to increase the levels of coenzyme Q10 in plasma. Besides inhibiting the synthesis of cholesterol, biosynthesis of coenzyme Q10 is also reduced, since coenzyme Q10 is an intermediate in the mevalonate pathway. Statins inhibit the rate-limiting step in cholesterol synthesis through acting on the key enzyme 3-hydroxy-3-methylglutaryl coenzyme A (HMGCoA) reductase. For patients who cannot tolerate statin therapy, alternatives include rechallenge with a different statin, dose reduction, or statin withdrawal. In primary prevention, up to 25.4% of patients stop taking statins by 6 months after the beginning of treatment. The most frequent symptom is myalgia, which occurs in 10–15% of patients treated with statins. Treatment with statins is highly effective in primary and secondary cardiovascular disease prevention, but their use can be associated with a variety of adverse effects, mainly affecting the muscles and liver.