Original articleEffects of Coenzyme Q10 on Statin-Induced Myopathy: A Meta-analysis of Randomized Controlled Trials
Section snippets
Data Sources
This study was designed to conform to the guidelines of the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement.20 The search included the MEDLINE, Cochrane Library, Scopus, and EMBASE databases and was limited to randomized controlled trials (RCTs) investigating the efficacy of CoQ10 in reducing statin-induced myopathy in adults published between November 1, 1987, and May 1, 2014. Bibliographies of all retrieved articles were searched for additional relevant
Search Results and Trial Flow
Initial screening for potential relevance excluded articles whose titles or abstracts were clearly irrelevant. After assessment, 6 articles met the inclusion criteria and were selected for the final meta-analysis.24, 25, 26, 27, 28, 29 A summary of the study selection process is shown in Figure 1.
Study Characteristics
Of 226 participants randomized, 118 were allocated to receive CoQ10 therapy and 108 to the control group in the 5 studies presenting data regarding plasma CK activity.24, 26, 27, 28, 29 The number of
Discussion
To our knowledge, the present systematic review is the first to assess the effects of CoQ10 supplementation on statin-induced myopathy and to provide a thorough synthesis of results from RCTs. We observed a lack of a significant effect of CoQ10 supplementation on statin-induced myopathy.
Many small studies have reported that CoQ10 might improve statin tolerance by preventing statin-associated myopathy.1, 3, 24, 26 This effect was attributed to the decline in CoQ10 levels during statin therapy.1,
Conclusion
This meta-analysis of available RCTs does not suggest any significant benefit of CoQ10 supplementation in improving statin-induced myopathy. Furthermore, large-scale, well-designed trials with higher CoQ10 doses are warranted, particularly those in which changes in myopathy-associated circulating and objective measures are among the primary outcomes.
Acknowledgments
Drs Banach and Serban contributed equally to this meta-analysis.
References (44)
- et al.
An assessment by the Statin Muscle Safety Task Force: 2014 update
J Clin Lipid
(2014) - et al.
The role of coenzyme Q10 in statin-associated myopathy: a systematic review
J Am Coll Cardiol
(2007) - et al.
Diagnosis, prevention, and management of statin adverse effects and intolerance: Canadian Working Group Consensus update
Can J Cardiol
(2013) - et al.
Exogenous CoQ10 supplementation prevents plasma ubiquinone reduction induced by HMG-CoA reductase inhibitors
Mol Aspects Med
(1994) - et al.
Effect of atorvastatin on left ventricular diastolic function and ability of coenzyme Q10 to reverse that dysfunction
Am J Cardiol
(2004) - et al.
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement
Int J Surg
(2010) - et al.
Assessing the quality of reports of randomized clinical trials: is blinding necessary?
Control Clin Trials
(1996) - et al.
Effect of coenzyme q10 on myopathic symptoms in patients treated with statins
Am J Cardiol
(2007) - et al.
Effect of coenzyme Q10 supplementation on statin-induced myalgias
Am J Cardiol
(2012) - et al.
Effects of CoQ10 supplementation on plasma lipoprotein lipid, CoQ10 and liver and muscle enzyme levels in hypercholesterolemic patients treated with atorvastatin: a randomized double-blind study
Atherosclerosis
(2007)
Effect of coenzyme Q(10) supplementation on simvastatin-induced myalgia
Am J Cardiol
Therapeutic approaches to mitochondrial dysfunction in Parkinson's disease
Parkinsonism Relat Disord
Statin myotoxicity: a review of genetic susceptibility factors
Neuromuscul Disord
Coenzyme Q10 affects expression of genes involved in cell signalling, metabolism and transport in human CaCo-2 cells
Int J Biochem Cell Biol
Mevalonate pathway: a review of clinical and therapeutical implications
Clin Biochem
A randomized trial of coenzyme Q10 in patients with statin myopathy: rationale and study design
J Clin Lipidol
An assessment by the Statin Intolerance Panel: 2014 update
J Clin Lipidol
Statin-induced myopathy: a review and update
Expert Opin Drug Saf
Hypocalcemic myopathy secondary to hypoparathyroidism
WMJ
Hypoparathyroidism presenting as myopathy with raised creatine kinase
Rheumatology (Oxford)
Hypoparathyroidism in a patient presenting with severe myopathy and skin rash: case report and review of the literature
Hormones (Athens)
Hypocalcemic myopathy without tetany due to idiopathic hypoparathyroidism: case report
Arq Neuropsiquiatr
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Potential Competing Interests: Dr Muntner has received research grants and served as a consultant for Amgen Inc.
Dr Toth serves on the Speakers Bureau for Amarin, AstraZeneca, GSK, Kowa, and Merck. He also serves as a consultant for Aegerion, Amgen, AstraZeneca, Atherotech, Kowa, Liposcience, Merck, Novartis, and Regeneron.
Dr Jones serves on the Scientific Advisory Board and receives grant support from Atherotech Diagnostics Lab, and he serves as a consultant for Sanofi-Regeneron Pharmaceuticals.