Supplementation with coenzyme Q10 may be an effective approach for managing statin-induced myopathy, according to an updated meta-analysis published in the Journal of the American Heart Association.
The authors searched relevant databases, including PubMed, EMBASE, and Cochrane Library, for randomized controlled trials that examined the association between coenzyme Q10 and statin-induced myopathy. From this search, 12 trials were identified, enrolling a total of 575 participants, who were randomized to receive coenzyme Q10 supplementation (n=294) or placebo (n=281).
Using a fixed-effect model and a random-effect model, the authors assessed the outcomes of coenzyme Q10 supplementation on statin-associated muscle symptoms and plasma creatine kinase levels; these were reported in terms of the pooled weighted mean difference (WMD). The authors also evaluated the studies’ methodological quality using the Cochrane Handbook, and publication bias using a funnel plot, Egger regression model, and the Begg-Mazumdar correlation test.
Compared with the placebo group, patients who received coenzyme Q10 supplementation experienced a reduction in statin-associated muscle symptoms: muscle pain (WMD -1.6; 95% CI, -1.75 to -1.44; P <.001), muscle weakness (WMD -2.28; 95% CI, -2.79 to -1.77; P =.006), muscle cramp (WMD -1.78; 95% CI, -2.31 to -1.24; P <.001), and muscle tiredness (WMD -1.75; 95% CI, -2.31 to -1.19; P <.001).
In comparing the 2 groups, no significant reduction in plasma creatine kinase levels (WMD 0.09; 95% CI, -0.06 to 0.24; P =.23) was reported. The authors observed significant heterogeneity in the included studies, even when adjusting for coenzyme Q10 dose and duration, and year of study publication.
The authors performed sensitivity analyses and revealed that the effect of coenzyme Q10 supplementation on muscle symptoms and plasma creatine levels did not differ significantly among the studies. No obvious publication bias was found for the effect of coenzyme Q10 supplementation or plasma creatine levels.
Limitations of the meta-analysis included a small number of eligible randomized controlled trials from which to draw data. Additionally, these trials included relatively small sample populations and therefore the impact of patient-related variables on outcomes were difficult to evaluate. The eligible studies were considered heterogeneous due to sample characteristics, coenzyme Q10 supplementation dose, and duration time.
The authors concluded that coenzyme Q10 supplementation effectively mitigated statin-associated muscle symptoms, suggesting that coenzyme Q10 supplementation may be used as a complementary therapy to manage myopathy induced by statin use.
Qu H, Guo M, Chai H, Wang WT, Gao ZY, Shi DZ. Effects of coenzyme Q10 on statin-induced myopathy: an updated meta-analysis of randomized controlled trials [published online September 28, 2018.] J Am Heart Assoc. doi:10.1161/JAHA.118.009835