Statins, Coenzyme Q10 and Genetic Susceptibility to Myopathy
Sathasivam and Lecky discuss the possible role coenzyme Q10 (CoQ10)
depletion as a patho-physiological mechanism of statin-induced
myopathy(1). They also indicated that one trial has shown a positive
effect of CoQ10 supplementation on statin tolerance (2), although this
trial was not placebo-controlled and patients were not on a standardised
dose or type of statin. In our study (3), 44 patients with prior statin-
induced myalgia were randomised to treatment with CoQ10 or placebo for 12
weeks in combination with upward dose titration of simvastatin at 10
mg/day, doubling every 4 weeks if tolerated to a maximum dose of 40 mg/day
simvastatin. We observed no difference between combined therapy and statin
alone in the myalgia score; in the number of patients who achieved and
tolerated 40 mg/day simvastatin or in the number remaining on any
simvastatin dose. An important explanatory variable, that may be
pertinent to responsiveness to CoQ10 in this group of patients, may be
genetic susceptibility to muscle disorders and underlying metabolic
myopathies.
Sathasivam and Lecky1 reference the study of Vladutiu et al.
who observed a 4-fold increase in mutations which cause three metabolic
myopathies: carnitine palmitoyltransferase II deficiency, McArdle’s
disease and myoadenylate deaminase deficiency, in individuals with
primarily statin-induced myopathies (4). However, they did not reference
Oh et al, who reported a 2.33 – 2.58 fold increase in the relative risk of
statin intolerance associated with polymorphisms in the CoQ2 gene (5). As
individuals with mutations for underlying metabolic myopathies may
represent a subgroup of the statin-treated population for whom CoQ10
supplementation may be more likely to confer a clinical benefit this
warrants further investigation.
2. Caso G, Kelly P, McNurlan MA, Lawson WE. Effect of coenzyme q10
on myopathic symptoms in patients treated with statins. Am J Cardiol.
2007;99(10):1409-12.
3. Young JM, Florkowski CM, Molyneux SL, et al. Effect of coenzyme
Q(10) supplementation on simvastatin-induced myalgia. Am J Cardiol.
2007;100(9):1400-3.
4. Vladutiu GD, Simmons Z, Isackson PJ, et al. Genetic risk factors
associated with lipid-lowering drug-induced myopathies. Muscle Nerve.
2006;34(2):153-62.
5. Oh J, Ban MR, Miskie BA, Pollex RL, Hegele RA. Genetic
determinants of statin intolerance. Lipids Health Dis. 2007;6:7.
Competing interests:
None declared
Competing interests:
No competing interests
29 January 2009
Joanna M. Young
Scientist
Christopher M. Florkowski, Sarah L. Molyneux, Russell S. Scott, and Peter M. George
Lipid and Diabetes Research Group, Christchurch Hospital, Pirvate Bag 4710, Christchurch 8040, NZ
Rapid Response:
Statins, Coenzyme Q10 and Genetic Susceptibility to Myopathy
Sathasivam and Lecky discuss the possible role coenzyme Q10 (CoQ10)
depletion as a patho-physiological mechanism of statin-induced
myopathy(1). They also indicated that one trial has shown a positive
effect of CoQ10 supplementation on statin tolerance (2), although this
trial was not placebo-controlled and patients were not on a standardised
dose or type of statin. In our study (3), 44 patients with prior statin-
induced myalgia were randomised to treatment with CoQ10 or placebo for 12
weeks in combination with upward dose titration of simvastatin at 10
mg/day, doubling every 4 weeks if tolerated to a maximum dose of 40 mg/day
simvastatin. We observed no difference between combined therapy and statin
alone in the myalgia score; in the number of patients who achieved and
tolerated 40 mg/day simvastatin or in the number remaining on any
simvastatin dose. An important explanatory variable, that may be
pertinent to responsiveness to CoQ10 in this group of patients, may be
genetic susceptibility to muscle disorders and underlying metabolic
myopathies.
Sathasivam and Lecky1 reference the study of Vladutiu et al.
who observed a 4-fold increase in mutations which cause three metabolic
myopathies: carnitine palmitoyltransferase II deficiency, McArdle’s
disease and myoadenylate deaminase deficiency, in individuals with
primarily statin-induced myopathies (4). However, they did not reference
Oh et al, who reported a 2.33 – 2.58 fold increase in the relative risk of
statin intolerance associated with polymorphisms in the CoQ2 gene (5). As
individuals with mutations for underlying metabolic myopathies may
represent a subgroup of the statin-treated population for whom CoQ10
supplementation may be more likely to confer a clinical benefit this
warrants further investigation.
1. Sathasivam S, Lecky B. Statin induced myopathy. BMJ. 2008; 337:
1159-62.
2. Caso G, Kelly P, McNurlan MA, Lawson WE. Effect of coenzyme q10
on myopathic symptoms in patients treated with statins. Am J Cardiol.
2007;99(10):1409-12.
3. Young JM, Florkowski CM, Molyneux SL, et al. Effect of coenzyme
Q(10) supplementation on simvastatin-induced myalgia. Am J Cardiol.
2007;100(9):1400-3.
4. Vladutiu GD, Simmons Z, Isackson PJ, et al. Genetic risk factors
associated with lipid-lowering drug-induced myopathies. Muscle Nerve.
2006;34(2):153-62.
5. Oh J, Ban MR, Miskie BA, Pollex RL, Hegele RA. Genetic
determinants of statin intolerance. Lipids Health Dis. 2007;6:7.
Competing interests:
None declared
Competing interests: No competing interests