Old news, I know – but it is one of Briffa’s hobby horses (not to mention Cybertiger, for those JABS aficionados reading this) and I happened upon an internet forum discussion that was linking to Briffa’s blog. His blog post contained this gem:
Another problem is that there is some evidence that even when patients bring up the possibility of side-effects with their doctor (and there exists scientific evidence to support such a link), the doctor will tend to dismiss the association. It occurs to me, therefore, that if someone is having side-effects such as fatigue, muscle pain and muscle weakness as a result of taking a statin, then they can’t necessarily rely on their doctor for help.
Previously, I have written about this problem, and have discussed the ability of statins to cause the depletion of the nutrient coenzyme Q10 in the body. Lower levels of this substance does seem to be a common causative factor in the common side-effects seen with statins. More importantly, though, is the fact that in practice coenzyme Q10 supplementation very often relieves what can be really quite debilitating symptoms. Not only that, but last year saw the publication of a study which supports the effectiveness of coenzyme Q10 for the reversal of statin-related symptoms.
Briffa states that lower levels of Q10 seems to be a common causative factor in the common side-effects and claims that “in practice” Q10 supplementation can relieve the symptoms. Well, that’s not what I’d heard. What does Briffa cite as evidence? “A study” A single study? Bit thin as evidence for prescribing Q10, isn’t it? Especially when there are reviews on Pubmed that say things like “Although there is not much of a safety concern with coenzyme Q10 supplementation, there is also not enough evidence to support its routine use for preventing the adverse effects of statin therapy, and it is therefore not recommended for this purpose at this time.” Cardiol Rev. 2005 Mar-Apr;13(2):76-9. And “In those limited studies that have assessed the effect of statin treatment upon tissue CoQ(10) levels, none have shown evidence of a fall in CoQ(10) [tissue] levels” Drug Saf.2005;28(8):659-76… and “Routine CoQ10 supplementation for all patients taking statins to prevent myotoxicity is not recommended.” Ann Pharmacother.2006 Feb;40(2):290-4.
Anyhoo, Briffa’s study was this one: Caso et al. “In conclusion, results suggest that coenzyme Q10 supplementation may decrease muscle pain associated with statin treatment. Thus, coenzyme Q10 supplementation may offer an alternative to stopping treatment with these vital drugs.” Sounds fair enough – and if CoQ10 is a potentially useful adjunct to statins that could help patients then great. But it was only a single study with 18 subjects taking Q10 and 14 taking Vitamin E. I still think it’s a bit thin as evidence on which to make judgements about which treatments to recommend or not. [Edit] Apart from anything else: This trial lacked a placebo-control design and patients were not on a standardised dose or type of statin. [linky] [/Edit]
Links: Briffa’s Q10 post; A Classic Briffa Q10 post. The first link is to the blog post I quoted from – if you want to read John Briffa’s full, unexpurgated views on Q10 and statins then I recommend you start there.
As always your comments corrections, and criticism are welcome.