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Wednesday, June 08, 2005

Is Co Q 10 getting more medically main stream?

A paper presented at the recent American College of Cardiology, as reported in Internal Medicine News, claimed that supplementation with Co Q 10 (100 mg a day) reduced statin related myopathic pain. This was a small RCT ( n=41). The subjects complained on muscle pain while taking a statin and had either normal or minimally elevated CK levels and 18/21 patients reported improvement in symptoms while taking the Co Q 10.
There is a large body of published material on Co q 10 and many of the Google hits take you to sites that are health product sites selling numerous supplements.
There are data that indicate that statins may lower the blood levels of Co Q 10 in animals and humans and muscle levels in animals and that these levels can be raised by oral administration of Co Q 10 which seems relatively free of side effects and drug interactions. (coumadin may be an exception) In Europe it has been used to some extent in the treatment of heart failure but in the U.S. it is not found in the medication list recommended by the ACC for HF treatment.
Dr. Peter H. Langsjoen, a cardiologist in Tyler Texas, has written extensively expounding the thesis that myocardial depletion of Co Q 10 is caused by statins and this plays a role in what he describes as a epidemic of heart failure. A 2003 Fortune article featured some of Dr. Langsjoen's views in an article on Lipitor and its promotion by Pfizer. (a subscription is needed to view the article so I have no link but the purported heart failure link to statins received some attention at that time).
The Wellness movement has written extensively about the value of Co Q 10 as a supplement to prevent statin related side effects. Dr. Julian Whitaker petitioned the FDA on May 24, 2002 to require a black box warning of all statins recommending that 100-200 mg of Co Q 10 be taken with the statin. Dr. Whitaker is described in the petition as the Clinical Director of the Whitaker Wellness Institute.
There is at least one indication that Co Q 10 is getting more into the main stream. A web site from UCSD mentions Co q 10 as possibly useful in the muscle problems that might occur with statins. They stop short of actually recommending it, however. It was a group from San Diego who reported the " syndrome" of myopathy with normal CK which attracted considerable attention and an editorial from the NCEP group's chairman,Dr. Scott Grundy, who opined the syndrome might be real and should be investigated further but made no mention of Co Q 10.
I have noticed that more and more physicians are trying Co Q 10 to mitigate complaints of muscle aching in patients on statins who have a normal CK for whom they feel the cholesterol lowering is a clinical priority. Most docs, in my experience, would discontinue the statin if the CK is elevated.

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