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Tuesday, May 15, 2007

Coenzyme Q Parkinsons trial -negative results-what about statin myopathy?

A recent randomized clinical trial with 300 mg.0f CoQ 10 per day for three months failed to show any benefit.

Hope for a neuroprotective effect of CoQ 10 was based in part on animal experiments in which mice with MPTP induced Parkinsonian symptoms were shown to have reduced loss of dopaminergic axons when treated with Coenzyme Q.

CoQ 10 has mainly been a star in the world of alternative medicine but also appears from time in efforts to gain acceptance in the more respected world of conventional medicine. In Europe, it seems to have claimed some role in treatment of heart failure and for time to time I have seen cardiologists adding it on to patients with severe HF. At least one Meta-analysis of clinical trials from Europe concluded it had some role in HF treatment.

Some Co Q 10 believers have latched onto the notion that CoQ10 is essential to prevent a putative loss of that enzyme brought about by statin therapy. In their view statin therapy has largely been responsible for what they characterize as a pan-epidemic of heart failure. In their argument they point triumphantly to the fact that Merck did patent a combination of a statin and CoQ 10. I had written about CoQ10 two years ago and mentioned that some physicians were tentatively using it in patients taking a statin who complained of muscle pain but had normal CK levels. That approach may have some validity.

Dr. Robert L. Wortmann, from the University of Oklahoma Medical School, provides some anecdotal evidence for its value in statin associated myalgia/myopathy syndrome. Anecdotal evidence , of course, does not enjoy the top dog role in the evidence hierarchy but in some cases the greater experience of a subject matter expert might have to suffice until the randomized trial data comes along if it ever does. Dr. Worthman and his group were able to accumulate a number of cases and in their opinion a trial of Co Q 10 sometimes seemed to work. They found that a number of patients were heterozygotes for one of several inborn errors of muscle metabolism such as McArdle disease but were asymptomatic before taking one of the statins.
CoQ10 seems fairly side effect free ( it might interfere with coumadin) but it is not cheap and drug insurance plans won't cover it so most docs may well try a different statin and then punt over to Zetia.