Date of Graduation

8-14-2010

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Rob Rosenow, PharmD, OD

Second Advisor

Annjanette Sommers MS, PAC

Abstract

Background: A significant number of the population is on 3-hydroxy-3methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) because statins are the main pharmacologic drug prescribed for the treatment of hypercholesteremia. Statins also have been shown to reduce the relative risks of coronary events. Statins work by inhibiting the mevalonate pathway. This is the same pathway from which Coenzyme Q10 is synthesized. Coenzyme Q10 is essential for muscle respiration. One of the theories is that statin therapy reduces coenzyme Q10 levels in muscle mitochondria, which leads to myalgia. One of the primary side effects of statin drugs is myalgia which often causes patients to decrease the dosage of the statin or discontinue it. The clinical question of whether coenzyme Q10 can be used in the treatment of myopathic pain caused by statin drug use is a common one encountered by health care providers in primary care. This article is a review of the literature to further address this question.

Methods: A systematic review of the English-language published literature was conducted using MEDLINE, CINAHL and ISI Web of Science using keywords myalgia, muscle pain, myopathy, statin, HMG-CoA, reductase inhibitors, Coenzyme Q10, CoQ10, and ubiquinone. There is very limited research examining the outcome of Coenzyme Q10 for the treatment of myopathy in statin users. Two randomized control studies researching this outcome and one prospective cohort study were retrieved and analyzed for quality and results.

Results: One randomized control study found a significant relationship between the use of Coenzyme Q10 and a decrease in myopathic symptoms, as did the prospective cohort study. However, the other randomized control study found no clinical significance in decreased myopathic symptoms with the addition of Coenzyme Q10. Fewer results were of statistical or clinical significance after the adjustments for known confounders were completed. Limited results showed Coenzyme Q10 supplementation decreased myopathic symptoms in patients on statin medications.

Conclusion: Current guidelines suggest placing patients on the lowest dose of statin medication to control the cholesterol and to decrease side effects like myopathy. Additional randomized trials of larger populations are needed to quantify and qualify possible risks of Coenzyme Q10 supplementation using myopathy as an independent risk factor.

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