CoQ10 and Statins: Why Take Them Together

Coenzyme Q10 (CoQ10) is important for energy production and cellular health, particularly in high-energy organs and muscle tissue. It also acts as a powerful antioxidant. 

Statins are used to manage cholesterol levels and support cardiovascular health, but they can reduce CoQ10 levels, which may lead to muscle discomfort. Taking CoQ10 supplements alongside statins may help manage these effects and support overall heart health, making it a potential addition for many individuals on statin therapy. 

The purpose of this article is to explore the potential advantages and considerations of taking CoQ10 and statins, their impact on cardiovascular health, and the use of CoQ10 to help manage statin side effects and support potential health benefits. 

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What Is CoQ10?

CoQ10 is a vitamin-like compound that is made in the body and exists in virtually all cell membranes. CoQ10 is particularly vital to mitochondrial production of ATP (the body’s energy source) and cellular respiration as part of the electron transport chain and, thus is an essential component of metabolic function (35). This makes it an especially important compound for organs with high energy demands, such as the heart and muscle tissues (49).  

CoQ10, in its reduced form, ubiquinol, functions as a powerful antioxidant, scavenging free radicals that could otherwise damage tissues and lead to inflammation and disease processes. It can be recycled and reused and has a synergistic effect when in the presence of other antioxidants, such as Vitamins E and C (51).

Sources of CoQ10

The richest food sources of CoQ10 include:

• Organ meats such as liver and heart
• Beef, pork, chicken
• Fish such as herring, mackerel, sardines, and yellowtail
• Vegetable oils such as olive oil
• Nuts and seeds: peanuts, pistachios, sesame seeds, walnuts, hazelnuts

In supplement form, it can be commonly found as CoQ10, ubiquinone, or ubiquinol. 

Potential Benefits of CoQ10

• Supporting heart health: many cardiovascular conditions, such as heart failure and atherosclerosis, are associated with oxidative stress. CoQ10’s antioxidant functions may help manage these effects and support cardiovascular health. Additionally, its role in energy production can support heart muscle function, potentially enhancing heart contractility (36). 
• Fibromyalgia: fibromyalgia patients tend to have lower CoQ10 levels, suggesting CoQ10 deficiency as a potential factor (36). Some patients supplementing with CoQ10 have reported a reduction in symptoms. 
• Blood pressure support: CoQ10 appears to support healthy blood pressure levels in some individuals, possibly through the production of nitric oxide, which helps to relax and dilate peripheral arteries (36). 
• Blood sugar regulation: CoQ10 supplementation has been associated with changes in fasting insulin, fasting blood glucose, and hemoglobin A1c levels.
• Immune support: CoQ10 may help support immune system function and protect against oxidation, which are important for overall health (36).  
• Neurological support: CoQ10’s antioxidant actions may help to manage oxidative processes that contribute to neurodegenerative conditions such as Alzheimer’s and Parkinson’s diseases (36). 

What Are Statins?

Statin medications are a tool for managing cholesterol imbalances by supporting healthy total cholesterol, low density lipoprotein (LDL), and triglyceride levels in individuals with high cholesterol and supporting cardiovascular health (48). 

Statins work by inhibiting hydroxymethylglutaryl-CoA (HMG-CoA) reductase which is an enzyme involved in the production of cholesterol. This leads to reduced cholesterol synthesis in the liver and increased cholesterol uptake from the blood. In addition, statins exhibit anti-inflammatory, antioxidant, and plaque stabilizing effects (52). 

Conditions Supported by Statins

• High cholesterol
• High triglycerides
• Atherosclerosis is a condition in which plaque builds up in the arteries
• Support for atherosclerosis-associated conditions such as heart attack, ischemic stroke, angina, and peripheral artery disease
• Nonalcoholic fatty liver disease

Common Statin Side Effects

Although generally well tolerated, statins can sometimes result in mild to severe side effects such as:

• Muscle pain and weakness
• Headache
• Nausea
• Diarrhea or constipation
• Liver dysfunction
• Increased risk for diabetes 
• Rhabdomyolysis in rare cases

Why Consider CoQ10 and Statins Together?

Statins and CoQ10 Levels

Although statins can effectively manage cholesterol synthesis by inhibiting HMG-CoA reductase, they also have the effect of reducing CoQ10, which is produced along the same pathway (6). Indeed, statins have been found to reduce blood levels of CoQ10 in human studies. 

The outcome of CoQ10 reduction is likely exacerbated by statin-induced effects on mitochondrial function, leading to poor muscle performance and muscle cell damage. This contributes to the muscle discomfort that some individuals on statins experience, a main cause for treatment discontinuation (43). A study confirmed that symptomatic individuals on statins showed evidence of structural muscle injury in their tissues. 

Potential Benefits of CoQ10 Supplementation with Statins

Muscle-related symptoms affect up to 25% of individuals on statin therapy and are one of the main causes of statin dose reduction and discontinuation. This can have important health implications. One study found significant increases in all-cause mortality and cardiovascular disease incidence in individuals who did not take statin therapy as prescribed. 

CoQ10 supplementation offers a potential option to help increase adherence by managing side effects. Recent randomized control studies demonstrated that supplementation with CoQ10 reduced statin-associated symptoms such as muscle discomfort. 

Additionally, CoQ10 use may offer additional cardiovascular support via its antioxidant actions and ability to support heart function in those with cardiovascular considerations (36). 

When CoQ10 and Statins Might Be Considered

In individuals experiencing muscle symptoms while on statins or who could benefit from increased cardiovascular support, CoQ10 can be supplemented at a dose of 100-600 mg daily (48). The CoQ10/ubiquinone forms are preferable to ubiquinol for this purpose, as studies on ubiquinol could not produce the same cardiovascular support. Working with a healthcare provider is ideal to determine the most appropriate form, dosage, and timing for maximum effect. 

Side Effects and Considerations of CoQ10 and Statins

CoQ10 Supplementation Side Effects

As CoQ10 is produced naturally in the body, side effects of CoQ10 supplements are rare but can include:

• Upset stomach
• Nausea
• Diarrhea
• Mild insomnia
• Liver enzyme elevation at higher doses

Considerations for Taking CoQ10 and Statins Together

Although CoQ10 is generally considered safe to take along with statin medications, it is important to work with a healthcare provider as both CoQ10 and statin can potentially interact with other medicines. 

Additionally, CoQ10 should not be taken in cases of gallbladder obstruction, and statins should be avoided in individuals with liver disease. Neither should be taken during pregnancy or when breastfeeding (53).

Lab Testing for Statins and CoQ10

CoQ10 Testing

CoQ10 testing can help identify which individuals are at greatest risk for CoQ10 reduction and thus might benefit from supplementation. 

Monitoring Cholesterol Levels

To monitor the efficacy of statin treatment, a fasting cholesterol panel should be measured before treatment and then every 4-12 weeks until the maintenance dose is achieved. After that, cholesterol should be monitored every 3-12 months to assess efficacy (52). 

Moderate intensity statins should result in a 30-50% reduction in LDL, while high intensity doses can reduce LDL by 50% or more below baseline. In individuals taking atorvastatin, full effects were achieved within 2 weeks of medication onset in 90% of individuals. If these levels are not met by the initial 4-12 week follow up, dosing or medication adjustments may be required (52). 

Monitoring for Complications

• Liver function tests should be measured before initiating statin therapy as liver disease is a contraindication to statin use. Otherwise, liver function tests do not need to be routinely run unless liver symptoms develop. 
• Creatine kinase testing, which assesses for muscle damage, is not needed unless severe muscle symptoms occur. 

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Key Takeaways

• CoQ10 is important for energy production and antioxidant protection, especially in heart and muscle tissues.
• Statins are a group of medications that are effective at managing cholesterol levels and supporting cardiovascular health but can reduce CoQ10 levels.
• Concurrent CoQ10 supplementation and statin use may help manage statin-induced muscle discomfort and support heart health.
• Regular lab tests and monitoring are crucial for safe and effective treatment with statins and CoQ10.
• Always consult healthcare providers to determine the right dosage and address any side effects or concerns with statin and CoQ10 use.