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Effect of Coenzyme Q10 on statin-associated myalgia and adherence to statin therapy: A systematic review and meta-analysis

Cormac Kennedy, Yasmin Köller, Elena Surkova
Atherosclerosis 2020 299:1-8

Bibliography

PubMed
PMID 32179207
DOI
10.1016/j.atherosclerosis.2020.03.006
Funding
A specific funding grant for this review was not identified in the accessible PubMed record checked during this audit.
Competing interests
The authors declared no conflicts of interest with respect to the manuscript.

Study snapshot

DesignSystematic review and meta-analysis of randomized controlled trials
ModelSystematic review and meta-analysis of randomized placebo-controlled trials of oral CoQ10 in adults with statin-associated myalgia, with statin continuation/adherence as a secondary outcome.
Sample8 studies included in the systematic review; 7 studies with 321 participants included in the quantitative meta-analysis. Individual trial sample sizes ranged from 37 to 76.
InterventionOral CoQ10 supplementation versus placebo in adults with statin-associated myalgia; included trials were published from 2007 to 2016 and used heterogeneous doses and myalgia definitions.
Duration
EndpointsMyalgia symptom severity; Continuation of statin therapy; Risk of bias; Sensitivity analyses

What the study showed, in plain terms

This 2020 systematic review is an important counterweight to the positive 2018 meta-analysis. It included eight randomized studies and pooled seven trials with 321 participants. Only two individual studies showed a positive effect of CoQ10 on muscle pain.

The pooled myalgia estimate did not show benefit: WMD -0.42 (95% CI -1.47 to 0.62). CoQ10 also did not improve the proportion of participants who remained on statin treatment (RR 0.99, 95% CI 0.81–1.20).

The review therefore concluded that current randomized evidence did not demonstrate improved statin-associated muscle pain or statin adherence. The disagreement across meta-analyses reflects a small, heterogeneous trial literature with inconsistent case definitions and symptom scales.

Key findings

Myalgia: 7 pooled studies/321 participants; WMD -0.42, 95% CI -1.47 to 0.62—no statistically significant benefit.

Statin continuation/adherence: RR 0.99, 95% CI 0.81–1.20—no improvement in the proportion remaining on statin therapy.

Only 2 of the 8 studies included in the systematic review independently demonstrated a positive effect of CoQ10 on muscle pain.

Included studies were published from 2007–2016 and ranged from 37–76 participants, emphasizing the small-trial nature of the evidence base.

Risk of bias was formally assessed with the Cochrane Risk of Bias tool and pooled/sensitivity analyses were performed.

What this study can and cannot tell us

The evidence base remained small: seven pooled studies and 321 participants.

Definitions of statin-associated myalgia, symptom scales, statin regimens, CoQ10 doses/formulations and treatment durations varied between trials.

Most trials were not preceded by a blinded statin-versus-placebo confirmation phase, so some enrolled symptoms may not have been pharmacologically caused by statins.

The pooled confidence interval remains compatible with modest benefit or harm; the result rules out a large consistent effect more confidently than it rules out small effects in selected patients.

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Dr. Khaled Mahmoud, MBBChCritical Care Medicine, Longevity Science & Editorial Direction Dr. Amr Yasser, PhDCardiometabolic, Musculoskeletal, Gut & Bioavailability Dr. Abdulla Mostafa, PhDCellular Senescence, Neurological, Mitochondrial & Brain-Ageing Biology