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Effects of coenzyme Q10 supplementation on myopathy in statin-treated patients: a systematic review and meta-analysis

Svenja Kovacic, Sandra D. Habicht, Gunter Peter Eckert
Journal of Nutritional Science 2025 14:e72

Bibliography

PubMed
PMID 41158831
PubMed Central
PMC12554813
DOI
10.1017/jns.2025.10043
Funding
Financial support was provided by the Society for Applied Vitamin Research (GVF, Jena, Germany).
Competing interests
The authors declared no conflict of interest.

Study snapshot

DesignSystematic review and meta-analysis of randomized controlled trials
ModelAdults taking statins with statin-associated muscle symptoms or muscle pain; CoQ10 supplementation versus placebo/control.
Sample7 randomized controlled trials; 389 participants.
InterventionCoQ10 100–600 mg/day versus placebo/control.
Duration30–90 days across included trials.
EndpointsMuscle pain intensity; Statin-associated muscle symptoms; Risk of bias; Heterogeneity

What the study showed, in plain terms

This 2025 systematic review and meta-analysis pooled seven randomized controlled trials involving 389 statin-treated participants with muscle symptoms. Four trials reported significant pain improvement with CoQ10 and three did not.

The pooled analysis found a modest reduction in muscle pain intensity with CoQ10: WMD -0.96 (95% CI -1.88 to -0.03; p<0.05). Included trials used approximately 100–600 mg/day for 30–90 days.

The result adds a newer positive signal to a literature that remains inconsistent. It should be interpreted alongside the negative confirmed-myalgia Taylor trial, the negative 2020 Kennedy meta-analysis, small sample sizes, heterogeneous symptom definitions and the 2026 ACC/AHA recommendation against routine CoQ10 for statin-attributed muscle symptoms.

Key findings

Seven randomized controlled trials with 389 total participants were included.

Pooled pain intensity favored CoQ10 by WMD -0.96 (95% CI -1.88 to -0.03; p<0.05).

Four included trials reported a statistically significant reduction in muscle pain, while three found no significant change.

Included studies generally used CoQ10 doses from 100 to 600 mg/day and lasted 30 to 90 days.

The pooled signal was modest and arose from a small, heterogeneous evidence base rather than a large definitive trial.

What this study can and cannot tell us

Only seven randomized trials were available, and the individual studies were small.

Trials varied in statin-associated muscle symptom definitions, pain scales, statin regimens, CoQ10 doses and formulations, and treatment duration.

Subjective muscle symptoms are susceptible to placebo and nocebo effects, and most trials did not use a blinded statin rechallenge to confirm pharmacologic statin causality.

The meta-analysis does not establish improved statin continuation, cardiovascular outcomes or a universally effective CoQ10 regimen.

Its modest positive result conflicts with important negative randomized and pooled evidence, so routine efficacy remains uncertain.

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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