Do statin drugs deplete the body’s CoQ10?

Dear Dr. Roach: Iam writing to inquire about the effects of statins on the body. My husband is a 66-year-old diabetic taking metformin and atorvastatin. A highly respected chemist friend told us that the statin drugs completely deplete the body of CoQ10, and recommended blood testing of the lipid particle size before beginning any statins. Is there any evidence that shows that this depletion is factual? If so, would taking a CoQ10 supplement help? Should my husband begin taking this, or does he need to consult with his doctor first? Do you know if the PSA (particle size assessment) blood test is covered by Medicare? — Anon.

Answer: CoQ10, also called ubiquinone, is a vitaminlike compound that is used in the metabolism of some, but not all, statin drugs. The decrease in body levels may, in theory, increase the likelihood of muscle symptoms in people taking statins, especially simvastatin and atorvastatin.

However, in practice, it isn’t clear that CoQ10 supplementation works to either prevent or treat muscle side effects. I don’t recommend it in people who have no trouble taking statins. I have had patients who used it for muscle aches associated with taking a statin, sometimes with success, but it isn’t clear whether this is a placebo response. Since CoQ10 is safe, it’s not unreasonable to try it. Pravastatin and Fluvastatin do not use the same pathway for metabolism and do not deplete CoQ10; however, they are not as potent at lowering cholesterol as atorvastatin is.

Your second question is about particle size. There is fair evidence that smaller LDL particles are worse in terms of causing damage to blood vessels. If someone had an unusual proportion of small LDL, it would make sense to treat him or her at lower levels of cholesterol than would otherwise be recommended, or possibly to use a more-intensive treatment. However, in practice, the number of people whose recommendations would change by knowing their particle size is relatively few.

In your husband’s case, being 66 and diabetic, being on a statin is very likely to have more benefit than harm in almost all levels of cholesterol, so I don’t see the indication, in his particular case, to get an LDL particle size test. It is reasonable in someone for whom a clinician is undecided about whether to give a statin. In these cases, I also consider family history and the use of HS-CRP, another marker that predicts coronary risk independent of cholesterol.

I do not believe the test is covered by Medicare, at the time of this writing.