Dr. Ron’s Research Review – February 14, 2018

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This week’s research review focuses on statin myopathy – CoQ10 and creatine.

Coenzyme Q10

Fifty patients treated with statins and reporting muscle pain were recruited. The Q10 group (n=25) received coenzyme Q10 supplementation over a period of 30 days (50 mg twice daily), and the control group (n=25) received placebo. The Brief Pain Inventory (BPI) questionnaire was used and blood testing was performed at inclusion in the study and after 30 days of supplementation. The intensity of muscle pain, measured as the Pain Severity Score (PSS), in the Q10 group was reduced from 3.9±0.4 to 2.9±0.4 (P<0.001). The Pain Interference Score (PIS) after Q10 supplementation was reduced from 4.0±0.4 to 2.6±0.4 (P<0.001). In the placebo group, PSS and PIS did not change. Coenzyme Q10 supplementation decreased statin-related muscle symptoms in 75% of patients. The relative values of PSS and PIS significantly decreased (-33.1% and -40.3%, respectively) in the Q10 group compared to placebo group (both P<0.05). From baseline, no differences in liver and muscle enzymes or cholesterol values were found. Coenzyme Q10 supplementation (50 mg twice daily) effectively reduced statin-related mild-to-moderate muscular symptoms, causing lower interference of statin-related muscular symptoms with daily activities. (Skarlovnik et al., 2014)

Creatine

An open-labeled case series of creatine supplementation was conducted in 12 patients with known intolerance to at least 3 statins. Controls were created by starting, withdrawing, and restarting creatine treatment during statin therapy. Myopathy scores were significantly higher after the statin-only treatment phase than at baseline but did not differ from baseline after the other treatment phases. Creatine loading plus maintenance creatine therapy prevented myopathy symptoms in 8 of 10 patients receiving statins. After these 8 patients stopped maintenance creatine therapy and developed myopathy symptoms while receiving statins alone, reloading creatine decreased symptoms to baseline levels. Also, increasing the creatine dosage from maintenance to loading diminished myopathy symptoms to baseline levels in 1 patient who developed symptoms 6 days after a statin was added to maintenance creatine therapy. (Shewmon and Craig, 2010)

Dr. Ron


 

Articles

Creatine supplementation prevents statin-induced muscle toxicity.
            (Shewmon and Craig, 2010) Download
Objective: To determine whether creatine supplementation would diminish the severity of statin-induced myalgia, weakness, and cramping. Methods: We conducted an open-labeled case series of creatine supplementation in 12 patients with known intolerance to at least 3 statins, and we created controls by starting, withdrawing, and restart- ing creatine treatment during statin therapy. Myopathy scores were significantly higher after the statin-only treatment phase than at baseline but did not differ from baseline after the other treatment phases. Creatine loading plus maintenance creatine therapy prevented myopathy symp- toms in 8 of 10 patients receiving statins. After these 8 patients stopped maintenance creatine therapy and developed myopathy symptoms while receiving statins alone, reloading creatine decreased symptoms to baseline levels. Also, increasing the creatine dosage from maintenance to loading diminished myopathy symp- toms to baseline levels in 1 patient who developed symptoms 6 days after a statin was added to maintenance creatine therapy.

Coenzyme Q10 supplementation decreases statin-related mild-to-moderate muscle symptoms: a randomized clinical study.
            (Skarlovnik et al., 2014) Download
BACKGROUND:  Statin use is frequently associated with muscle-related symptoms. Coenzyme Q10 supplementation has yielded conflicting results in decreasing statin myopathy. Herein, we tested whether coenzyme Q10 supplementation could decrease statin-associated muscular pain in a specific group of patients with mild-to-moderate muscle symptoms. MATERIAL/METHODS:  Fifty patients treated with statins and reporting muscle pain were recruited. The Q10 group (n=25) received coenzyme Q10 supplementation over a period of 30 days (50 mg twice daily), and the control group (n=25) received placebo. The Brief Pain Inventory (BPI) questionnaire was used and blood testing was performed at inclusion in the study and after 30 days of supplementation. RESULTS:  The intensity of muscle pain, measured as the Pain Severity Score (PSS), in the Q10 group was reduced from 3.9±0.4 to 2.9±0.4 (P<0.001). The Pain Interference Score (PIS) after Q10 supplementation was reduced from 4.0±0.4 to 2.6±0.4 (P<0.001). In the placebo group, PSS and PIS did not change. Coenzyme Q10 supplementation decreased statin-related muscle symptoms in 75% of patients. The relative values of PSS and PIS significantly decreased (-33.1% and -40.3%, respectively) in the Q10 group compared to placebo group (both P<0.05). From baseline, no differences in liver and muscle enzymes or cholesterol values were found. CONCLUSIONS:  The present results show that coenzyme Q10 supplementation (50 mg twice daily) effectively reduced statin-related mild-to-moderate muscular symptoms, causing lower interference of statin-related muscular symptoms with daily activities.

 

References

 

Shewmon, DA and JM Craig (2010), ‘Creatine supplementation prevents statin-induced muscle toxicity.’, Ann Intern Med, 153 (10), 690-92. PubMed: 21079234
Skarlovnik, A, et al. (2014), ‘Coenzyme Q10 supplementation decreases statin-related mild-to-moderate muscle symptoms: a randomized clinical study.’, Med Sci Monit, 20 2183-88. PubMed: 25375075