The Statin-CoQ10 Connection
Updated: Feb 10
I was motivated to put this together after talking health strategies with a friend who, like me, has high cholesterol. While watching our kids high school soccer my friend asked if, in addition to atorvastatin, I was supplementing with “CoQ10”. I had never even heard of CoQ10. Sounded like some kind of designer drug. Surprised at my ignorance, he went on to explain a friend had advised him to supplement with CoQ10 if he started on statins. Was this just a marketing ploy by a supplement supplier? Is there some real science behind this concern…Could it affect me?
What is CoQ10?
CoQ10, aka coenzyme Q, is a quinone found ubiquitously in animals and bacteria. As such, it's also called ubiquinone-10, an antioxidant your body produces naturally. It has the following structure:
The "10" represents the number of isoprenyl groups in the tail. It is found in all your body's tissues, but the highest concentrations will be found in organs with high metabolic rates and lots of mitochondria, the heart, kidneys, and liver.
What is the major function of CoQ10?
CoQ10 is an important membrane stabilizer in cells and an excellent oxygen radical scavenger throughout the body. A critical function of CoQ10 is in the production of adenosine triphosphate (ATP) via the electron transport chain (see schematic below). CoQ10 plays a key role in energy production in your body.
What are CoQ10 levels throughout life?
Levels of CoQ10 in our body decline as we age. Furthermore, poor physical conditioning and chronic diseases are often associated with lower levels.
Certains diseases associated with low levels of CoQ10 include diabetes, Parkinson’s disease, and heart problems. Chronic inflammation may also have ties to low levels of CoQ10.
What is the relationship between statins and CoQ10?
To understand how statins affect CoQ10 levels, we need to first look at how statins function. Statins block the production of cholesterol in your liver by competitive binding to 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase. So statins are called HMG CoA reductase inhibitors. HMG-CoA reductase is a rate-controlling enzyme in a metabolic pathway to produce cholesterol in your liver. A pathway called the mevalonate pathway. When a statin is bound to the HMG-CoA reductase, plasma cholesterol concentration is lowered. This is good! You can read more on the benefits of lowering cholesterol here. But that's not the only isoprenoid whose biosynthesis is interrupted... It is estimated that attenuating the mevalonate pathway can impact the production of more than 30,000 biomolecules, including CoQ10. Nothing is reallly every black and white, is it?... Blood plasma concentration of CoQ10 has been documented to drop as much as 50% after 30 days of statin therapy.
What are potential symptoms of low CoQ10?
For some individuals, you may not feel anything at all. Due to its role in ATP synthesis and mitochondrial function, you would expect that fatigue, shortness of breath, and muscle pain will be associated with lower CoQ10. Other functions of CoQ10 are summarized below.
How can you measure your levels?
A simple blood test can give you answers. The reference intervals for plasma CoQ10 range from 0.40 to 1.91 μmol/l in healthy adults. Although a good indicator of plasma concentration, it will not correlate directly with tissue concentration.
Blood plasma concentration of CoQ10 has been documented to drop as much as 50% after 30 days of statin therapy.
Can I increase my CoQ10 levels?
For a healthy individual, 3 to 5 mg is considered an adequate daily dose. Some foods on the higher end for CoQ10 include pork, lamb, beef, chicken, and fish. Vegetables with higher levels include spinach, pea, broccoli, cauliflower. And for fruits look to oranges, strawberries, and apples. Heart, chicken leg, herring, and trout contain particularly high amounts of CoQ10. Listed below are some CoQ10 concentrations in specific foods.
A more extensive list of foods and CoQ10 content can be found here.
Organ Meats (per 100 grams)
Beef heart 11.3 mg
Beef liver 3.9 mg
Chicken hearts 9.2 mg
Liver 11.6 mg
Fatty Fish (per 100 grams)
Mackerel 6.75 mg
Trout 0.85 mg
Meat (per 100 grams)
Beef 3.1 mg
Chicken 1.4 mg
Pork has 2.4 mg
Reindeer meat 15.8 mg
Soybeans (per 100 grams)
Boiled soybeans 1.2 mg
Tofu 0.3 mg
soy milk 0.25 mg
Vegetables (per 100 grams)
Broccoli 0.6 to 0.86 mg
Supplements?...and any downsides?
If you are looking to supplement with larger doses you can supplement with CoQ10 from inexpensive sources such as that listed below. And, of course, there are many more. I am supplementing with 1000mg of CoQ10 daily as reported in a review by Vaghari et al based on my body weight. Research is ongoing but there is evidence that a higher intake will help push plasma supplemented CoQ10 into brain as well as peripheral tissues. Supplementing as high as 3000 mg/per day has not resulted in any reported any adverse side effects. My plan is to review blood and tissue work with doctor and deciding together if modification of dosage is warranted.
As I am implementing a strict strategy to knock my LDL cholesterol down below 100 mg/dL, I will be talking with my doctor about testing for blood and tissue CoQ10 levels to determine if diet and supplementation plan is sufficient to keep my levels optimum. I'll update this post as I learn more.