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Erling
Statins and CoQ10
October 20, 2003 06:14AM
For those taking any one of the "statin" drugs -

In view of the reported requirement to take a statin -- such as Lipitor -- for a period of time after an ablation procedure, one should be aware of the way in which these 'HMG-CoA reductase inhibitor' drugs shut off ones internal synthesis of coenzyme Q10, and consider compensating by taking supplemental CoQ10. The following 2001 letter from the International Coenzyme Q10 Association to the FDA is educational in this regard.

[wwwcsi.unian.it] (click on 'current issues')


Current Issues

Following the recent events regarding serious side-effects related to statins (the Baycol issue) the International Coenzyme Q10 Association released an official statement (see below) which was sent to the Food and Drug Administration. The same letter will be sent to the European Agency for the Evaluation of Medical Products and to the equivalent Japanese agency.

Institute of Biochemistry - University of Ancona
Via Ranieri - 60131 Ancona-Italy
Phone: 071-2204674 Fax: 071-2801932
e-mail: [email protected]
Prof. Gian Paolo Littarru

HFD-511
Food and Drug Administration
5600 Fishers Ln.
Rockville MD 20857

Ancona, September 5th 2001

Object: Biochemical and Potential Clinical Consequences of Inhibiting Coenzyme Q10 Biosynthesis by HMG-CoA Reductase Inhibitors: A Critical Opinion by the International Coenzyme Q10 Association.


Dear Sirs,

Please accept this letter as a position statement on the growing problem of adverse side effects related to the use of HMG-CoA reductase inhibitors. The International Coenzyme Q10 Association is a group of scientists and medical professionals with a research focus on coenzyme Q10, which plays a crucial role in cellular ATP production. It has been demonstrated that HMG-CoA reductase inhibitors, also known as statins, block the biosynthesis of coenzyme Q10 and of dolichol, besides the well known effect on cholesterol synthesis. Several studies have shown that administration of different kinds of statins can lead to a parallel decrease of coenzyme Q10 and cholesterol in plasma (1- 9, 19). Animal studies have also demonstrated a tissue depletion in the course of statin treatment (10 - 12) which was particularly evident in aged animals (13) . We can reasonably hypothesize that in some conditions where other CoQ10 impoverishing situations exist, treatment with statins may seriously impair plasma and possibly tissue levels of coenzyme Q10. A physiological decline in tissue CoQ10 has for instance been implicated in ageing (17,18) which would make the elderly more susceptible to statin-induced CoQ10 depletion.

A decrease in tissue coenzyme Q10 may have adverse effects on cellular ATP production, as has been proven in dogs and guinea pigs (12, 13), and may manifest clinically as systolic and diastolic left ventricular dysfunction with symptoms of fatigue and exertional dyspnea. In patients with pre-existing congestive heart failure the addition of statin therapy causes a decrease in blood CoQ10 levels and a decline in myocardial function (1). Although statin therapy has been shown to have benefits, the long-term response in ischemic heart disease may have been blunted due to the CoQ10 depleting effect. Some evidence of this has already appeared in that oral CoQ10 supplementation in diabetic patients receiving HMG-CoA reductase inhibitors reduced cardiothoracic ratio (9).

It is reasonable to suggest that skeletal muscle pathology such as myalgia and rhabdomyolysis is also related to decreases in tissue coenzyme Q10 concentrations. There are some indications of rapid improvement in statin-induced myalgia and fatigue with supplemental CoQ10 (20). In different kinds of muscle disease the beneficial effects of coenzyme Q10 supplementation have been shown to correlate with improvement in oxidative phosphorylation as monitored by NMR techniques (14 - 16). A few cases have already been reported where CoQ10 reverses the condition of cardiac failure in the course of treatment with statins (1).

These observations may relate to two Merck & Co., Inc. patents for combining CoQ10 with statin in the same capsule: US Patent 4929437, issued May 29, 1990 and US Patent 4933165, issued June 12, 1990, both titled "Coenzyme Q10 with HMG-CoA Reductase Inhibitors". It is possible that the recently reported statin-related deaths are the tip of a side effect iceberg and the magnitude of the potential problem cannot be overstated. It is urgently incumbent upon the scientific community, the pharmaceutical industry and the regulatory bodies, such as the United States Food and Drug Administration to be certain that we are not inadvertently creating a life-threatening deficiency of an essential co-factor in many millions of patients.

Attached are pertinent supporting publications and abstracts along with copies of the Merck & Co., Inc. statin/CoQ10 combination patents.

This letter has been reviewed by all of the undersigned members of the Scientific Committee of the International Coenzyme Q10 Association who feel that studies are warranted to examine whether the clinical use of statins can be made safer and possibly more effective by the addition of coenzyme Q10.

We should make every effort to investigate the reasons for, and to prevent further developments of, what have already been serious medical consequences.

We would very much appreciate your input and response.

With all due respect,

Gian Paolo Littarru M.D. Prof. Biochemistry
University of Ancona, Italy

Chairman of the International CoQ10 Association

On behalf of:

Flint Beal, M.D. Prof. - Cornell Medical Centre, NY, USA
Fredrick Crane, Ph.D. Prof. - Purdue University, IL, USA
Gustav Dallner, Ph.D. Prof. - Stockholm University, Sweden
Udo Hoppe, M.D. Prof. - Paul Gerson Unna-Skin Research Centre, Germany
Takeo Kishi, Ph. D. Prof. - Kobe Gakui University, Japan
Peter Langsjoen M.D. - Diplomate American Board of Cardiology, TX, USA
Giorgio Lenaz M.D. Ph.D. Prof. - Bologna University, Italy
Svend Aage Mortensen M.D. Prof. - Heart Centre Rigshospital, Copenhagen, Denmark
Tetsuya Nakamura Ph.D. Prof. - Shibaura Institute of Technology, Japan
Etsuo Niki Ph.D. Prof. - Human Stress Signal Research Centre, Japan
Roland Stocker Ph.D. Prof. - Heart Research Institute, Sydney, Australia
Yoshitomo Oka M.D. Ph.D. Prof. - Yamaguchi University School of Medicine, Japan
Yorihiro Yamamoto Ph.D. Prof. - School of Engineering, University of Tokyo, Japan


References

1. Folkers K., Langsjoen P., Willis R., Richardson P., Xia L., et al. Lovastatin decreases coenzyme Q levels in humans. Proc. Nat Acad. Sci. USA. 87: 8931-8934, 1990.

2. Ghirlanda G., Oradei A., Manto A., Lippa S., Uccioli L. et al. Evidence of plasma CoQ10-lowering effect by HMG-CoA reductase inhibitors: a double blind, placebo-controlled study. J. Clin. Pharmacol. 3: 226-229, 1993.

3. Bargossi AM, Grossi G, Fiorella PL, Gaddi A, Di Giulio R, Battino M. Exogenous CoQ10 supplementation prevents plasma ubiquinone reduction induced by HMG-CoA reductase inhibitors. Mol Asp Med. 15: s187-93, 1994.

4. Mortensen SA., Leth A., Agner E., Rohde M. Dose-related decrease of serum coenzyme Q10 during treatment with HMG-CoA reductase inhibitors. Mol Asp Med. 18: s137-s144, 1997.

5. Kaikkonen J, Nyyssonen K, Tuomainen TP, Ristonmaa U, Salonen JT. Determinants of plasma coenzyme Q10 in humans. FEBS Lett. 443:163-6, 1999.

6. De Pinieux G, Chariot P, Ammi-Said M, Louarn F, Lejone JL, Astier A, Jactot B, Gherardi R. Lipid-lowering drugs and mitochondrial function: effects of HMG-CoA reductase inhibitors on serum ubiquinone and blood lactate/pyruvate ratio. Br J Clin Pharmacol. 42: 333-7, 1996.

7. De Lorgeril M, Salen P, Bontemps L, Belichard P, Geyssant A, Itti R. Effects of lipid-lowering drugs on left ventricular function and exercise tolerance in dyslipidemic coronary patients. J Cardiovasc Pharmacol. 33: 473-8, 1999.

8. Human JA, Ubbink JB, Jerling JJ, Gelport R, Varmaak WJ, Vorster HH, Lagendijk J, Potgieter HC. The effect of Simvastatin on the plasma antioxidant concentrations in patients with hypercholesterolaemia. Clin Chim Acta 263: 67-77, 1997.

9. Miyake Y, Shouzu A, Nishikawa M, Yonemoto T, Shimizu H, Omoto S, Hayakawa T, Inada M. Effect of treatment with 3-hydroxy-3-methylgltaryl coenzyme A reductase inhibitors on serum coenzyme Q10 in diabetic patients. Arzneimittelforschung 49: 324-9, 1999.

10. Willis RA., Folkers K, Tucker JL., Ye CQ, Xia LJ., Tamagawa H. Lovastatin decreases coenzyme Q levels in rats. Proc. Natl. Acad. Sci. USA ; 87: 8928-30, 1990.

11. Loop RA, Anthony M, Willis RA, Folkers K. Effects of ethanol, lovastatin and coenzyme Q10 treatment on antioxidants and TBA reactive material in liver of rats. Mol Asp Med. 15: s195-206, 1994.

12. Satoh K, Yamato A, Nakai T, Hoshi K, Ichihara K. Effects of 3-hydroxy-3-methylgltaryl coenzyme A reductase inhibitors on mitochondrial respiration in ischaemic dog hearts. Br J Pharmacol. 116: 1894-8, 1995.

13. Diebold BA, Bhagavan NV, Guillory RJ. Influences of lovastatin administration on the respiratory burst of leukocyctes and the phosphorylation potential of mitochondria in guinea pigs. Biochim Biophys Acta. 1200: 100-8, 1994.

14. Nishikawa Y, Takahashi M, Yorifuji S, Nakamura Y, Ueno S, Tarui S, Kozuka T, Nishimura T. Long-term coenzyme Q10 therapy for a mitochondrial encephalomyopathy with cytochrome c oxidase deficiency: a 31P NMR study. Neurology 39: 399-403, 1989.

15. Mizuno M, Quistorff B, Theorell H, Theorell M, Chance B. Effects of oral supplementation of coenzyme Q10 in 31P-NMR detected skeletal muscle energy metabolism in middle-aged post-polio subjects and normal volunteers. Mol Asp Med. 18: s291-8, 1997.

16. Barbiroli B, Iotti S, Lodi R. Improved brain and muscle mitochondrial respiration with CoQ. An in vivo study by 31P-MR spectroscopy in patients with mitochondrial cytopathies. Biofactors 9:253-60, 1999.

17. Kalen A., Appelkvist E.L., Dallner G. Age related changes in the lipid composition of rate and human tissue. Lipids, 24: 579-584, 1989.

18. Soderberg M., Edlund C., Kristensson K., Dallner G. Lipid composition of different regions of the human brain during aging. J. Neurochem. 54, 2: 415-423, 1990.

19. Watts GF, Castelluccio C, Rice Evans C, Taub NA, Baum H, Quinn PJ. Plasma coenzyme Q (ubiquinone) concentration in patients treated with simvastatin. J Clin Pharmacol 46: 1055-1057, 1995.

20. Walravens PA, Greene C, Frerman FE, Lovastatin, Isoprenes, and Myopathy Lancet Nov.4; 2 (8671): 1097-1098, 1989.
Re: Statins and CoQ10
October 20, 2003 10:52AM
Erling -

I see you've been busy. Thanks for the reminder and precaution about the downside of Lipitor and statins. I'll be sure to supplement with Q10.....if I absolutely must take the Lipitor.... I'm quite uncertain about the benefits vs. the risks.

Also - please go to [www.spacedoc.net]

and note this personal testimonial of the NASA MD and former astronau, Duane Graveline, who has now published a book called Lipitor, The Thief of Memory - based on his personal experience with statins.

The site gives some previews of his comments in the book.

Thanks again. Jackie
Chris h
Re: Statins and CoQ10
October 20, 2003 11:04AM
Greetings Erling
Many thanks for your help - you seem to be an old hand, and a great magnessium advocate.
I have read some posts in the past over the best type of oral CQ 10 supplementation to take. I remember some discussion to the effect if the capsule contents didn't dissolve in water then they were no good. I also seem to remember the statement that as CQ 10 was suspended in oil in the capsule then it obviously wouldn't but that stomach acid would break it down.
I use Holland and Barrett capsules and take 120mg a day. These don't dissolve in water but are they oK.??.

Thanks
Chris H
Erling
Re: Statins and CoQ10
October 22, 2003 07:07AM
Hi Chris,

Sorry to have been slow in getting back to you. I don't know much about the various forms of CoQ10 -- nothing at all about Holland and Barrett capsules. There are forms that claim to be much more "bioavailable" than others, for instance those using the "Bio-Solv" process, a trade mark of Tishcon Corporation (patent pending?). Using google and the search words, Bio-Solv CoQ10, brings up hundreds of results with interesting (sales-pitch) information from a variety of supplement manufacturers, for example this:

"To improve the bioavailability and dissolution of CoQ10, ________ has joined forces with Tishcon Corporation to offer a new process known as Bio-Solv™ technology that enhances CoQ10 solubility dramatically. Coenzyme Q10 is a lipid-soluble compound synthesized in all cells, primarily from the amino acid tyrosine. Traditionally, CoQ10 is poorly absorbed by the body because this coenzyme is only lipid-soluble and does not dissolve easily in water. In partnership with Tischon Corporation, ________ presents a new delivery system. This new technology delivers CoQ10 in a more soluble, bioavailable form."

Erling
Chris H
Re: Statins and CoQ10
October 24, 2003 07:50AM
Many thanks Erling

Please see my topic on "Fish oil and things" I am toying with the idea of making your water. I don't care what the wife thinks.

Be seeing you

Chris H
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