Effects of Coenzyme Q10 on Statin-Induced Myopathy: An Updated Meta-Analysis of Randomized Controlled Trials

Abstract

Background Previous studies have demonstrated a possible association between the induction of coenzyme Q10 (CoQ10) after statin treatment and statin-induced myopathy. However, whether CoQ10 supplementation ameliorates statin-induced myopathy remains unclear. Methods and Results PubMed, EMBASE , and Cochrane Library were searched to identify randomized controlled trials investigating the effect of CoQ10 on statin-induced myopathy. We calculated the pooled weighted mean difference ( WMD ) using a fixed-effect model and a random-effect model to assess the effects of CoQ10 supplementation on statin-associated muscle symptoms and plasma creatine kinase. The methodological quality of the studies was determined, according to the Cochrane Handbook. Publication bias was evaluated by a funnel plot, Egger regression test, and the Begg-Mazumdar correlation test. Twelve randomized controlled trials with a total of 575 patients were enrolled; of them, 294 patients were in the CoQ10 supplementation group and 281 were in the placebo group. Compared with placebo, CoQ10 supplementation ameliorated statin-associated muscle symptoms, such as muscle pain ( WMD , -1.60; 95% confidence interval [ CI ], -1.75 to -1.44; P<0.001), muscle weakness ( WMD , -2.28; 95% CI , -2.79 to -1.77; P=0.006), muscle cramp ( WMD , -1.78; 95% CI , -2.31 to -1.24; P<0.001), and muscle tiredness ( WMD , -1.75; 95% CI , -2.31 to -1.19; P<0.001), whereas no reduction in the plasma creatine kinase level was observed after CoQ10 supplementation ( WMD , 0.09; 95% CI , -0.06 to 0.24; P=0.23). Conclusions CoQ10 supplementation ameliorated statin-associated muscle symptoms, implying that CoQ10 supplementation may be a complementary approach to manage statin-induced myopathy.

Keywords: coenzyme Q10; coronary disease; meta‐analysis; statin therapy; statin‐induced myopathy.

Figure 1

Literature search process and study selection.

Figure 2

Risk of bias summary.

Figure 3

Forest plot for statin‐associated muscle symptoms: coenzyme Q10 vs placebo (fixed‐effect model). CI indicates confidence interval; ID, identification; WMD, weighted mean difference.

Figure 4

Forest plot for statin‐associated muscle symptoms: coenzyme Q10 vs placebo (random‐effect model). CI indicates confidence interval; ID, identification; WMD, weighted mean difference.

Figure 5

Meta‐regression plot. A, Mean change in muscle pain score according to administration doses of coenzyme Q10 (CoQ10). B, Mean change in muscle pain score according to CoQ10 supplementation time. C, Mean change in muscle pain score according to year of publication. D, Mean change in plasma creatine kinase (CK) according to administration doses of CoQ10. E, Mean change in plasma CK level according to CoQ10 supplementation time. F, Mean change in plasma CK level according to year of publication.

Figure 6

Forest plot for plasma creatine kinase: coenzyme Q10 vs placebo (fixed‐effect model). CI indicates confidence interval; ID, identification; WMD, weighted mean difference.

Figure 7

Forest plot for plasma creatine kinase: coenzyme Q10 vs placebo (random‐effect model). CI indicates confidence interval; ID, identification; WMD, weighted mean difference.

Figure 8

Forest plot for plasma creatine kinase on the basis of region (fixed‐effect model). CI indicates confidence interval; ID, identification; WMD, weighted mean difference.

Figure 9

Forest plot for plasma creatine kinase on the basis of region (random‐effect model). CI indicates confidence interval; ID, identification; WMD, weighted mean difference.

Figure 10

Publication bias. A, Funnel plot for muscle pain. B, Begg test for muscle pain. C, Egger test for muscle pain. D, Funnel plot for plasma creatine kinase (CK). E, Begg test for plasma CK. F, Egger test for plasma CK. WMD indicates weighted mean difference.