Could statins be adding to the epidemic of ‘heart failure’?

Statins are drugs that reduce cholesterol by inhibiting an enzyme in the liver known as ‘HMG-CoA reductase’ which ‘drives’ cholesterol production (most of the cholesterol in the bloodstream is made in the liver and does not come directly from the diet). But HMG-CoA reductase also facilitates the production of a substance known as ‘coenzyme Q10’ which itself participates in the production of what is known as ‘adenosine triphosphate’ (ATP) – the most basic unit of energy ‘fuel’ in the body. The major biochemical process which involves CoQ10 that drives ATP and energy production in the body is known as ‘oxidative phosphorylation’.

Now that we have the potted biochemistry lesson over, we can see that statins have the potential, by lowering CoQ10 levels, to put a break on oxidative phosphorylation and ATP production in the muscles. The end result may be fatigue? Muscle pain is another potential consequence.

In a study published this week in the Journal of the American College of Cardiology (JACC), Danish researchers measured CoQ10 levels in individuals taking simvastatin (a commonly-prescribed statin), and compared them with those not taking statins [1]. The levels in those taking the statin were significantly lower.

Now, studies such as this one are what is termed ‘epidemiological’ in nature, which means it looks at associations between things, but cannot prove that one thing is causing another. However, of relevance here is other evidence which finds that giving statins to people does indeed have the capacity to lower levels of CoQ10 in the body [2].

What was also interesting about the JACC study is that it found that those treated with statins had lower levels of oxidative phosphorylation than those not taking them. They also had reduced ‘insulin sensitivity’. This is relevant for a number of reasons, including the fact that insulin facilitates the uptake of nutrients such as glucose into the cells. Lowered insulin sensitivity can therefore ‘starve’ the cells of essential nutrients. Reduced insulin sensitivity is also the underlying fault in type 2 diabetes. It is perhaps worth bearing in mind that statin use has been proven to increase the risk of type 2 diabetes.

Another thing worth bearing in mind here, I think, is the fact that the heart is a muscle, and depleting it of CoQ10 may be hazardous for cardiac health. Specifically, it may weaken the heart and lead to what is known as ‘heart failure’ (also known as ‘congestive cardiac failure’). I think the ‘benefits’ of statins are vastly overstated, generally speaking. However, if someone is to take statins, I think it’s a reasonable safeguard to take CoQ10 on a daily basis. 100 mg a day is a decent dose, I think, though higher doses are likely to better when symptoms of statin toxicity are present.

In researching this article, I came across an interesting review of the evidence for statin-inducted CoQ10 depletion in both humans and animals [3]. Here’s what the authors of this review have to say in their concluding remarks:

Statin-induced CoQ10 deficiency is completely preventable with supplemental CoQ10 with no adverse impact on the cholesterol lowering or anti-inflammatory properties of the statin drugs. We are currently in the midst of a congestive heart failure epidemic in the United States, the cause or causes of which are unclear. As physicians, it is our duty to be absolutely certain that we are not inadvertently doing harm to our patients by creating a wide-spread deficiency of a nutrient critically important for normal heart function.

References:

1. Larsen S, et al. Simvastatin Effects on Skeletal Muscle – Relation to Decreased Mitochondrial Function and Glucose Intolerance. J Am Coll Cardiol. 2013;61(1):44-53

2. Passi S, et al. Statins lower plasma and lymphocyte ubiquinol/ubiquinone without affecting other antioxidants and PUFA. Biofactors 2003;18(1-4):113-24.

3. Langsjoen PH, et al. The clinical use of HMG CoA-reductase inhibitors and the associated depletion of coenzyme Q10. A review of animal and human publications. Biofactors 2003;18(1-4):101-11.

12 Responses to Could statins be adding to the epidemic of ‘heart failure’?

  1. helen 4 January 2013 at 8:03 pm #

    @Kris….Is your mum’s doctor aware of the research on the web site of the company that makes the simvastatin that it is of no benefit to women at all??? and Cholesterol does not cause stroke so why would he think lowering cholesterol was a good idea? It would appear that some of these men of science have no more knowledge about the human body and the functions of its components like cholesterol than some illiterate backwoods man. And with a bit more research into things your mum’s doctor might find that COQ10 & vitamin E were far more effective at blood normalisation than warfarin, which after all is a poison as any drug is. I find the general medical establishments rigid adherence to their dogma as frightening as any religious zealots………if not for doctors like Dr Briffa who try to change “conventional” thinking about chronic problems I would be worried indeed.

  2. Kris Gunnars 4 January 2013 at 8:50 pm #

    I’d like to ask your opinion about one thing.

    My grandmother had a stroke quite a few years ago and she has been using Warfarin ever since. She also had congestive heart failure about one year ago…. and she happens to be taking Simvastatin to reduce cholesterol.

    I’ve spoken to her geriatric physician about removing the Simvastatin, but he doesn’t think it’s a good idea.

    I’ve thought about giving her some CoQ10 and her doctor said that it would be fine as long as it didn’t interact with the Warfarin, but I did some research on the matter and it seems that CoQ10 can interact with Warfarin.

    I would like her to try it out, since she had heart failure and has general muscle weakness, but I don’t want to cause her to have another stroke. Any advice on what to do?

  3. Rita 4 January 2013 at 10:16 pm #

    Dr. Briffa,
    Thank you for this information, which I’d like to pass along to friends and family who are taking statins. But I know that each statin has a slightly different mechanism of action, some with stronger effects and harsher side effects than others.
    Is it possible to infer from the most recent JACC study that all statins, not just simvastatin, have a similar effect on CoQ10 levels and ATP production as well as producing reduced ‘insulin sensitivity’ ?

  4. Sue Gooch 5 January 2013 at 12:56 am #

    “I’ve spoken to her geriatric physician about removing the Simvastatin, but he doesn’t think it’s a good idea.”

    Why doesn’t that surprise me! My husband gave up his statins voluntarily (well I do pass every anti-statin article his way!) without dropping dead of heart problems (which he’s never had anyway). He also embarked on the low carb diet and saw his BP drop and his BS results improve to the point at which his GP said he could stop both his BP meds and his other Diabetic tablet. When he mentioned he’d also stopped his statin, he shook his head in worried fashion and told him he really should continue with it and tried to blind him with science. So he is taking it again.

    Curiously I had noticed how forgetful my very bright husband had become and how his intellectual capabilities were slipping just a bit. Then I noticed he seemed much better. Now he’s taking his statins again he seems to be reverting. I can’t honestly say I can time the differences to statin use etc. because I don’t know when he stopped. It bothers me that he will ignore all the evidence I have presented him with and follow the GP on this one.

  5. Mark. 5 January 2013 at 2:10 am #

    Simvastatin is dirt cheap as a generic drug here in the USA. CoQ10 supplement capsules are far more expensive. It’s rather bizarre…

  6. Modesty 6 January 2013 at 12:25 am #

    I’m waiting for the report on statins in relation to the increasing numbers of Alzheimer cases, our brain (and body) need cholesterol .

  7. Ted Hutchinson 7 January 2013 at 1:52 am #

    Those who enjoy reading the full text of science papers may like to read this particular paper here

  8. Maggie 7 January 2013 at 9:00 am #

    Someone told that doctors get all their information about statins from statin salespeople. I think he could be right!

  9. Leigh Ann Spence 9 January 2013 at 2:41 am #

    Is ubiquinol substitutable for CoQ10? I’m not sure I understand the difference between them and whether they are interchangeable or not. I’ve read that ubiquinol is more easily absorbed and doesn’t need as high of a dose. Dr. Briffa, can you shed some light on this? Are they interchangeable, and if so, what dosage of ubiquinol is recommended?

  10. Dave Wyman 10 February 2013 at 9:49 pm #

    Sue wrote:

    “blind him with science.”

    If we can’t rely on science then we can’t know anything, Sue.

    “It bothers me that he will ignore all the evidence I have presented him with and follow the GP on this one.”

    I might follow what my wife has to say to me – she’s a scientist. Are you sure, though, you haven’t tried to “blind” your husband with your version of science?

    I’m not implying that I believe in the efficacy of statins. I don’t think it’s fair, though, to knock the scientific method one hand, when the results show something you don’t like, and then try to use the scientific method on the other hand when it backs up what you believe.

  11. Ted Hutchinson 12 February 2013 at 10:09 am #

    @ Dave Wyman “I don’t think it’s fair, though, to knock the scientific method one hand, when the results show something you don’t like, and then try to use the scientific method on the other hand when it backs up what you believe.”
    I agree with you. So when a doctor tests your Total Cholesterol Level and tells you the only option is Statin therapy what are you to do?
    In this thread on The Harbcombe Diet forum Cholesterol reading 8.14. In dilema and need help analysing I’ve set out a series of evidence based posts presenting the science to support alternative strategies to measure and lower the real risk factors that Statin Therapy is aiming to resolve.
    There is much we can all do to improve our anti-inflammatory reserves and better control our inflammatory response.
    If we know the mechanism of statins mimics the action of magnesium and vitamin D surely it’s sensible to make sure we are magnesium and vitamin D replete using the standards of those who are still living as human DNA evolved.
    We know statins function as anti-inflammatory agents, so surely it makes sense to restore the omega 3 (anti-inflammatory) omega 6(pro-inflammatory) ratio that human DNA evolved with?
    More details and links to the evidence on THD forum at above link

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  1. Statins deplete the body of a nutrient that is vital for heart function | Dr Briffa's Blog - A Good Look at Good Health - 30 May 2013

    [...] the cells of which contain mitochondria which depend on coenzyme Q10. Back in January, I wrote a post which explored the possibility that statins may be contributing to increasing incidence of heart [...]

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