מחקרים קליניים על Q10 וסטטינים

Ann Intern Med. 2009 Jun 16;150(12):858-68. Comment in: Ann Intern Med. 2009 Jun 16;150(12):885-6. Narrative review: statin-related myopathy. Statin-related myopathy is a clinically important cause of statin intolerance AND discontinuation. The spectrum of statin-related myopathy ranges from common but clinically benign myalgia to rare but life-threatening rhabdomyolysis. Observational studies suggest that myalgia can occur in up to 10% of persons prescribed statins, whereas rhabdomyolysis continues to be rare. The mechanisms of statin-related myopathy are unclear. Options for managing statin myopathy include statin switching, particularly to fluvastatin OR low-dose rosuvastatin; nondaily dosing regimens; nonstatin alternatives, such as ezetimibe AND bile acid-binding resins; AND coenzyme Q10 supplementation. Few of these strategies have high-quality evidence supporting them. Because statin-related myopathy will probably become more common with greater numbers of persons starting high-dose statin therapy AND the increasing stringency of low-density lipoprotein cholesterol level targets, research to better identify patients at risk for statin myopathy AND to evaluate management strategies for statin-related myopathy is warranted. Coenzyme Q10 Supplementation Because coenzyme Q10 depletion may contribute to statin myopathy, oral coenzyme Q10 supplementation has been evaluated (78, 79). Caso AND coworkers (78) randomly assigned 32 persons with statin myopathy to either coenzyme Q10, 100 mg/d, OR vitamin E, 400 IU/d, while maintaining current statin therapy. Pain was assessed through the Brief Pain Inventory (86), which provided measures of pain severity AND interference in daily activities. After 30 days, both pain severity AND interference decreased by about 40% in the coenzyme Q10 group only, suggesting that coenzyme Q10 improved myopathy symptoms in patients receiving statin therapy (78). Meanwhile, Young AND colleagues (79) randomly assigned 44 patients intolerant of statins to either coenzyme Q10, 200 mg/d, OR placebo for 12 weeks. Patients discontinued lipid-lowering therapies (except ezetimibe) AND instead started simvastatin, 10 mg/d, with a doubling dose of simvastatin every 4 weeks to a maximum of 40 mg/d, if tolerated. Pain was assessed by using a modified visual analogue scale (87). The trial found no significant difference in myalgia score; number of patients tolerating simvastatin therapy, 40 mg/d; OR number of patients who continued to receive therapy (79). Because of a lack of firm evidence, a recent systematic review did not recommend routine use of coenzyme Q10 (9). However, supplementation still might be considered in some patients who do not benefit from other approaches because some patients may respond, if only through a placebo effect (9), AND because coenzyme Q10 has no known detrimental effects. Conclusion Myalgia affects up to 10% of patients receiving statin treatment. Fortunately, statin-induced fatal rhabdomyolysis is extremely rare. However, statin myopathy will probably become an increasingly relevant problem in absolute terms because of the increasing number of patients receiving statin treatment AND the stringency of recent LDL cholesterol targets. Increased access to health information from the Internet OR other sources may increase patient fears of statin side effects, leading to nonadherence to statin therapy AND sometimes self-medication with alternate therapies, such as red rice yeast, guggulipid, OR garlic preparations. Although such therapies may have acceptable tolerability, consistent data do not yet support their efficacy. Consequently, identifying patients at risk for statin myopathy AND using more established management strategies to maximize the ratio of efficacy to side effects are important. In patients with statin myopathy, therapy with fluvastatin OR rosuvastatin, alternate dosing regimens, AND ezetimibe OR bile acid–binding resins have demonstrated reasonable tolerability AND efficacy. Coenzyme Q10 supplementation is not currently recommended for routine use. Further studies are warranted for the development of alternate strategies in statin myopathy AND of newer statins with lower potential for statin myopathy.

לפי סקירה זו עדיין לא הוכח כי יש תועלת בנטילת Q10 כטיפול שיגרתי מניעתי במשתמשי סטטינים.

שלום למסקנה, ישנם הרבה מאוד מחקרים על קואנזים Q10 והשפעתו החיובית על אנשים הנוטלים תרופות ממשפחת הסטטינים. להלן לינק לסקירת מחקרים שנעשו על Q10 (כולל מקורות המחקרים בתחתית הדף): http://www.solgar.co.il/?CategoryID=225&ArticleID=819 בנוסף, אני מצרפת עבורך לינק למצגת מהרצאתו של מנתח הלב הבכיר, בעל השם העולמי, פרופסור פרנקלין רוזנפלד האוסטרלי בנושא טיפול בעזרת תוסף התזונה Q10 בבעיות שכיחות הקשורות במערכת הלב וכלי הדם: http://www.solgar.co.il/?CategoryID=601&ArticleID=822&sng=1 הרבה בריאות והמשך שבוע טוב, הדר