Statins Deplete CoQ10: What Cardiac Patients Need to Know | Healos™

• Statins Deplete CoQ10: What Cardiac Patients Need to Know

"Since I started the statin, I've been exhausted, and my legs ache." It's one of the most common things people say in the months after a heart attack or heart surgery. Somewhere along the way, many also read that statins "deplete CoQ10" and wonder whether that's the explanation.

It's partly true, and the details matter.

Here is the short answer. Statins block the same liver pathway the body uses to make CoQ10, so blood CoQ10 levels fall on statin therapy. Whether that causes fatigue or muscle aches is less clear: research on CoQ10 for statin muscle symptoms is mixed, and many symptoms have other causes. The safe approach is to keep taking your statin, report symptoms, check other causes of fatigue and discuss CoQ10 with your pharmacist.

简短的答案： 「开始吃他汀以后，我总是很累，腿也酸。」这是心梗或心脏手术后几个月里最常听到的话之一；很多人也读到过他汀「会消耗 CoQ10」，想知道这是不是原因。这话部分正确，而细节很重要。他汀阻断的肝脏合成途径也是身体合成 CoQ10 的途径，所以服他汀时血液 CoQ10 会下降；这是否导致疲劳或肌肉酸痛不太确定，CoQ10 改善他汀肌肉症状的研究结论不一，很多症状另有原因。安全的做法是继续服用他汀、报告症状、排查其他疲劳原因，并与药剂师讨论 CoQ10。

Why statins lower CoQ10

Statins work by blocking an enzyme called HMG-CoA reductase, the first key step in the liver's cholesterol pathway, known as the mevalonate pathway. CoQ10, a molecule cells use to produce energy in their mitochondria, is made along the same pathway. So when cholesterol production falls, CoQ10 production falls too. A meta-analysis of placebo-controlled trials confirmed that statin therapy reduces circulating CoQ10 (Banach et al., Pharmacological Research, 2015).

That doesn't make statins the wrong choice. Each 1 mmol/L drop in LDL reduces major vascular events by about 22% (Cholesterol Treatment Trialists' Collaboration, Lancet, 2010), which is why your cardiologist wants you on one (see statins for life).

为什么他汀会降低 CoQ10： 他汀通过阻断一种叫 HMG-CoA 还原酶的酶起作用，这是肝脏胆固醇合成途径（甲羟戊酸途径）的第一个关键步骤；而细胞在线粒体中产生能量所用的 CoQ10，也在同一途径上合成。所以胆固醇合成减少时，CoQ10 合成也随之减少，安慰剂对照试验的荟萃分析证实他汀会降低血液中的 CoQ10（2015）。但这并不意味着他汀是错误的选择：LDL 每降低 1 mmol/L，主要血管事件减少约 22%（Lancet 2010），这正是心脏科医生希望你服用他汀的原因。

Does lower CoQ10 explain fatigue and muscle aches?

The honest answer is: sometimes, maybe, and not always.

• The CoQ10 research is mixed. A 2018 meta-analysis found CoQ10 supplements may improve statin-associated muscle symptoms (Qu et al., Journal of the American Heart Association, 2018); an earlier one did not (Banach et al., Mayo Clinic Proceedings, 2015).

• Expectation plays a big role. In the SAMSON trial, people who had stopped statins because of side effects took statin, placebo and no tablets in random months without knowing which; about 90% of the symptom burden they reported on statins also appeared on placebo (Wood et al., NEJM, 2020).

• Fatigue after heart surgery has many causes that have nothing to do with statins (see next section).

So lower CoQ10 is real, but it's rarely the whole story.

CoQ10 降低能解释疲劳和肌肉酸痛吗： 诚实的回答是：有时候，也许，但不总是。CoQ10 的研究结论不一：2018 年一项荟萃分析发现补充 CoQ10 可能改善他汀相关的肌肉症状（JAHA 2018），而更早的一项没有发现（Mayo Clin Proc 2015）。预期作用很大：SAMSON 试验中，因副作用停用他汀的人在不知情的情况下按随机月份服用他汀、安慰剂或不服药，他汀期间报告的症状负担约 90% 在安慰剂期间同样出现（NEJM 2020）。心脏手术后的疲劳有很多与他汀无关的原因。所以 CoQ10 降低是真实的，但很少是全部原因。

Other causes of fatigue to check

Before blaming the statin, ask your team to look at:

• Recovery itself: the inflammation and oxidative stress of surgery take weeks to months to settle (see "the surgery was successful").

• Anaemia or low iron after surgery.

• Other medicines, such as beta-blockers, which can slow the heart rate and blunt energy.

• Low thyroid, low vitamin D or low B12.

• Poor sleep or sleep apnoea.

• Depression, which affects about one in five heart attack survivors.

• Deconditioning, which cardiac rehab is designed to reverse.

需要排查的其他疲劳原因： 在归咎于他汀之前，请医疗团队看看：康复本身——手术带来的炎症和氧化应激需要数周到数月才能平息；术后贫血或缺铁；其他药物，如 β 受体阻滞剂会减慢心率、让人乏力；甲状腺功能低、维生素 D 或 B12 偏低；睡眠差或睡眠呼吸暂停；抑郁——约五分之一的心梗幸存者会经历；体能下降——心脏康复正是为扭转它而设计的。

What to do: a safe plan

1. Keep taking your statin. Don't stop on your own.

2. Describe your symptoms to your doctor: where the aches are, when they started, whether they're getting worse. Severe muscle pain, weakness or dark urine needs prompt attention.

3. Check other causes with simple blood tests where appropriate.

4. Ask about adjustments if the statin is the likely cause: a different statin, a lower dose or added medicines such as ezetimibe.

5. Discuss CoQ10 with your pharmacist. It's generally well tolerated, but it can affect INR in people taking warfarin, so your anticoagulation clinic needs to know (see the medication-nutrient map).

怎么做：一个安全的计划： 1. 继续服用他汀，不要自行停药；2. 向医生描述症状：哪里酸痛、何时开始、是否加重；严重肌肉疼痛、无力或尿色变深需要及时就医；3. 必要时通过简单验血排查其他原因；4. 如果他汀很可能是原因，询问调整方案：换一种他汀、减量或加用依折麦布等药物；5. 与药剂师讨论 CoQ10：它通常耐受良好，但服用华法林的人可能受 INR 影响，需要告诉抗凝门诊。

How Healos™ supports people on statins

Healos™ works alongside your statin, never instead of it. The Replenish stage of the 91-Day Protocol includes CoQ10 among the nutrients that surgery and heart medicines commonly deplete, at amounts matched to your medication list and pharmacist-reviewed before your kit ships, including a check for warfarin. The protocol moves through Detox, Replenish and Repair, with follow-ups at day 30 and day 60 (with a reminder to book your blood test) and a blood-test report review at day 90, so symptoms reach your doctor rather than turning into a quiet decision to stop. Sovereign Monthly · Recovery continues month to month.

Healos™ 如何支持服用他汀的人： Healos™ 与他汀并行，绝不替代它。91 天方案的补给阶段把 CoQ10 列为手术和心脏药物常消耗的营养素之一，剂量与用药清单匹配，发货前经药剂师审核（包括华法林核查）。方案依次经过排毒、补给、修复，第 30 天跟进、第 60 天跟进并提醒验血、第 90 天验血报告解读，让症状传达给医生，而不是变成悄悄停药的决定；Sovereign Monthly · Recovery 按月延续。

The bottom line

Statins do lower CoQ10, because they share its production pathway. But fatigue and aches after heart surgery usually have several causes, the CoQ10 evidence is mixed, and the statin's protection is large. Keep taking it, report symptoms, check other causes, ask about adjustments if needed and talk to your pharmacist before adding CoQ10, especially if you take warfarin.

结论： 他汀确实会降低 CoQ10，因为两者共用合成途径。但心脏手术后的疲劳和酸痛通常有多个原因，CoQ10 的证据不一，而他汀的保护作用很大。继续服用，报告症状，排查其他原因，必要时询问调整方案；补充 CoQ10 前先问药剂师，尤其是服用华法林时。

Frequently asked questions

Do statins lower CoQ10? Yes. Statins block the liver pathway that also produces CoQ10, and a meta-analysis of placebo-controlled trials confirmed lower circulating CoQ10 on statins.

Should I take CoQ10 with my statin? Discuss it with your pharmacist or doctor. Evidence for CoQ10 easing statin muscle symptoms is mixed, but it's generally well tolerated; it can affect INR if you take warfarin.

Can statins cause muscle pain and fatigue? They can, but many symptoms have other causes: in the SAMSON trial, about 90% of the symptoms people reported on statins also appeared on placebo. Report symptoms rather than stopping.

Why am I so tired after heart surgery? Common reasons include the healing process itself, anaemia, beta-blockers, poor sleep or sleep apnoea, low thyroid or vitamins, depression and deconditioning. Ask your team to check.

常见问题： 他汀会降低 CoQ10 吗？会，他汀阻断的肝脏途径也合成 CoQ10，荟萃分析证实服他汀者血液 CoQ10 降低。要和他汀一起补 CoQ10 吗？请与药剂师或医生讨论，改善肌肉症状的证据不一，但通常耐受良好，服华法林可能影响 INR。他汀会引起肌肉痛和疲劳吗？可能，但很多症状另有原因，SAMSON 中约 90% 在安慰剂期也出现，请报告而不是停药。心脏手术后为什么这么累？愈合过程、贫血、β 阻滞剂、睡眠或睡眠呼吸暂停、甲状腺或维生素偏低、抑郁和体能下降都常见，请团队排查。

References

1. Banach M, et al. Statin therapy and plasma coenzyme Q10 concentrations: a systematic review and meta-analysis of placebo-controlled trials. Pharmacological Research. 2015;99:329–336.

2. Banach M, et al. Effects of coenzyme Q10 on statin-induced myopathy: a meta-analysis of randomized controlled trials. Mayo Clinic Proceedings. 2015;90(1):24–34.

3. Qu H, et al. Effects of coenzyme Q10 on statin-induced myopathy: an updated meta-analysis of randomized controlled trials. Journal of the American Heart Association. 2018;7(19):e009835.

4. Wood FA, et al. N-of-1 trial of a statin, placebo, or no treatment to assess side effects (SAMSON). New England Journal of Medicine. 2020;383:2182–2184.

5. Cholesterol Treatment Trialists' Collaboration. Efficacy and safety of more intensive lowering of LDL cholesterol. Lancet. 2010;376(9753):1670–1681.