CoQ10 with statins

Researchers studying the effects of the cholesterol-lowering statin drugs over the last decade found that patients taking statins were likely to also have lowered levels of coenzyme Q10 (CoQ10), a coenzyme naturally produced in the body and important to the function of organs such as the heart. Further study has also indicated that supplementing with CoQ10 while taking statins can reverse the deficiency and limit the side effects.

A few facts and recommendations about CoQ10:

CoQ10 functions inside cells to make energy; the highest amounts of the coenzyme are found in the heart, liver, kidneys and pancreas. The muscles of the heart are especially sensitive to CoQ10 deficiency.

Statins act by inhibiting an enzyme, HMG-CoA reductase, that is responsible for synthesizing both cholesterol and CoQ10. So statins seem to simultaneously decrease cholesterol and CoQ10 levels.

A 2004 report in the American Journal of Cardiology found that 70% of people in a study group taking the statin Lipitor showed heart muscle weakness after six months. This weakness was reversed by taking CoQ10.

CoQ10 has also been studied for these statin side effects: muscle pain and weakness, fatigue, memory loss, shortness of breath and peripheral neuropathy.

A common recommendation for those taking a statin: supplement with 100 mg CoQ10 softgel twice daily, in the morning and at noon. Avoid insomnia by taking it early in the day. Be sure to consult your doctor about the possibility of CoQ10 interacting with any blood thinner you may be taking.

Reference: Marc Silver et al. Effect of atorvastatin on left ventricular diastolic function and ability of coenzyme Q10 to reverse that dysfunction. American Journal of Cardiology. Volume 94, Issue 10 , Pages 1306-1310, 15 November 2004.

See the NYBC entries for more details:

http://nybcsecure.org/product_info.php?cPath=47&products_id=317
(Jarrow 100mg CoQ10 Qsorb)

or

http://nybcsecure.org/product_info.php?cPath=47&products_id=357(Douglas Labs 200mg chewable tablet formula)

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CoQ10 for heart health

Clinical studies have shown repeatedly that CoQ10 has potent abilities to assist the heart muscle, and as an adjunct treatment for angina, congestive heart failure, arrhythmia, hypertension (high blood pressure), and drug toxicity. In Japan, it has been widely used, and over several decades, for these types of heart health issues, and that’s one reason why its potential effectiveness and safety profile are at this point quite well characterized.

Research has also shown that as cellular levels of CoQ10 decrease, HIV disease progresses. Other studies have documented CoQ10’s immune restorative qualities, including restoration of T cell function. Many people with HIV find that CoQ10 is an important nutrient to aid in detoxification if one uses nucleoside analogs (AZT ddI, ddC, d4T, etc.), or other toxic drugs. (For example, studies have shown clear benefit when used with a heart toxic chemotherapy drug called adriamycin.)

In addition, we’ve seen widely circulated the recommendation, based on various levels of evidence, that people taking statin drugs—used to manage cholesterol—also take CoQ10. (Levels of CoQ10 in the blood are notably depleted when using this class of drugs, and there is potential for metabolic disruptions in the body as a result.)

A 2007 pilot study showed relief of muscle pain (myopathy) in people taking statins who also took 100mg/day of CoQ10. However, we have also found recommendations for higher dosages (200mg/day or more) for a variety of heart-related conditions.

For further details, see NYBC’s entry on Q-sorb Plus 100mg (Jarrow), specifically designed for enhanced absorption.

See also other forms of CoQ10, at both higher and lower dosages and in combination with other supplements, at
http://nybcsecure.org/index.php?cPath=47

Niacin for heart health in diabetics

A news item in the journal Diabetes Forecast reported that taking the B vitamin Niacin in addition to statin drugs was a good way to increase the amount of HDL cholesterol (the so-called “good” cholesterol, as opposed to the “bad” or LDL cholesterol) for diabetics who were being treated for high cardiovascular risk.
Higher levels of HDL cholesterol have been linked in a number of studies to lower risk for heart attack, so Niacin appears to be a good way for diabetics to reduce one of the main health challenges of their condition.

Reference: “Vitamin B for your heart,” in Diabetes Forecast, April 2010.

NYBC stocks Niacin in two strengths:

Niacin 100mg

and

Niacin 500mg

Please read the NYBC entries on these two products for recommendations on how to gradually increase Niacin dosage in order to minimize “flushing” (redness, itchiness) that can be associated with taking Niacin.

CoQ10 – 200mg

NYBC has recently decided to stock CoQ10 in a 200mg/capsule format (Jarrow)</, since many research studies involve supplementation at that daily level or even higher. As a not-for-profit purchasing co-op, NYBC seeks low-cost options for people choosing to use supplements, so this format from the well-regarded Jarrow line seemed a good value as well.

An extract from the NYBC write-up on this supplement–

Clinical studies have shown repeatedly that coenzyme Q10 has potent abilities to assist the heart muscle, and as an adjunct treatment for angina, congestive heart failure, arrhythmia, hypertension (high blood pressure), and drug toxicity.

Research has also shown that as cellular levels of coenzyme Q10 decrease, HIV disease progresses. Other studies have documented its immune restorative qualities, including restoration of T cell function. Absorption of dietary fat soluble coenzyme Q10, due to the high inflammatory cytokine levels, is disrupted, so supplementation may help. Many PWHIV believe CoQ10 is an important nutrient to aid in detoxification if one uses nucleoside analogues (AZT ddI, ddC, d4T, etc.) or any toxic drug. Due to this impaired absorption, it’s best to take a form of CoQ10 that is mixed with lecithin or some other fat to improve its uptake. However, it may be that only very high doses will help (like 200-400 mg a day!) This will not be cheap.

CoQ10 is very helpful in conjunction with certain drugs. Studies have shown clear benefit when used with a heart toxic chemotherapy drug called adriamycin. In addition, some have suggested that it is very important to use CoQ10 when taking one of the statin drugs, used to manage high LDL cholesterol since the level of CoQ10 in the blood is depleted when using this class of drugs.

Statin side effects: reason to consider the alternatives?

There’s been a lot of buzz about a new study published in the New England Journal of Medicine that found that statin use by people with low cholesterol but high levels of an inflammation marker (C-reactive protein, or CRP) very substantially decreased heart attack and stroke rates over a two-year period. The study participants were men 50 and older and women 60 and older with no history of cardiovascular disease or high cholesterol, but with high levels of CRP. Many also had other cardiovascular risk factors such as obesity, high blood pressure, or smoking.

Does this study suggest that millions of people with normal cholesterol levels but high levels of CRP should start taking statins on a regular basis? There is a caution here, which was raised by an editorial in the NEJM accompanying the study, and has been echoed in many other places, from the New York Times to the British Journal of Medicine: what about the long-term effects of taking statins? It was worrisome to note that in this study, participants taking the statin (Crestor) over the two-year period had an increase in diabetes. This finding brings to mind an unfortunate pattern marring the US drug approval process in recent decades: drugs win approval and are widely marketed, but several years later it turns out that there are side effects to long-term use, sometimes so prevalent and so severe that recommendations for use of the drug must be curtailed. So it’s best to give very careful thought to “who should take a statin?” (This was the title of the New York Times editorial regarding the study.)

Furthermore, when discussing how to manage chronic conditions over the long term, we shouldn’t neglect good options in nutrition and dietary supplements. Here’s how George Carter at our sister organization FIAR puts it, in his direct response to the NEJM study:

Are there cheaper and safer alternatives to lowering CRP? Yes! A low-fat diet, for example, can cut CRP in half in 4 weeks.

How about just adding some fiber? See http://www.medscape.com/viewarticle/553590.
They found an 18.1% reduction in CRP using supplemental fiber. While rosuvastatin appears to have done better with a 37% reduction, just using fiber can get one half way there. Also, it is unclear what degree of reduction might be clinically important, although a generally agreed upon level of greater than 1.0 mg/liter CRP is considered problematic.

Vitamin C has also shown some benefit. One study reported that participants who took about 500 milligrams of vitamin C supplements per day saw a 24 percent drop in plasma C-reactive protein (CRP) levels after two months. Another study among healthy non-smokers saw a 25.3% reduction in CRP levels among those with a level greater than 1.0 mg/L at the beginning of the study.

We’ll conclude by adding that of course dietary supplements like fish oil (with their omega-3 fatty acids), niacin, pantethine, CoQ10 and the B vitamins also have a role to play in controlling cardiovascular risk. Their effectiveness has been widely studied and documented, they have been in use for a long time, and they have very well-known safety profiles. It only makes sense that these supplements should be part of the arsenal of protective and preventive means available to those concerned about managing risk to the heart and circulatory system.

References:

Ridker, PM, et al. Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein. NEJM, 9 Nov 2008

Who Should Take A Statin? Editorial in the New York Times, Nov. 17, 2008. Accessed at http://www.nytimes.com/2008/11/17/opinion/17mon2.html?hp

FIAR press release on NEJM statin study accessed at
http://www.fiar.us/StatinResultsMediaLetter.pdf

Recommendations for Cardiovascular Health: from “Supplement Your Prescription,” by Hyla Cass, M.D.

We return to this excellent guide published in 2007 by Hyla Cass, a practicing physician and expert on integrative medicine.

In Chapter 4 of the book, Dr. Cass reviews recent findings that call into question the idea that dietary cholesterol causes cardiovascular disease. In line with the current scientific thinking on this subject, she suggests looking at underlying inflammation as essential to any understanding of risks to heart and circulatory system health. As a consequence, she says, people who want to reduce risk of cardiovascular disease should consider dietary changes that are anti-inflammatory (that is, a diet high in antioxidants, anti-inflammatory herbs, and antioxidant-rich foods–that’s colorful fruits and vegetables, curry, turmeric, rosemary, ginger, green tea, dark chocolate, low-toxin fish like salmon or sardines).

Statin drugs, though they come with some side effects, have proven of benefit to certain groups of people with cardiovascular complications, including diabetics, those who have had a heart attack, and those diagnosed with cardiovascular disease. Like many others, Dr. Cass recommends supplementing with CoQ 10 if you’re taking statins. She also supports use of omega-3 fatty acids (from fish oil), niacin (though not recommended for diabetics), plant sterols, tocotrienols (a form of the antioxidant vitamin E), and D-ribose for controlling cholesterol and otherwise countering cardiovascular disease. In addition, the B vitamins are recommended to help lower homocysteine, high levels of which are associated with artery damage and increased risk of heart disease.

Citation: Hyla Cass, M.D., Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition (Basic Health Publications, 2007).

New England Journal of Medicine Editorial: Vytorin and Zetia may not work, and should only be prescribed as a last resort

Here’s the latest news on Vytorin and Zetia, two drugs that are widely prescribed as cholesterol-lowering agents.

We repeat some of the suggestions we made when the failings of these two drugs were first revealed: consider such alternatives as statins plus niacin*; or a supplement based on plant sterols and other components, Cardio Edge from Douglas Labs.

* See NYBC entries for Niacin 100mg (recommended as initial dose to minimize “flushing”) and Niacin Timed-Release / Niatab 500mg, the full-strength dose.
 —- 
Journal Issues Warning on Two Cholesterol Drugs
New YorK Times
By ALEX BERENSON
Published: March 30, 2008

CHICAGO — Two widely prescribed cholesterol-lowering drugs, Vytorin and Zetia, may not work and should be used only as a last resort, The New England Journal of Medicine said in an editorial published on Sunday.

The journal’s conclusion came as doctors at a major cardiology conference in Chicago saw for the first time the full results of a two-year clinical trial that showed that the drugs failed to slow, and might have even sped up, the growth of fatty plaques in the arteries. Growth of those plaques is closely correlated with heart attacks and strokes.

We accessed the full story at http://www.nytimes.com on 3/30/2008.