Interview with dr. med. Markus Look, internist from Bonn and author of the report of the Drug Commission of the German Medical Association (AKDÄ) on statins and Q10. In a statement for the AKDÄ Look at the existing knowledge of the relationship between the intake of cholesterol-lowering drugs from the current drug family of statins and the reduction of the vital endogenous substance Q10 put together: statins inhibit the production of cholesterol at the same time the production of Q10.
Q10 deficiency avoided by statins?
Because of these biochemical reactions in the body, it is plausible that Q10, taken with the statins, can avoid an undesirable Q10 deficiency for the patient. But the evidence for this is lacking in the form of large-scale clinical studies according to the current state of science. The substance Q10 is available without a prescription as a food supplement and is not patentable. Should every statin patient buy and swallow Q10 for themselves? Dr. Look advises the individual decision after consultation with a doctor or pharmacist.
Why does our body need the energy enzyme Q10?
Dr. Look: Coenzyme Q10 ("ubiquinol") performs an important function in generating energy in the power plants of every body cell, the mitochondria. Here, food energy is converted into metabolic energy. Q10 is also one of the most important antioxidants in the organism, ie it protects the cell walls from aggressive molecules.
Why is the heart just consuming so much Q10?
Dr. Look: It is clear that all organs with high energy requirements depend on optimal Q10 supply - the constantly beating heart is such an organ.
Where does the Q10 come from, which is vital for us?
Dr. Look: Q10 is both ingested and synthesized by the organism itself. For example, to ingest 100 milligrams of Q10, you would need to eat about 1.6 kilograms of sardines.
The four million Germans who take statins to lower elevated cholesterol levels may experience Q10 deficiency. Why?
Dr. Look: You're right with saying "can". Unfortunately, there are no studies in the sense of the highest evidence level I, ie the highest evidential value that we have to have for official population-wide recommendations. From a current perspective, statins are intended for long-term therapy, even lifelong therapy. Even without statin therapy, elderly people already have lower Q10 levels than younger people. It is therefore plausible to expect a Q10 deficiency situation in old people under long-term statin therapy and especially at high dose.
Possible Mechanism: The substance provided by the key enzyme of cholesterol synthesis is still needed to form Q10, except for cholesterol synthesis. Statins inhibit this enzyme, the body produces less cholesterol. It is a logical hypothesis that a reduction of this enzyme by statins can therefore also reduce the Q10 production.
What consequences can a lack of Q10 have in patients with high cholesterol and heart failure?
Dr. Look: Heart failure may be caused by heart attacks or without relevant constriction of the coronary arteries due to other factors (viruses, genetic, other reasons). But, not every patient with high cholesterol suffers from heart failure, and not everyone has to be treated with a statin.
However, it is easy to imagine that impairment of energy production in the "power plants" of the cell (mitochondria, see question 1) leads to stress in the muscles or death of muscle cells. The person perceives this as muscle pain and weakness, and in the laboratory, elevated levels of a muscle enzyme (creatine kinase) can be found. It is conceivable that a Q10 deficiency worsens an existing heart failure and contributes to pumping failure.
What do you recommend to statin patients to prevent a lack of Q10?
Dr. Look: Given the lack of large-scale studies, this is an individual decision between doctor and patient against the background of the described inhibition of Q10 synthesis by statins. However, the number of studies investigating the coadministration of Q10 and statin or Q10 administration as an attempt to remedy statin-mediated side effects is too small. Therefore, one can not pronounce a general recommendation, even at the expense of health insurance.
Is the physicians aware of the problem of the potential Q10 deficiency in statin patients? How can the education be contributed?
Dr. Look: I assume that this is specialist knowledge, but I do not have representative data on possible questioning of colleagues on this topic. Clarity can only be achieved by large, so-called head-to-head trials in which statins alone are compared with statins plus Q10. These studies must be done on several thousand patients and take several years.
Presenting the Q10 hypothesis to colleagues at the present time may be right, but it also carries the risk of provoking unfounded fears in patients as well. Conservative institutions therefore see this as somewhat critical. Because as long as the proofing studies outlined by me do not happen, the colleagues in practice are always in the dilemma of having to interpret the data according to their own feelings.
It is a small scandal, in my opinion, that the scientific community has not been able to carry out these head-to-head studies. In the last 20 years, tens of thousands of patients have been treated with statins in studies. That a Statin / Q10 comparison group was never compared to the exclusive Statingruppe is very criticized. Already ten years ago, it would have been easy to see whether the combination therapy, Q10 plus statin, had fewer side effects or even an even better overall result in reducing heart attacks and mortality, especially in high-risk patients, than statin monotherapy. Dr. Look, we thank you for the conversation.