The effect of statin treatment on circulating coenzyme Q10 concentrations: an updated meta-analysis of randomized controlled trials

Systematic review and meta-analysis of randomized controlled trials; 12 RCTs with 1,776 participants; populations included dyslipidemia, type 2 diabetes, heart failure (NYHA II/III) with LVEF <40%, HIV infection, STEMI, and healthy subjects; participant ages and sexes varied.

Statin therapy (lipophilic or hydrophilic statins) vs placebo; durations ranged from 14 days to 26 weeks; dosages not consistently reported.

Statin treatment decreased circulating CoQ10 versus placebo (SMD −2.12; 95% CI −3.40 to −0.84; p = 0.001) with substantial heterogeneity (I2 = 98%). Both lipophilic (SMD −1.91; 95% CI −3.62 to −0.20; p = 0.017) and hydrophilic (SMD −2.36; 95% CI −4.30 to −0.42; p = 0.028) statins lowered CoQ10, with no meaningful difference between groups (SMD −0.20; 95% CI −0.208 to 0.618; p = 0.320). Both low–middle and high–intensity statins reduced circulating CoQ10 (SMD −2.403; 95% CI −3.992 to −0.813; p < 0.001 and SMD −1.727; 95% CI −2.746 to −0.709; p < 0.001, respectively). Meta-regression showed no clear link between duration and CoQ10 decrease (p = 0.994). Conclusion: statin-induced CoQ10 depletion could contribute to SAMS and CoQ10 supplementation may be a promising complementary approach for SAMS.

Significant heterogeneity across studies due to diverse populations and study designs; potential publication bias; variability in statin types, doses, and durations; several studies had small sample sizes.