Question about HIV meds, heart attack and statins

[Guest guest]

Hi all, I've posted a few times in the past and got many friendly and

informative replies. Thanks much!!

I have another question: I had a heart attack about 2 1/2 years ago, taking

Isentress/Intellence/Viread, along with heart meds, including Crestor (Statin).

Does anybody know if it's safe to stop the statin. I ask because I think it's

what's causing a lot of muscle/joint pain. I used to run and no longer due to

the burning muscles once I start running.

Any information would be greatly appreciated.

Thanks much and Happy New Year!

Rich

[Guest guest]

It is very important to continue statins if you have had a heart attack! It reduces your risk of another!It might not just be the statins causing your muscle pain. some HIV meds also cause muscle pain. Both statins and HIV meds lower serum CoEnzyme Q 10 levels. CoEnzyme Q 10 is very important for the manufacture of energy in cells.For the muscle pain with statin use, you might try 50 mg CoEnzyme Q 10 three times daily. Research has also used higher doses. One concern with CoQ 10 supplementation with HIV is one small study showing an increase in neuropathy symptoms. Blood CPK levels may not be able to accurately show if muscle pain during statin therapy is not leading to muscle

damage.CoQ 10 supplementation is very safe. However, one study of CoQ 10 found that neuropathy symptoms worsened in HIV patients. Note that this is a pilot study, so it is small and not definitive. (Christensen ER,

Stegger M, Jensen-Fangel S, et al. Mitochondrial DNA levels in fat and

blood cells from patients with lipodystrophy or peripheral neuropathy

and the effect of 90 days of high-dose coenzyme Q treatment: a

randomized, double-blind, placebo-controlled pilot study. Clinical Infectious Diseases. 2004;39:1371-1379.)Higher blood levels are achieved if the dose is split into twice daily or even three times daily dosing. Oil based supplements give higher blood levels. Also, 'nano particle' forms of CoQ 10 give higher blood levels.See wikipedia article on CoEnzyme Q10 for most complete single source information I found on CoQ 10 basics. Note that the research numbers in the following studies are small. Thus, there is no conclusive evidence for CoQ 10. , in the last 35 years, the funding of medical

research in the US

has converted from being primarily funded by the government (70% in 1980) to

over 70% funded by private corporations.

Co-Enzyme Q is a naturally occurring substance, meaning it cannot be

patented. Thus no private corporation

can make a big profit from research on Co-Enzyme Q. Thus, we cannot expect studies large enough to give definitive answers.Following is the best review article I found:------------------------------------Does Coenzyme Q10 Relieve Statin-Induced Myopathy?Gayle , PharmD, BCPS, ELS

Authors and Disclosures

Posted: 09/18/2009

Print This

processing....

Information from Industry

Assess clinically focused product information on Medscape.

Click Here for Product Infosites – Information from Industry.

Question

Does coenzyme Q10 alleviate muscle tenderness or spasm associated with statins?

Response from Gayle , PharmD, BCPS, ELS

Assistant Professor, Eastern Virginia Medical School, Norfolk,

Virginia; Clinical Pharmacist, Chesapeake Regional Medical Center,

Chesapeake, Virginia

Coenzyme

Q10 (CoQ10) is a vitamin-like compound synthesized by the body and

obtained from dietary fat. Another name for CoQ10 is ubiquinone,

implying its ubiquity in the body. Coenzyme Q10 is present in almost

all cells, where it functions as a cofactor in adenosine triphosphate

production and as an antioxidant.[1]

Although

adverse effects of statins are relatively rare -- considering that

millions of prescriptions are dispensed each year -- the most common

adverse effect is myopathy, ranging from mild muscle pain to the rare

fatal rhabdomyolysis. The mechanism of statin myopathy is unclear;

however, statins reduce the synthesis not only of cholesterol but also

of CoQ10. One theory suggests that statin myopathy results from

mitochondrial dysfunction in muscle caused by CoQ10 deficiency.

Insufficient CoQ10 might limit mitochondrial energy production, disrupt

normal cellular respiration, and result in the development of myopathy.[1]

Thus,

supplemental CoQ10 has become a popular treatment for statin myopathy.

It is well tolerated, and serious adverse effects have not been

reported.[2]

CoQ10

is regulated as a dietary supplement in the United States, so

manufacturers are not required to demonstrate efficacy or safety before

marketing. However, several small studies addressing the effectiveness

of CoQ10 for statin myopathy have been published.

In a randomized controlled trial of 32 patients with hypercholesterolemia and statin-associated myopathy, Caso and colleagues[3]

treated 18 patients with CoQ10, 100 mg (Q-Sorb®; Nature's Bounty;

Bohemia, New York) daily, and 14 patients with vitamin E, 400 IU

(chosen to control for the antioxidant effects of CoQ10) daily for 30

days. Compared with the vitamin E group, the CoQ10 group showed a 40%

decrease in pain severity and a 38% reduction in pain interference with

daily activities.[3]

Young and colleagues[4]

conducted a randomized controlled trial of 44 patients with previous

statin myopathy. Patients were randomly assigned to CoQ10, 200 mg

(Q-Gel®; Tishcon Corporation; Salisbury, land) daily, or placebo

for 12 weeks, combined with simvastatin, titrated every 4 weeks from 10

mg to a maximum of 40 mg daily. Although CoQ10 serum levels increased

in the treatment group and decreased in the placebo group, myalgia

scores, number of patients continuing to receive simvastatin, and

number of patients titrated to simvastatin, 40 mg daily, were the same

in both groups.[4]

Mabuchi and colleagues[5]

studied 49 patients with hypercholesterolemia (but no history of

myopathy) who were randomly assigned to CoQ10, 100 mg (Kaneka; Osaka,

Japan) daily, or placebo in combination with atorvastatin, 10 mg daily

for 16 weeks. CoQ10 serum levels increased in the treatment group and

decreased in the placebo group, but indicators of muscle injury,

including serum aspartate aminotransferase, alanine aminotransferase,

and creatine kinase, did not differ between groups.

In

summary, more research is needed to determine whether CoQ10 is useful

for treatment of statin myopathy. Coenzyme Q10 might be worth a try

(with careful monitoring) in patients with mild statin-induced

myopathy. No research is available to support the use of CoQ10 for

prevention of statin myopathy.