Statins and Q10: Interview with Dr. med look
interview with dr medical 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, Dr. Look compiled the existing knowledge about the connection between the intake of cholesterol-lowering drugs from the current active ingredient family of statins and the reduction of the vital endogenous substance Q10: Statins inhibit the production of Q10 at the same time as cholesterol synthesis.
Avoid Q10 deficiency with statins?
Due to these biochemical reaction processes in the body, it is plausible that Q10, taken together with the statins, can prevent an undesirable Q10 deficiency for the patient. But the evidence for this in the form of large clinical studies according to the current state of science is missing. The substance Q10 is available as a food supplement without a prescription and is not patentable. Should every statin patient buy and swallow Q10 themselves? dr Look advises you to make an individual decision after consulting your doctor or pharmacist.
Why does our body need the energy enzyme Q10?
dr Look: Coenzyme Q10 (“ubiquinol”) fulfills an important function in generating energy in the power plants of every cell in the body, the mitochondria. This is where food energy is converted into metabolic energy. However, Q10 is also one of the most important antioxidants  in the body, ie it protects the cell walls from aggressive molecules.
Why does the heart consume so much Q10?
dr Look:Â It makes sense that all organs with a high energy requirement depend on an optimal supply of Q10 – the constantly beating heart is one such organ.
Where does the Q10 that we need for life come from?
dr Look:Â Q10 is both ingested with food and synthesized by the organism itself. For example, to get 100 milligrams of Q10 from food, you would need to eat about 1.6 kg of sardines.
The four million Germans who take statins to lower high cholesterol levels can experience an undersupply of Q10. Why?
dr Look:Â You rightly say “can”. Unfortunately, there are no studies in the sense of the highest evidence level I, i.e. the highest level of evidence that we need for official, population-wide recommendations. Statins are currently intended as long-term therapy, even lifelong therapy. Older people already have lower Q10 levels than young people without statin therapy. According to this, it is plausible to expect a Q10 deficiency situation in old people on long-term statin therapy and especially at high doses.
On the possible mechanism: the substance provided by the key enzyme in cholesterol synthesis is required not only for cholesterol synthesis but also for the formation of Q10. Statins inhibit this enzyme and the body produces less cholesterol . It is a logical hypothesis that statin suppression of this enzyme may consequently also decrease Q10 production.
What are the consequences of a lack of Q10 in patients with high cholesterol and cardiac insufficiency?
dr Look: Heart failure  can be caused by a heart attack  or by other factors (viruses, genetics, other reasons) without a relevant narrowing of the coronary arteries. But, not every patient with high cholesterol has heart failure, and not everyone needs to be treated with a statin.
However, one can well imagine that an impairment of energy production in the “power plants” of the cell (mitochondria, see question 1) leads to stress  in the muscles or the death of muscle cells. The person perceives this as muscle pain and weakness, and elevated levels of a muscle enzyme (creatine kinase) can be found in the laboratory. It is conceivable that a Q10 deficiency aggravates an existing cardiac insufficiency and contributes to pump failure.
What do you recommend to statin patients to prevent a lack of Q10?
dr Look:Â In view of the lack of large-scale studies on the subject, 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 examining the combined administration of Q10 and statins or the administration of Q10 as an attempt to eliminate statin-mediated side effects is too small. Therefore, one cannot make a general recommendation, even at the expense of the health insurance companies.
Are the doctors aware of the problem of the potential Q10 deficiency in statin patients? How can you contribute to raising awareness?
dr Look:Â I assume that this is specialist knowledge, but I do not have representative data on any questioning of colleagues on this topic. Only large, so-called head-to-head studies in which statins alone are compared with statins plus Q10 can provide clarity. These studies have to be carried out on several thousand patients and last for several years.
Presenting the Q10 hypothesis to colleagues at this point in time may be correct on the one hand, but it also harbors the risk of arousing unfounded fears in patients too. Conservative institutions are therefore somewhat critical of this. Because as long as the supporting studies I have outlined do not take place, colleagues in practice are always in the dilemma of having to interpret the data according to their own feelings.
In my opinion, it is a small scandal that the scientific community has not yet managed to carry out these head-to-head studies. Over the past 20 years, tens of thousands of patients have been treated with statins in trials. The fact that a statin/Q10 comparison group was never compared with the statin-only group is very critical. Ten years ago, it would have been easy to check whether the combination therapy, Q10 plus statin, had fewer side effects or even better overall results in reducing heart attacks and mortality, especially in high-risk patients, than statin monotherapy. Dr. Look, thank you for the interview.
