By Andrew Shea - June 6, 2016
Reviewed by Risa Schulman, PhD
Cholesterol is a substance our bodies make and use to perform various essential functions such as making cell membranes and creating hormones. Most of the cholesterol needed for good health is produced by the liver, with the rest coming from diet. It’s essential for human life.
But too much cholesterol in our blood can put us at risk for heart disease and stroke. More than 70 million Americans have this problem. Some people can reduce high cholesterol levels by changing their diet and exercise, but millions need the help of prescription medicine.
Medicines that Lower Cholesterol
Several prescription drugs are approved for the treatment of high LDL cholesterol, including bile acid sequestrants, niacin and most recently a class of injectable drugs called PCSK9 inhibitors.
The vast majority of people treated for high cholesterol – millions of Americans – are taking cholesterol-lowering medicines collectively known as statins. You may know them by brand names such as Lipitor, Crestor or Zocor.
Statins are popular in part because they are relatively inexpensive and have shown themselves effective in lowering the type of cholesterol doctors consider bad for heart health.
Statins: An Important Nutritional Downside
What many people don’t know is that cholesterol-lowering statins also inhibit the body’s production of CoQ101-4, especially when consuming a high dose or taking the medicine for a long time. This leads to less Ubiquinol CoQ10 in the blood.
Even small decreases in Ubiquinol CoQ10 can disrupt the body’s ability to produce energy and cause other issues. Plus, in some people taking statins for a long period of time, having less Ubiquinol CoQ10 can be associated with fatigue and muscle cramps.
Moreover, the Ubiquinol (pronounced “you-bik-win-all”) form of CoQ10 can help defend against the oxidation of LDL cholesterol. But in people with lowered CoQ10 levels due to statin use, LDL cholesterol was more susceptible to oxidation, and oxidized cholesterol is a known risk factor for certain vascular problems.
How Do Statins Reduce Ubiquinol CoQ10?
To be sure, there’s a lot to like about cholesterol-lowering statins, and you should follow your doctor’s advice if she’s prescribed you one.
But how is it that medicine so effective in lowering cholesterol can also cause us to have less of a nutrient as important as CoQ10?
The answer is that our bodies make cholesterol in much the same way they make CoQ10; heart-healthy Ubiquinol CoQ10 is actually carried by cholesterol in the blood.
In the adjacent and simplified illustration, you can see that a compound called acetoacetyl-CoA is changed into an organic compound called mevalonate with the help of an enzyme called HMG-CoA reductase. From there, mevalonate can be used to make either cholesterol or CoQ10.
Statins are good at inhibiting the action of HMG-CoA reductase, which decreases the amount of mevalonate available to make cholesterol – quite important to treating a case of high cholesterol. Unfortunately, this also means there is less mevalonate available for the body to make Ubiquinol CoQ10.
Human studies have demonstrated statin medicines can significantly lower the amount of Coenzyme Q10 in the blood – both its conventional and Ubiquinol forms – even in those cases when a person has taken a standard dose for as few as three months1.
What Should Statin Users Do?
It’s fairly simple to address the issue of CoQ10 depletion caused by cholesterol-lowering medicine.
Because CoQ10 is difficult to obtain through diet alone, consider taking a dietary supplement that contains the nutrient. It’s a good idea to check with your health care provider before starting any vitamin or supplement.
Use care to choose the form of CoQ10 that’s right for you.
Conventional CoQ10 is a fine option for most young people because their bodies can efficiently convert it into Ubiquinol. This conversion becomes progressively harder and less efficient as we age, making Ubiquinol CoQ10 a better choice for anyone older than 30 and especially over the age of 40.
Ubiquinol CoQ10 is also a potent antioxidant that not only neutralizes harmful free radicals but seems to have the rare ability to regenerate other antioxidants such as vitamins C and E.
As of the time of publication, Andrew Shea is a Director of Marketing at Kaneka North America LLC, a manufacturer of CoQ10 ingredients. Dr. Barry is an employee of Kaneka and Dr. Schulman is a paid consultant to the company.
1 Passi S, Stancato A, Aleo E, Dmitrieva A, Littarru GP. Statins lower plasma and lymphocyte ubiquinol/ubiquinone without affecting other antioxidants and PUFA. Biofactors. 2003;18(1-4):113-24.
2 De Pinieux G, Chariot P, Ammi-Said M et al., Lipid-lowering drugs and mitochondrial functions: effects of HMG-CoA reductase inhibitors on serum ubiquinone and blood lactate/pyruvate ratio. Br. J. Clin. Pharmacol. 1996;42(3):333–337.
3 Mortensen SA, Leth A, Agner E, Rohde M. Dose-related decrease of serum coenzyme Q10 during treatment with HMG-CoA reductase inhibitors. Mol Aspects Med Suppl 1997;18: S137–144.
4 Watts GF, Castellucci C, Rice-Evans C et al., Plasma coenzyme Q (ubiquinone) concentrations in patients treated with simvastatin. J. Clin Pathol. 1993;46(11):1055–1057.