The effect of ezetimibe and simvastatin on coenzyme Q10 levels in healthy men

I. Berthold; A. Naini; S. di Mauro; W. Krone; H. K. Berthold

doi:10.1055/s-2005-863041

Experimental and Clinical Endocrinology & Diabetes, Table of Contents

The effect of ezetimibe and simvastatin on coenzyme Q10 levels in healthy men

I Berthold ¹, A Naini ², S di Mauro ², W Krone ¹, HK Berthold ³

¹Universität zu Köln, Medizinische Klinik II und Poliklinik für Innere Medizin, Köln
²Columbia University, Department of Neurology, New York, USA
³Arzneimittelkommission der deutschen Ärzteschaft, Berlin

Abstract

Introduction: Coenzyme Q10 is an antioxidant and plays an important role in mitochondrial metabolism. Statins have been associated with a decrease in Q10 levels because inhibition of cholesterol synthesis also inhibits Q10 synthesis. Ezetimibe, a cholesterol absorption inhibitor, has been shown to increase HMG-CoA-reductase activity and cholesterol synthesis. Purpose of the present study was to evaluate the effects of a 14 day-treatment with either Eze or Simva alone or Eze plus Simva on the Q10 levels in healthy men.

Material and Methods: This monocenter study was a prospective randomized 3-group trial examining the effects of Eze (10mg/day), Simva (40mg/day) and their combination (10mg/day Eze plus 40mg/day Simva) on blood concentrations of Q10 of 72 healthy men (3 groups of 24 each) with a mean age of 32±9yrs and pre-treatment LDL-C ≤190mg/dl.

Results: The LDL-C concentrations were at baseline 105±23mg/dl in the Eze group, 113±30mg/dl in the Simva group and 116±35mg/dl in the combination group (p=0.40). They decreased in all three groups after 14 days of treatment –22±10% in the Eze group, –41±12% in the Simva group and –60±10% in the combination group; ANOVA p<0.0001). The mean±SD blood concentration of Q10 at baseline was 0.97±0.28µg/ml in the Eze group, 1.01±0.29µg/ml in the Simva group and 0.98±0.33µg/ml in the combination group (p=0.89). After 14 days of treatment the Q10 levels remained unchanged in the Eze group (+1±21%, n.s.). They decreased in the Simva and in the combination group (–16±16% p=0.0003 and –28±12% p<0.0001, respectively).

Conclusions: Eze has no effect on Q10 blood levels while Simva causes their marked decrease. Co-administration of Simva and Eze does not ameliorate the Simva-induced decrease in Q10 concentrations as could be expected from the possible compensatory increase in endogenous cholesterol synthesis. Routine Q10 supplementation during statin therapy in order to avoid common side-effects of statins attributed to Q10 deficiency such as exercise intolerance, myopathy and myoglobinuria should be evaluated.