Cardiovascular disease (CVD) is the leading cause of death in the U.S.—more than any cancer— with 17% of national healthcare costs focusing on the disease alone. The American Heart Association predicts that by 2030 approximately 40% of the U.S. population will have some form of CVD, accounting to direct medical costs nearing $818 billion. Indirect costs due to lost productivity add $276 million to the bill, bringing the overall toll to more than a trillion dollars.
 
With the widespread impact of CVD, statins have become the standard method of care within the medical establishment, and a key tool in fighting high cholesterol and CVD.
 
At Engredea/Natural Products ExpoWest in Anaheim, CA, Steven Sisskind, MD, and Scott Steinford, executive director of the CoQ10 Association, discussed how statin usage impacts the health of the consumer (for better and for worse), and why Coenzyme Q10 (CoQ10) supplementation is important for patient care.
 
According to Dr. Sisskind, the focus of the discussion wasn’t to point out “how bad statin use is,” but rather that “statins are in massive use in the United States and around the world. Twenty-five percent of people 45+ are using statins—that’s 32 million people, according to the CoQ10 Association’s 2015 Cardiologist CoQ10 Survey.”
 
Dr. Sisskind suggested the role of the supplement industry isn’t to condemn statin use, but rather support physicians and consumers looking for ways to optimize health outcomes. 
 
While he acknowledged that statins are a useful tool for managing CVD-related health conditions, they are not a perfect solution to the problem, according to Dr. Sisskind. The USAGE survey (Understanding Statin Use in America and Gaps in Education)—the largest known cholesterol survey conducted in the U.S.—revealed that 50% of statin users discontinue the medication within months, and 25% stopping after just one month. Furthermore, nearly 75% of new users discontinue their therapy by the end of the first year.
 
Compliance Conundrum
Why is compliance such an issue among statin users? Physical side effects, perhaps a result of CoQ10 deficiency, could be a huge factor. “Sixty-two percent of users surveyed in the 10,000 person USAGE survey reported stopping taking their statins due to side effects,” noted Dr. Sisskind.
 
He also cited data from the Research Now Cardiologist CoQ10 Survey (March 2015), which found 50% of cardiologists said muscle pain was frequently (more than 25%) or often (16-25%) reported with statin use. An additional 32% of cardiologists said fatigue was frequently or often a side effect, while smaller portions of patients experienced other side effects.
 
In addition to muscle plain and fatigue, rash, nausea, yellowing of the skin or eyes, dark urine, loss of appetite, diabetes concerns, diarrhea, abdominal pain, and memory loss or confusion may be associated with statin use.
 
Clinical research suggests that low CoQ10 levels could be to blame for some side effects associated with statin use. Research published in Archives of Neurology (2004) suggested that statin (Atorvastatin) usage decreased CoQ10 levels in the blood of patients, reporting a 49% reduction in just 30 days.
 
An additional randomized, clinical trial (Medical Science Monitor, 2014) found that CoQ10 supplementation (50 mg twice daily) reduced statin-related mild-to-moderate muscular symptoms in statin users, reducing the impact of the side effects in their daily activities.
 
Mr. Steinford, executive director of the CoQ10 Association, noted that while these are important studies, more research is needed to further substantiate CoQ10 in the eyes of the medical community.
 
Supplementation & Education
In its efforts to spread the word about the benefits of supplementation, the CoQ10 Association reached out to cardiologists with its 2015 survey to uncover more details about how the supplement is used and perceived.
 
The report found that 71% of cardiologists recommended CoQ10 to at least some of their patients, and was the top supplement they recommended overall. When asked what supplements cardiologists recommended to their patients 45% listed CoQ10 without prompting, versus the other top listed supplements, such as fish oil (21%) or a vitamin (13%).
 
Despite this positive feedback, Mr. Steinford still believes more work needs to be done to educate physicians and consumers. “With the CoQ10 Association research, we specifically chose cardiologists because we knew that was most likely the group of physicians that was going to recognize or be aware of CoQ10’s benefits,” he explained. While understanding of CoQ10 among cardiologists is relatively high, that level of awareness drops off among other types of doctors, such as general practitioners, who could be more effective from a preventive standpoint. “The other aspect of this though, is that cardiologists really only see the heart patients when the first line of medicine—general medicine—didn’t work,” he explained. “So many doctors aren’t even aware of the benefits of CoQ10 as a heart supplement, much less something that should be prescribed with statins.”
 
While it’s good news that 45% of cardiologists reported recommending CoQ10, Mr. Steinford said the down side is that while some believe in the supplement’s benefits, many aren’t convinced that it really helps.
 
“Most cardiologists feel moderately familiar with CoQ10 supplements, but could know more. This is a good opportunity for us to be able to educate the physicians more. It indicates a willingness to know more,” Mr. Steinford stated. “Of those aware of CoQ10 deficiency issues, 61% recognized they could know more, and those that were not aware, 29% are actively looking for more information.”