Introduction
HMG CoA-reductase inhibitors or statins are clearly the most effective class of drugs for
lowering LDL cholesterol. Those drugs have been associated with a beneficial impact on
cardiovascular morbiditi and mortality. As such, statins have become some of the most widely
prescribed drugs in the United States with many millions of patients taking them on a regular
basis. According to the most recent NCEP (National Cholesterol Education Program) guidelines,
the indications for the use of statins have been broadened such that patients with even low
normal LDL cholesterol levels are now being treated in hopes of favorably altering the incidence
of stroke and myocardial infarction. Statins are frequently used in the elderly and have gained
very broad acceptance in the medical community. Statins have been noted to have significant
anti-inflammatory and plaque-stabilizing effects which has added to their broader usage.
It is well established that the mevalonate pathway is involved not only in the biosynthesis of
cholesterol but also in the biosynthesis of the essential co-factor required for energy production,
coenzyme Q1o (CoQlo, ubiquinone). As such, HMG CoA reductase inhibitors block the cellular
production of cholesterol and of coenzyme Qlo (Rudney 1981, Goldstein 1990). This drugnutrient
interaction has been reviewed (Bliznakov 1998, Bliznakov 2002).
The peer-reviewed scientific evidence supports the following findings:
1. Statins block the endogenous biosynthesis of both cholesterol and CoQlo by inhibiting the
enzyme HMG CoA reductase, thus decreasing mevalonate, the precursor of both cholesterol and
CoQio.
2. CoQlo is essential for mitochondrial ATP production and is a potent lipid soluble antioxidant
present in cell membranes and carried in the blood by LDL. CoQl 0 is biosynthesized in the
body and available fiom dietary sources.
3. Statin-induced decreases in CoQlo are more than just hypothetical drug-nutrient interactions.
Good evidence exists of significant CoQlo depletion in humans and animals during statin
therapy.
4. Scientific evidence confirms the existence of detrimental cardiac consequences from statininduced
CoQlO deficiencies in man and animals.