Statin therapy is frequently limited by myopathic symptoms creating a critical need for strategies to prevent statin myopathy. Coenzyme Q10 supplementation is a simple, attractive therapy that requires an appropriately powered and randomized trial to determine whether CoQ10 eliminates or reduces statin myalgia in symptomatic patients. Simultaneous genetic studies should attempt to determine if genetic variants contribute to the variability in the response to CoQ10 therapy. Studies designed to determine if CoQ10 prevents the onset of myalgia in statin-naive patients are not practical because of the number of subjects that would be required in such a trial. In addition, the absence of pharmacologic grade CoQ10 supplement and a study sponsor makes such a trial difficult. Nevertheless, such trials are the only way to demonstrate conclusively whether or not clinicians should prescribe CoQ10 to their patients on statin therapy.