Statin cardiomyopathy? A potential role for Co-Enzyme
Q_{10} therapy for statin-induced changes in diastolic LV
performance: Description of a clinical protocol
Issue title: The Third Conference of the International CoQ10
Association
Affiliations: Heart Failure Institute, Division of Cardiology,
Department of Medicine, Advocate Christ Medical Center and the University of
Illinois/Christ Cardiovascular Disease Fellowship Program, Oak Lawn, IL 60453,
USA
Note: [] Address for correspondence: Marc A. Silver, MD, Clinical
Professor and Chairman, Department of Medicine, Director, Heart Failure
Institute, Advocate Christ Medical Center, Oak Lawn, IL 60453, USA. Tel.: +1
708 346 4239; Fax: +1 708 346 2500; E-mail: Marc.Silver@Advocatehealth.com
Abstract: Lipid-lowering statins are thought to have a favorable safety
profile. Statins inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA)
reductase, the rate-limiting step of mevalonate synthesis. Mevalonate is the
substrate for further synthesis of cholesterol and Co Enzyme
Q_{10}(CoQ_{10}).
CoQ_{10} plays an important role during oxidative
phosphorylation in the myocardial cell. Since myocardial diastolic function is
a highly ATP dependent, we reasoned that early changes of diastolic function
may be an early marker of ventricular dysfunction Methods: Patients who are to commence on statin therapy will be
enrolled in the trial. Baseline measurements of plasma
CoQ_{10}, total cholesterol, LDL, HDL,
CoQ_{10}/LDL ratio, peak E, peak A velocities, E/A ratio,
deceleration time, isovolumetric relaxation time, color M-mode propagation
velocity will be performed and patients will then begin to take Oral
atorvastatin (Lipitor, Parke-Davis) 20 mg daily for three to six months. All
baseline measurement will be repeated after 3 to 6 months of statin therapy.
Those patients demonstrating > 1 measurement of diastolic LV function that
worsened during the 3 to 6 months of statin therapy will be supplemented with
CoQ_{10} 300 mg. daily for 3 months. A followup
echocardiogram and blood CoQ_{10} level will be measured in
patients who received CoQ_{10} supplementation. Results: Statistical analysis will be performed using the paired t
test to compare coenzyme levels and echocardiographic indices at baseline and
after treatment and after supplementation.
