Efeito da suplementação de coenzima q10 nos sintomas musculares relacionados ao uso de estatinas: revisão sistemática e metanálise

Abstract

Introduction/objective: The treatment and prevention of cardiovascular diseases involve the use of statins, substances that act by inhibiting 3-hydroxy-3-methylglutaryl- CoA reductase (HMG-CoA reductase), the main rate-limiting enzyme in the synthesis of cholesterol in different tissues. Although they are generally well tolerated, a significant proportion of patients treated with statins may present elevated plasmatic levels of creatine kinase, generalized myopathy and even rhabdomyolysis. Statin-related muscle symptoms (SRMS) are the main cause of treatment discontinuation and a possible explanation for this adverse effect is the reduction in coenzyme Q10 (CoQ10) levels in plasma and muscles. CoQ10 plays a crucial role in energy metabolism, is essential for aerobic muscle function and has been frequently supplemented by healthcare professionals in the management of SRMS. This review aimed to investigate the benefits of CoQ10 supplementation in patients with SRMS, through a systematic review and metaanalysis. Methodology: The systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and comprised a search for scientific articles carried out on December 13, 2023, and updated on September 26, 2024, in the PubMed - Medline and Cochrane Library databases. The descriptors used in the search were “statin induced myopathy AND coenzyme Q10” and “statin associated muscle symptoms AND coenzyme Q10”. The research protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with registration number CRD42023493782. All included studies were randomized clinical trials that evaluated the effect of CoQ10 supplementation in patients with SRMS, published in English. A meta-analysis was performed based on the results found in the included studies, comparing the relief of SRMS in patients treated with CoQ10 and controls who received placebo. Results: The search for the studies initially identified 169 publications, of which 24 were duplicates. After reading the titles and abstracts, 30 studies were selected for complete reading, and of these, eight studies were included for data extraction. One study was included after reading the others, resulting in nine randomized clinical trials for the meta-analysis, based on the eligibility criteria. The nine studies comprised 420 patients with SRMS, randomized into 216 cases and 204 controls. Patients in the case group were treated with CoQ10 and controls with placebo. Four studies demonstrated the benefit of CoQ10 supplementation in relieving SRMS, however, five did not demonstrate this effect. The meta-analysis conducted to investigate the effects of CoQ10 supplementation in relieving SRMS did not prove the benefit of this substance (p=0.076). Conclusion: Based on the results obtained in the systematic review, four of the nine selected studies described a significant reduction in SRMS in the group of patients treated with CoQ10, compared to controls, however, the efficacy of CoQ10 supplementation in alleviating MREs was not proven in the meta-analysis