Coincidentally, your article on statins arrived in the same mail delivery as my copy of the Australian Adverse Drug Reactions Bulletin (www.tga.gov.au/adr/aadrb.htm), which reported that the risk of depression from statins is about 1.4 per cent (7 October, p 46). You commented on the difficulty in determining the true benefit of these drugs, given the long time frames over which they are intended to be taken. We should all remember that similar time delays may well apply to discovering the true risks of statins.
From Richard Paterson
As James Kingsland wrote in his article on statins, "blocking of HMG CoA reductase inhibits the production of many other molecules beside cholesterol".
Statins also block the synthesis of coenzyme Q10. In a 30-day study using atorvastatin blood levels of CoQ10 were halved (Archives of Neurology, vol 61, p 889). This block was neither mentioned in Kingsland's article nor considered by the Clinical Trials Service Unit (CTSU) - whose report is at http://www.ctsu.ox.ac.uk/~hps/statin_paper.shtml - although three other antioxidants were included in the trial. CoQ10, an antioxidant, is a key component of the oxygen-driven electron transport system in mitochondria, and this system plays a large part in ATP (adenosine triphosphate) synthesis in all our cells except red blood cells.
ATP is the crucial energy source of heart and brain and its loss is ultimately responsible for deaths following myocardial infarction or ischaemic stroke.
The potential for a fall in CoQ10 was recognised long before these reports. A major drug company was granted a patent for combined CoQ10/statin therapy in 1990 - see US Patent 4933165 at www.uspto.gov. One can only speculate as to the reason why this was never taken up.
The reported side effects of statins in muscle and cognitive function could be the result of blocking CoQ10 synthesis.
Finally, the CTSU studied people who already had a substantial risk of death within five years. As your article said, the meta-analysis cranked out significant positive results, but there was no dramatic effect on outcome, even in these patients, at the doses which have to be used to minimise side effects.
So prescribing statins for almost everyone - or putting them in the tap water, as one madcap enthusiast in the UK suggests - could benefit only those who profit from selling them. If "you bet your life on" taking statins, you should insist on a coenzyme Q10 supplement. As the article suggests, there are alternatives such as a healthy lifestyle, boosting vitamin D and perhaps - for those whose can take it - low-dose aspirin.
Falmouth, Cornwall, UK
So far we only have isolated case reports or uncontrolled studies suggesting that giving supplements of coenzyme Q10 can prevent or minimise adverse effects of statins such as induced muscle pain and fatigue (Web letters, 4 November). Medical authorities believe it is premature to support the widespread use of CoQ10 in patients treated with statins. Hopefully this issue will be addressed in a large-scale controlled study.
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