Miracon Science

Statins (CSE inhibitors)

Active substances and pharmaceuticals concerned

Name of active substance Trade name Affected micronutrients
Atorvastatin Sortis® and generics Coenzyme Q10
Nicotinic acid
Omega-3 fatty acids
Vitamin D
Simvastatin Gerosim®, Zocord® und Generika
Pravastatin Panchol® und Generika
Rosuvastatin Crestor®

Mechanism of interaction

Mechanism of interaction
Coenzyme Q10 Cholesterol synthesis is inhibited by blocking 3-hydroxy-3-methylglutaryl-CoA reductase. However, due to this inhibition, other isopentenyl pyrophosphate-dependent biomolecules such as coenzyme Q10 are not synthesized. Coenzyme Q10 is an essential source of energy production in the body.
Nicotinic acid Nicotinic acid has a lipid-lowering effect at pharmacologically active doses. In combination with statins, their lipid-lowering and cardioprotective effects are increased.
Omega-3 fatty acids Omega-3 fatty acids have a triglyceride-reducing effect. They extend the lipid-lowering and cardioprotective effects of statins.
Vitamin D The hydroxylated vitamin D metabolites and HMG-CoA reductase interact positively. As a result, the cardioprotective effect of CSE inhibitors is enhanced and extended.

Consequences and possible symptoms of the interaction

Negative consequences of the interaction Possible symptoms
Coenzyme Q10 Decrease of coenzyme Q10 levels
  • Fatigue, weakness
  • Muscle weakness and pain
  • Disorders of cardiac bioenergetics, endothelial dysfunctions
  • Increased risk of Alzheimer's disease, tumors, Parkinson's disease
  • Increased laboratory parameters for nitrosative stress
Positive consequences of the interaction Possible symptoms
Nicotinic acid Additive effect on lipid reduction
  • Reduction of LDL and total cholesterol is improved
  • HDL increases
  • Additional triglyceride and lipoprotein(a)-reduction
Omega-3 fatty acids Additive effect on lipid reduction
  • Reduction of cardiovascular risk factors
  • Decrease of stroke risk
Vitamin D Reduction of cardiovascular risk factors
  • Triglyceride level decreases
  • Heart attack and stroke rates decrease
  • Suppression of parathyroid hormone
  • Prevention of statin induced myalgia

Recommended Supplementation

Active substance Recommended supplementation Dosage
CSE-Inhibitors Nicotinic acid 1–3 g Nicotinic acid/d p.o. or
3 x 800 mg inositol nicotinate/d p.o.
Omega-3 fatty acids 1.5–3 g/d p.o.
Vitamin D 1000–2000 I.U./d p.o.

Special instructions for use

Instructions for use
Coenzyme Q10 The selenium status in whole blood should also be monitored. . However, there is no general recommendation for Selenium substitution.
Nicotinic acid Gradually increase dose and monitor.
Vitamin D The 25-OH-D serum level must be above 30 ng/ml for an additive effect. Monitoring of serum levels is recommended.
Hericium (medicinal mushroom) Lovastatin in the hericium fungus is a natural statin and must be considered when taking additional statins

 

References

References
Durrington PN et al. An omega-3 polyunsaturated fatty acid concentrate administered for one year decreased triglycerides in simvastatin treated patients with coronary heart disease and persisting hypertriglyceridaemia. Heart. 2001 May;85(5):544-8.
Fitzgerald K et al. Statin-induced Myopathy. Glob Adv Health Med. 2012 May;1(2):32-6. doi: 10.7453/gahmj.2012.1.2.008.
Gröber Uwe: Mikronährstoffe. Metabolic Tuning – Prävention – Therapie. 3. Auflage, 2011
Gröber Uwe: Arzneimittel und Mikronährstoffe. Medikationsorientierte Supplementierung. 3. akt. und erw. Auflage, 2014
Kühnast S et al. Niacin Reduces Atherosclerosis Development in APOE*3Leiden.CETP Mice Mainly by Reducing NonHDL-Cholesterol. PLoS One. 2013 Jun 19;8(6):e66467. Print 2013.
Lee BJ et al. Effects of coenzyme Q10 supplementation (300 mg/day) on antioxidation and anti-inflammation in coronary artery disease patients during statins therapy: a randomized, placebo-controlled trial. Nutr J. 2013 Nov 6;12(1):142. doi: 10.1186/1475-2891-12-142.
Mabuchi H et al. Reduction of serum ubiquinol-10 and ubiquinone-10 levels by atorvastatin in hypercholesterolemic patients. J Atheroscler Thromb. 2005;12(2):111-9.
Mergenhagen K et al. Low vitamin D as a risk factor for the development of myalgia in patients taking high-dose simvastatin: a retrospective review. Clin Ther. 2014 May;36(5):770-7. doi: 10.1016/j.clinthera.2014.02.023. Epub 2014 Apr 16.
Qin XF et al. Effects of vitamin D on plasma lipid profiles in statin-treated patients with hypercholesterolemia: A randomized placebo-controlled trial. Clin Nutr. 2014 May 2. pii: S0261-5614(14)00125-3. doi: 10.1016/j.clnu.2014.04.017. [Epub ahead of print]
Stargrove Mitchell Bebel, Treasure Jonathan, McKee Dwight L.: Herb, Nutrient, and Drug Interactions: Clinical Implications and Therapeutic Strategies. 2008

 

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