G'day, Warwick Bishop here and welcome to my podcast and videocast station. Really do appreciate you tuning in and I hope you find today's podcast interesting and videocast interesting. Look, what I really wanted to touch on is one of the biochemical processes that appears to be implicated when we use statin therapy. Well, as you may or may not remember, when we are using statins, we're acting in a pathway that starts with acetyl-CoA being converted down a series of different chemical reactions into HMG-CoAs, mevalonic acid, and subsequently down into cholesterol. So why is all this important? Well, you've either listened to a previous podcast where I was talking about philoquinones and menaquinones, which you might also know as vitamin K, both one and two. So philoquinones is the group of or the name, the technical name, scientific name given to the vitamin K1 compound. And menaquinones, and there's a number of vitamin K2 compounds, menaquinones is the scientific name for that group. Well, that... suffix not prefix suffix so the word ends in quinone you may have heard that quinone before that term quinone you may have heard in relation to something called ubiquinone ubiquinone and ubi stands for ubiquitous quinone that chemical structural compound ubiquinone actually has another name and you might know it by that ubiquinones are the name is coenzyme Q10. And we know coenzyme Q10 is very important in the processes within the cell. In particular, it's extremely important in energy formation because coenzyme Q10 is indeed the agent or one of the agents in the electron. transfer pathway that occurs within the mitochondria. So if we look upstream, we see acetyl-CoA become HMG-CoA, become mevalonic acid or mevalinate, and mevalinate then gets converted to a number of different things. Through a number of intermediaries, it can end up as menaquinone or that vitamin K2 compound I was alluding to before, but it can also end up as ubiquinone or coenzyme Q10. So that coenzyme Q10 is super important because we want to know whether diminishing the amounts of that coenzyme Q10 could be related to some of the statin-related side effects, in particular muscle aches and pains. Well, there was a very nice study done back in, oh, it was just a couple of years ago now, about 2022, or at least published in 2022, where the researchers looked at approximately 80 people with subtle to mild statin-related muscle side effects and put them through a process where they really tried to evaluate whether there was evidence that coenzyme Q10 levels related back to the sort of symptoms that these individuals were feeling in their legs. So they had baselines and these particular researchers were able to talk their subjects into going above and beyond because not only did these subjects give venous blood samples, which, you know, giving blood samples, I don't think it's anyone's favorite thing to do. But more importantly, these participants, these individuals within the study were happy to allow the researchers to do muscle biopsy and assess those muscle biopsies. for presence of coenzyme Q10. Now they did that at baseline and they did that after supplementation and they compared a placebo and a non-placebo group. So you would think this would give them really good information to understand whether coenzyme Q10 levels firstly related to statin-related muscular symptoms and two, whether altering or providing supplementation could alter either plasma or tissue levels. Well, sort of unfortunately, or fortunately, depending on which way you're looking at the study, but unfortunately, we didn't show any major problems there. And in fact, there was no clear link between coenzyme Q10 levels and symptoms, nor was there really a good response. to coenzyme Q10 level supplementation in terms of altering plasma levels or even muscle tissue levels. So this particular study really, which looks like it was very well done and really a very beneficial study in trying to give us some information, didn't give us significant insight into either coenzyme Q10 being implicated in statin-related muscular symptoms, nor that supplementation with coenzyme Q10 would make much of a difference to those levels. Now, I think one still has to be aware that these are generalizations and that in an individual patient, there could be a circumstance where it's probably worth a try of coenzyme Q10 if someone has muscle aches and pains to see if in that individual it could make a difference. So my own practice in this space is to open the door to people to consider coenzyme Q10 supplementation if they're on statin therapy. It may be beneficial and certainly if they notice a personal benefit, then why wouldn't you do it? But the data is not there to support it. What is interesting, though, is that we do have on the horizon a new agent called bembedoic acid, which works essentially through the same enzymatic pathway, but higher upstream. So after acetyl-CoA, bembedoic acid works at ATP citrate liase, blocking acetyl-CoA. CoA to HMG and mevalonic acid and so forth. So going upstream, not altering HMG CoAs probably would still have an impact, a significant impact on mevalonic acid or mevalinate, but really importantly, bembadoc acid. doesn't go right through the body. Its action is only in the liver. So for people who might get aches and pains from diminished coenzyme Q10 within the muscles as a consequence of statin therapy, if that were unique to them, and that was their individual response, then bimbidoc acid, which is not far away from our therapeutic alimentarian, could offer a solution. Well, there you go. I hope you found that little spiel on the biochemistry of statins, coenzyme, Q10, or ubiquinone, and even bambidoic acid. Interesting. If you do have any queries or questions, please feel free to drop me a note. at info at drwarwickbishop.online. Always interested to hear people's feedback. And if you've got any suggestions for any future podcasts, please let me know. I'm always open to that as well. Till next time, of course, I do hope you live as well as possible for as long as possible. Take care and bye for now.
