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As many as 20 million Americans take statin medications to lower their cholesterol.

Lipitor, Mevacor, Zocor and Crestor are just a few examples of statins that are prescribed for people at risk of heart disease due to high cholesterol levels. All these medications work by inhibiting HMG-CoA reductase, a cholesterol-producing enzyme in the liver. Simply put, statins slow down the body's cholesterol factory.

But the human body does not have isolated pathways, and the liver enzyme HMG-CoA reductase helps produce other important elements besides cholesterol. One of these elements is known to be essential to good health: Coenzyme Q-10 (CoQ10). The scientific name for CoQ10 is ubiquinone, reflecting its pervading presence throughout the body.

CoQ10 is a substance that is found in every single human cell. It is a necessary ingredient for key biochemical reactions that produce energy. Although there are some dietary sources of CoQ10, most of what we need is produced in the liver — unless, of course, the liver's enzyme process is blocked.

CoQ10 increases the amount of energy available to parts of the body that most need it: the heart, brain, kidneys and skeletal muscles. Not surprisingly, low levels of CoQ10 have been linked to an increased incidence of congestive heart failure, heart attacks and hypertension.

It does not make sense to take a cholesterol-lowering medication to decrease the chances of having a heart attack if that same medication is also increasing the risk of heart disease by blocking the production of CoQ10. In Canada, statin prescriptions must carry a warning about CoQ10 depletion. In the United States, Merck Pharmaceuticals has owned a patent since 1992 on a drug that combines Mevacor with CoQ10, but the combination is not marketed.

Thus it falls to each individual taking a statin medication to educate themselves and supplement appropriately with CoQ10.

Grains, fish

Dietary sources of CoQ10 include whole grains and oily fish like salmon and tuna. But CoQ10 is a large molecule and less than half of what we ingest is actually absorbed. Although supplements from 50 mg a day to 1200 mg a day have been used, the most commonly recommended dose is 200 mg a day. Taken in a soft-gel form with a fatty meal helps increase absorption. It is a safe supplement; side effects are infrequent, usually mild and quickly reversed when CoQ10 is discontinued.

Once absorbed, CoQ10 must be converted to its active form, and this conversion may be a problem for some people. As we age, the conversion process becomes less efficient, so the elderly (even those not taking statin medications) are at risk of low levels of active CoQ10. Patients over 50 years old are often recommended a supplement that provides ubiquinol, the already-converted form of CoQ10. Both forms — ubiquinone (CoQ10) and ubiquinol — are readily available over the counter.

When an essential substance is found in every single cell, it is most likely needed for many aspects of good health. There are multiple studies being conducted to investigate the actions of CoQ10, the problematic effects of low levels, and benefits of supplements. Low levels of CoQ10 have been implicated in many diseases, including Alzheimer's, Parkinson's, angina, asthma, breast cancer, diabetes, pre-eclampsia, macular degeneration, renal failure and gum disease. Research is ongoing, investigating the links between CoQ10 and these health problems.

Important antioxidant

CoQ10 is also an important antioxidant, scavenging free radicals that would otherwise cause damage to healthy cells. It is the only internally-produced antioxidant that can act on lipids within the body. One study showed CoQ10 to have a direct anti-plaque forming effect, minimizing the size of cholesterol plaques in the aorta.

There are many potential reasons to supplement with CoQ10, but the most obvious is to complement statin medications. If you are taking a statin for high cholesterol, talk to your physician about CoQ10. The science of it just makes sense.

You can learn more about this supplement by going to the University of Maryland Medical Center's site on the internet (http://www.umm.edu/altmed/articles/coenzyme-q10-000295.htm)

Dr. Stacey Kerr, a longtime Sonoma County family physician, graduated from UC Davis Medical School and has been certified in her specialty by the American Board of Family Medicine. Her columns are not intended as a substitute for hand-on medical advice or treatment. Consult your health care provider before adhering to any recommendations in this column. Email comments to drkerr@the-doctors-inn.com.