Archives of Internal Medicine; Vol. 172; No. 15; August 13/27, 2012; pp.1180-118 Beatrice A. Golomb, MD, PhD; Marcella A. Evans, BS; Joel E. Dimsdale, MD; HalbertL. White, PhDUniversity of California, San Diego No drug is without adverse effect potential, and fatigue and exertionalintolerance are adverse effects reported by patients receiving statins. These authors evaluated whether moderate dose statins affected energy andexertional fatigue in a primary prevention population of 1016 subjects (692 menand 324 women), taken for 6 months. Both fatigue and exertional intolerance were significantly higher in both menand women, but women were disproportionately affected: * 40% of treated women cited worsening in either energy or exertional fatigue * 20% of treated women characterized both energy or exertional fatigue asworse or as much worse * 10% of treated women characterized both energy or exertional fatiguecomponents as much worse To our knowledge, this is the first randomized evidence affirming unfavorablestatin effects on energy and exertional fatigue. Effects were seen in a generallyhealthy sample given modest statin doses, and both simvastatin [Zocor] and pravastatin [Pravachol] contributed to the significant adverse effect of statins onenergy and fatigue with exertion. Particularly for women, these unfavorable effectswere not uncommon. These findings are important, given the central relevance of energy andfunctional status to well-being. These effects, germane to quality of life, merit consideration when prescribing or contemplating use of statins, particularly in groups without expectednet morbidity/mortality benefit, extending to high-risk primary prevention andwomen and elderly persons (including those with coronary artery disease). Physicians should be alert to patients reports of exertional fatigue ordiminished energy during statin use. COMMENTS FROM DAN MURPHY Documenting the exertional fatigue and diminished energy with statin use shouldsurprise no one. Energy and exertional activities require ATP. One cannot make adequate levels ofATP without CoQ10. Standard biochemistry texts (I like Salway, 2004, below) show that cholesterol ismade from glucose, primarily in the liver. Statin drugs block this process. Importantly, statin drugs also block the production of CoQ10. Hence, leading toexertional fatigue and diminished energy. Keshav Singhs 2006 book Oxidative Stress, Disease and Cancer states: CoQ10 is a lipid-soluble antioxidant and an integral component of themitochondrial respiratory chain for oxidative energy production. Statins are at present one of the most widely prescribed drugs in the Westernworld. Statins not only reduce the synthesis of cholesterol but also of CoQ10. Statins…deplete body CoQ10 levels.