Page 8 - GP Spring 2019

in patients with heart failure not only im- LDL cholesterol when utilized alone, and tell your physician if you plan to use
proved functional capacity, but also signifi- concomitantly with statins. Because the these supplements because they can
cantly reduced cardiovascular events and ACL enzyme is upstream from HMG-CoA, have anticoagulant effects.
mortality.” (Note: energy deprived state). adverse muscle related side effects are not
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an issue with bempedoic acid. It shows po- Finally, studies of alternative treatments for
What is important to know is that CoQ10 is tential for future use alone or together with cardiovascular disease continue with some
only fat soluble, and this can have a bearing statin medications for the treatment and promise of future alternatives or adjuncts.
on whether supplementation is effectively prevention of atherosclerosis. 17,18 Never take supplements such as nattoki-
assimilated. Some skepticism regarding nase without your physician’s approval.
published studies is in order because there Human atherosclerotic plaques often con- Dangerous or fatal consequences are possi-
was no mention of whether supplemen- tain a lot of fibrin, and fibrinolytic agents ble when these supplements are combined
tation was accompanied by fats or fatty such as urokinase have been utilized in the with anticoagulants such as aspirin, warfa-
foods; hence, this could have contributed treatment of cardiovascular disease. Fibri- rin, or Plavix.
to equivocal results. Ubiquinol is a reduced nolytic agents are rarely used because they
form of CoQ10 which is electron-rich, fat are expensive and problematic. Howev- References:
and water soluble, and better absorbed er, nattokinase (NK), a fibrinolytic agent 1. A Historical Perspective on the Discovery of
than CoQ10. Research supports its use found in natto (fermented soy), may have Statins, Endo, Akira,Proc Jpn Acad Ser B Phys
Biol Sci. 2010 May 11; 86(5): 484-493.
instead of CoQ10. “Simvastatin induces a place. “Recent research has demonstrat- 2. Lipid Modification: Cardiovascular Risk As-
subclinical mitochondrial dysfunction in ed that NK has potent fibrinolytic activity, sessment and the Modification of Blood Lipids
healthy subjects, which can be partly re- antihypertensive, anti-atherosclerotic, and for the Primary and Secondary Prevention of
versed by treatment with ubiquinol. This lipid-lowering, antiplatelet, and neuropro- Cardiovascular Disease, (PDF) National Clin-
model of pharmacologically induced and tective effects.” Although insufficient ical Guideline Center (UK July 2014). PMID
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reversed mitochondrial dysfunction can research has been conducted to date, no 25340243.
be used to study the effects of compounds other substance is effective in achieving so 3. Statins for the primary prevention of car-
that enhance mitochondrial function in many therapeutic benefits concomitantly diovascular disease, Taylor F, Huffman MD,
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healthy subjects.” “…pharmacokinetic for the treatment of cardiovascular disease. Macedo AF, Moore TH, Burke M, Davey
Smith G, Ward K, Ebrahim S (2013). Co-
data demonstrates that the reduced form Studies indicate that it is safe, inexpensive, chrane Database Syst Rev , 1 (1): CD004816.
of coenzyme Q10 or ubiquinol, has greater well-tolerated, and many believe that natto Doi:10.1002/14651858.CD004816.pub5.
bioavailability and produces higher plas- consumption is related to longevity. Ear- PMID 23440795.
ma concentrations when consumed orally, ly evidence indicates possible benefits in 4. Prescription Cholesterol-lowering Medica-
compared with ubiquinone. treating hypertension and preventing Al- tion Use in Adults Aged 40 and Over: United
15
zeimers disease as well. States, 2003-2012, NCHC Databrief No. 177
Also, be aware that cholesterol is a pre- December, 2014.
cursor to Vitamin D. Anyone taking To sum up, when statins are prescribed: 5. Statin-Associated Side Effects, Thompson
statins should have their Vitamin D levels PD, Panza G, Zaleski A, Taylor B. Journal of the
checked. Actually, there is much controver- • Periodic liver function tests are in- American College of Cardiology, Vol. 67, Issue
sy regarding what levels of Vitamin D are dicated to confirm that the drug is 20, May 2016 DOI: 10.1016/j.jacc.2016.02.071.
6. Highlights of Prescribing Information; Lip-
considered acceptable. With supplementa- well-tolerated. itor (atorvastatin calcium) at www.accessdata.
tion, hypervitaminosis is a real possibility, • Supplementation with Ubiquinol may fda.gov, PDF Retrieved 1 May 2017.
since Vitamin D is fat-soluble (and more be beneficial in counteracting the 7. Statin therapy inhibits remyelination in the
easily stored), unlike Vitamin C, which is drug-induced depletion of CoQ10 and central nervous system, Miron VE, Zehntner
water-soluble and more easily excreted. associated adverse effects of statins. SP, Kuhlman T Ludwin SK, Owens T, Ken-
Chances are a Vitamin D3 supplement is • Regular fish consumption and/or nedy TE, Bedell BJ, Antel JP. Am J Pathol.,
indicated, but patients should get tested and supplementation with a pharmaceu- 2009 May; 174(5):1880-90, doi: 10.2353/aj-
follow their physician’s recommendation tical-grade omega-3 fish oil or pre- path.2009.080947. Epub 2009 Apr 6.
based on results. scription medications such as Lovaza 8. Simvastatin interferes with process out-
growth and branching of oligodendrocytes,
may benefit patients with cardiovas-
Research on alternative treatments to statin cular disease (or risk factors). These Smolders I, Smets I, Maier O, Vandeven M,
Steels P, Ameloot M. J Neurosci Res. 2010 Nov
therapy for cardiovascular disease and pre- supplements must be refrigerated to 15;88(15):3361-75 , doi: 10.1002/jnr.22490.
vention are in progress. Factors that have avoid lipid peroxidation (spoilage, 9. Addition of omega-3 fatty acid and coenzyme
limited the effectiveness of statins have or becoming “rancid”). If not using a Q10 to statin therapy in patients with combined
been addressed with a new drug that uti- pharmaceutical agent such as Lovaza, dyslipidemia, Toth S, Sajty M, Pekarova T,
lizes a different mechanism. “Bempedoic choose a fish oil with United States Mughees A, Stefanic P, Katz M, Spisakova K,
acid (ETC-1002) reduces cholesterol syn- Pharmacopea (USP) or I.F.O.S.(Inter- Pella J, Pella D. J Basic Clin Physiol Pharma-
thesis through inhibition of adenosine tri- national Fish Oil Standards) approv- col.,2017 Jul 26; 28(4):327-336, doi:10.1515/
phosphate citrate lyase (ACL), an enzyme al such as Nature Made or Pharmax. jbcpp-2016-0149.
upstream from 3-hydroxy-3-methylglu- Note: fish oil is difficult to digest and 10. Coenzyme Q10: The Essential Nutrient,
Saini, Rajiv. J Pharm Bioallied Sci., 2011
taryl-coenzyme (HMG-CoA).” Early tri- should be taken with food. For those Jul-Sept; 3(3): 466-467, doi: 10.4103/0975-
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als indicate that it is well-tolerated and has who have difficulty tolerating it, divid- 7406.84471.
no major side effects. It effectivly reduces ed doses may be recommended. Also

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