Research has not shown that any one statin is least likely to cause muscle aches. The largest review of placebo-controlled trials found no clear evidence that the risk differed between statins, and most muscle aches reported by people taking a statin were not caused by the medicine itself. Which statin you take, at what dose, and whether anything changes is a decision for your prescriber. This guide covers what the research says about muscle symptoms, CoQ10, vitamin D and other factors.
Key Takeaways
- In 19 large placebo-controlled trials, muscle pain or weakness was reported by 27.1% of people on a statin and 26.6% on placebo.
- Those trials found no clear evidence that the risk differed between individual statins. Choosing, dosing or switching a statin is your prescriber's call.
- Your body uses the same early pathway to make cholesterol and CoQ10, and statins lower circulating CoQ10 levels.
- CoQ10 trials for statin-associated muscle symptoms are mixed: one meta-analysis found improvement, two found no clear benefit.
- In a large randomized trial, vitamin D did not lower muscle symptoms in new statin users.
- Do not stop or change a statin without talking to your prescriber, and tell them about every supplement you take.
Evidence grade: Emerging. CoQ10 for statin-associated muscle symptoms has been tested in small randomized trials (about 300 to 575 people per meta-analysis) with conflicting pooled results, and NCCIH concludes the overall evidence does not support a benefit.
What Are Statin-Associated Muscle Symptoms?
Statins are prescription medicines that lower LDL cholesterol by slowing how much cholesterol the liver makes. Some people who take them notice muscle aches, tenderness, cramps or weakness. Researchers call these statin-associated muscle symptoms.
MedlinePlus describes muscle damage as an uncommon side effect of statins. In rare cases it can lead to muscle pain and kidney damage. If you start having muscle pain, your provider may order a blood test to look for muscle damage.
A scientific statement from the American Heart Association reports that the risk of serious statin-related muscle injury is less than 0.1%. In U.S. practice, roughly 10% of patients stop a statin because of subjective complaints, most often muscle symptoms without a raised level of creatine kinase (CK), an enzyme that leaks from damaged muscle. In randomized trials, the difference between statin and placebo groups for these symptoms is less than 1%.
How Common Are Muscle Symptoms on a Statin?
The Cholesterol Treatment Trialists' Collaboration pooled individual data from 19 double-blind trials of a statin versus placebo, with 123,940 participants followed for a median of about 4.3 years.
- 27.1% of people taking a statin and 26.6% taking placebo reported muscle pain or weakness.
- In the first year, statins caused a small excess of mostly mild muscle pain. Only about 1 in 15 muscle reports in the statin groups was actually due to the statin.
- After the first year, there was no significant excess in new reports.
- More intensive regimens had a slightly higher rate than moderate or less intensive ones.
- Average CK rose only slightly, by an amount the authors called clinically insignificant.
Overall, the authors concluded that more than 90% of muscle symptom reports in people taking a statin were not caused by the statin. That does not mean symptoms are imagined. Muscle aches have many everyday causes, and only your clinician can sort out what is behind yours.
Why Statin Choice Belongs to Your Prescriber
Many people search for the statin least likely to cause muscle pain. The trial data do not single one out: the CTT analysis found no clear evidence that the relative risk differed between statins. OPA Nutrition sells supplements, not medicines, and we do not rank or recommend prescription drugs.
MedlinePlus notes that when muscle pain occurs, it may go away if a provider switches the statin, and that you should talk to your provider if you would like to stop or change to a different treatment. Your prescriber weighs your cholesterol levels, your heart risk, your other medicines and your symptoms when deciding whether to change anything.
For a practical checklist on tracking symptoms and what to raise at your appointment, see our guide to statin muscle aches and what to discuss with your doctor.
CoQ10's Role in Muscle Energy
Coenzyme Q10 (CoQ10) is a substance naturally present in the body, with the highest levels in the heart, liver, kidneys and pancreas. It is an essential part of the mitochondrial electron transport chain, the process cells use to make energy, and it also works as an antioxidant in cell membranes and in lipoproteins.
Every cell makes its own CoQ10. Part of the molecule is built from mevalonate, the same intermediate the body uses to make cholesterol. The enzyme that statins block, HMG-CoA reductase, is a key step in that shared pathway. That overlap is why researchers have asked whether statins affect CoQ10 and, through it, muscle energy. Food also supplies small amounts; see our list of foods that contain CoQ10.
How Statins Affect Circulating CoQ10
A 2015 meta-analysis of placebo-controlled trials found that statin therapy significantly lowered plasma CoQ10, by an average of about 0.44 micromoles per liter. The drop appeared with each of the four statins studied and with both water-soluble and fat-soluble types, and it showed up in both shorter and longer trials.
The same authors noted that the clinical relevance of the drop is unclear. A lower blood level does not by itself show that muscle CoQ10 is low, or that low CoQ10 is causing a person's symptoms.
What CoQ10 Trials Found for Muscle Symptoms
Several meta-analyses have pooled the randomized trials of CoQ10 in people with statin-associated muscle symptoms. Their conclusions differ.
| Analysis | Trials and people | Main finding |
|---|---|---|
| Banach et al., Mayo Clinic Proceedings, 2015 | 6 trials, 302 patients | No significant effect on muscle pain (a non-significant trend toward less pain) and no significant change in CK |
| Qu et al., Journal of the American Heart Association, 2018 | 12 trials, 575 patients | Lower scores for muscle pain, weakness, cramps and tiredness than placebo; no change in CK; results varied widely between trials |
| Kennedy et al., Atherosclerosis, 2020 | 7 trials, 321 patients in the pooled analysis | No benefit for muscle aches compared with placebo and no difference in how many people stayed on their statin; only 2 of 8 reviewed studies were positive |
The trials were small, ranging from a few dozen to under 80 people each in the 2020 review, and they used different doses and symptom scales. The 2018 analysis reported high heterogeneity for muscle pain, meaning the individual trial results did not agree well. Taking the body of evidence together, NCCIH states that, although results of individual studies have varied, the overall evidence does not support the idea that CoQ10 reduces muscle pain caused by statins.
If you are curious about timing and how long CoQ10 studies ran, see how long CoQ10 takes to work.
What Vitamin D Research Shows
Observational studies had suggested a link between vitamin D and statin tolerance, so researchers tested it in a randomized trial. Within the large VITAL trial, 2,083 adults who started a statin had already been randomly assigned to 2,000 IU of vitamin D3 a day or placebo.
Over 4.8 years, 31% of people in both groups reported muscle symptoms, and 13% in both groups stopped their statin because of them. The results were the same whatever a person's vitamin D level was at the start.
The NIH Office of Dietary Supplements adds two points. Because the body makes vitamin D from a cholesterol-derived compound, statins may reduce vitamin D synthesis. And high intakes of vitamin D, especially from supplements, might reduce the potency of atorvastatin, lovastatin and simvastatin, which appear to share a metabolizing enzyme with vitamin D. Ask your prescriber before adding high-dose vitamin D.
Exercise and Other Factors
Statins do not appear to reduce strength in most people. In the STOMP trial, 420 healthy adults who had never taken a statin received high-dose atorvastatin or placebo for six months. Average muscle strength and exercise capacity did not change, but more people on the statin than on placebo reported muscle aches (19 versus 10), and average CK rose slightly.
Other things can raise the chance of muscle problems or change how a statin is handled in the body. MedlinePlus notes that some medicines, supplements and foods interact with statins, and that grapefruit affects how the liver breaks down some statins. New or unusually hard exercise can also leave muscles sore, which is one reason to tell your clinician what changed around the time symptoms began.
About OPA CoQ10 Ubiquinone
OPA CoQ10 Ubiquinone provides 200 mg of coenzyme Q10 as ubiquinone in one capsule a day, formulated for cellular energy and antioxidant support. It is not a treatment for statin side effects, and it does not replace anything your prescriber recommends. If you take a statin or any other medicine, ask your doctor or pharmacist before adding it.
Safety and Interactions
- Keep taking your statin as prescribed. MedlinePlus warns that stopping a statin on your own can lead to a serious problem or, in rare cases, death. Talk to your provider if you want to stop or change treatment.
- Report muscle symptoms. Tell your provider about muscle pain, weakness or cramps. They may order a blood test to check for muscle damage.
- CoQ10 side effects. No serious side effects have been reported. Mild insomnia or digestive upset may occur.
- CoQ10 interactions. CoQ10 may interact with the blood thinner warfarin and with insulin, and it may not be compatible with some types of cancer treatment. Talk to your doctor or pharmacist if you take any of these. See which medications should not be taken with CoQ10 for more detail.
- Vitamin D. High supplemental intakes might reduce the potency of atorvastatin, lovastatin and simvastatin. The adult upper limit for vitamin D is 100 mcg (4,000 IU) a day.
- Foods and other supplements. Ask your provider which foods and supplements to avoid with your statin; grapefruit is one known example.
Frequently Asked Questions
Does the type of statin affect the risk of muscle aches?
Research has not identified one. A pooled analysis of 19 large placebo-controlled trials found no clear evidence that the risk of muscle symptoms differed between statins. Which statin and dose suit you is a decision for your prescriber.
Why might statins affect muscles?
The exact reason is not settled. One idea under study involves CoQ10: statins block an enzyme in the pathway the body uses to make both cholesterol and CoQ10, and statins lower blood CoQ10 levels. Whether this explains muscle symptoms has not been proven.
Does CoQ10 help with statin-associated muscle aches?
The evidence is mixed. A 2018 meta-analysis of 12 trials reported lower symptom scores, while 2015 and 2020 meta-analyses found no clear benefit over placebo. NCCIH says the overall evidence does not support it. Ask your prescriber before adding it.
Does vitamin D help with statin muscle aches?
In a randomized trial of 2,083 new statin users, 2,000 IU of vitamin D a day did not reduce muscle symptoms or the number of people who stopped their statin.
How common are muscle aches that are actually caused by a statin?
Less common than many people think. In large trials, muscle complaints were nearly as frequent on placebo as on a statin, and only about 1 in 15 reports in the statin groups in the first year was due to the statin.
Can I stop my statin if my muscles ache?
Not on your own. MedlinePlus advises taking your statin as prescribed and talking to your provider about side effects or if you want to stop or change treatment.
Sources
- National Center for Complementary and Integrative Health. Coenzyme Q10. NIH. Accessed 2026.
- MedlinePlus. Statins. U.S. National Library of Medicine. Accessed 2026.
- Cholesterol Treatment Trialists' Collaboration. Effect of statin therapy on muscle symptoms: an individual participant data meta-analysis of large-scale, randomised, double-blind trials. Lancet. 2022.
- Newman CB, Preiss D, Tobert JA, et al. Statin Safety and Associated Adverse Events: A Scientific Statement From the American Heart Association. Arterioscler Thromb Vasc Biol. 2019.
- Hernández-Camacho JD, Bernier M, López-Lluch G, Navas P. Coenzyme Q10 Supplementation in Aging and Disease. Front Physiol. 2018.
- Banach M, Serban C, Ursoniu S, et al. Statin therapy and plasma coenzyme Q10 concentrations: a systematic review and meta-analysis of placebo-controlled trials. Pharmacol Res. 2015.
- Banach M, Serban C, Sahebkar A, et al. Effects of coenzyme Q10 on statin-induced myopathy: a meta-analysis of randomized controlled trials. Mayo Clin Proc. 2015.
- Qu H, Guo M, Chai H, et al. Effects of Coenzyme Q10 on Statin-Induced Myopathy: An Updated Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc. 2018.
- Kennedy C, Köller Y, Surkova E. Effect of Coenzyme Q10 on statin-associated myalgia and adherence to statin therapy: a systematic review and meta-analysis. Atherosclerosis. 2020.
- Hlatky MA, Gonzalez PE, Manson JE, et al. Statin-Associated Muscle Symptoms Among New Statin Users Randomly Assigned to Vitamin D or Placebo. JAMA Cardiol. 2023.
- NIH Office of Dietary Supplements. Vitamin D: Fact Sheet for Health Professionals. Accessed 2026.
- Parker BA, Capizzi JA, Grimaldi AS, et al. Effect of statins on skeletal muscle function. Circulation. 2013.
Disclosure: OPA Nutrition sells supplements, including products mentioned in this article. This content is for education only and is not medical advice. Statements about dietary supplements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease. Talk to your healthcare provider before using any supplement, especially if you take medication or have a medical condition.
Written and reviewed by Michael Gonzales, Founder, OPA Nutrition · Last reviewed: · How OPA researches and writes
