Abstract
Purpose: To compare the safety and efficacy of two commonly used statins namely; atorvastatin and rosuvastatin, and determine the efficiency of CoQ10 in the reversal of statin-induced myopathy.
 Methods: An investigational study design was adopted using randomized trials involving patients suffering from ischemic heart disease and receiving either atorvastatin or rosuvastatin. The study was conducted at Punjab Institute of Cardiology, Lahore, Pakistan during the period, November 2016 - February 2017. A total number of 95 male and female patients, between the ages of 40 and 80 years, were selected. Their blood samples were analyzed for lipid profile, total cholesterol, serum high-density lipoprotein-cholesterol (HDL-C), serum triglycerides, low-density lipoproteins-cholesterol (LDL-C) and total cholesterol/HDL-C ratio.
 Results: Gender and dose showed significant correlation with creatine phosphokinase (CPK) levels, (p = 0.001) and (p > 0.001), respectively. The patients using rosuvastatin 20 mg had a higher risk of developing myopathy than those treated with atorvastatin 40 mg (p = 0.023), while atorvastatin 20 mg patients were more prone to induce myopathy than 10 mg (p = 0.001) recipients. Atorvastatin 20 mg produced higher CPK levels than rosuvastatin 10 mg (p = 0.002). A substantial increase in CPK levels was found with rosuvastatin 20 mg and atorvastatin 20 mg usage (p > 0.001). It was observed that rosuvastatin 20 mg significantly increased the risk of myopathy compared to atorvastatin 10 mg (p > 0.001). However, rosuvastatin 20 mg/day considerably reduced the blood cholesterol as compared to atorvastatin 10mg/day (p = 0.001). CPK levels reduced significantly following treatment with CoQ10 (p = 0.022).
 Conclusion: Rosuvastatin users are more prone to the risk of myopathy, myalgic symptoms and rise in CPK levels than atorvastatin users, and these effects are dose related. CoQ10 is effective in lowering CPK levels and reversing myalgia.
Highlights
Cardiovascular diseases are considered to be the primary cause of disability and death in the entire world; Asian countries are amongst the highest at risk, threatened by this disease [1]
The results revealed that males, 142.59 ± 73.75 had significantly increased levels of creatine phosphokinase (CPK) as compared to females, 65.17 ± 24.47 (p = 0.007)
Comparative effect of atorvastatin and rosuvastatin on CPK levels revealed that patients using rosuvastatin 20 mg, 139.6 ± 87.88 were significantly at higher risk of statin induced myopathy compared to those using atorvastatin 40 mg, 95.45 ± 38.52 (p = 0.023)
Summary
Cardiovascular diseases are considered to be the primary cause of disability and death in the entire world; Asian countries are amongst the highest at risk, threatened by this disease [1]. Statins are considered to be very effective in lipid lowering but they have side effects. The commonly known side effect is myopathy which is a common worldwide problem [4]. The biochemical marker for the evaluation of statin induced myopathy is the elevation in creatinine kinase (CK) levels. Glueck and colleagues evaluated the effectiveness, acceptability, and safety profile of rosuvastatin and other statins. They established that 5mg and 10mg/day doses of rosuvastatin were well tolerated, effective and had a good safety profile [5]
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