Dear Dr. Roach: I am writing to inquire about the effects of statins on the body. My husband is a 66-year-old diabetic taking metformin and atorvastatin. A highly respected chemist friend told us that the statin drugs completely deplete the body of CoQ10, and recommended blood testing of the lipid particle size before beginning any statins. Is there any evidence that shows that this depletion is factual? If so, would taking a CoQ10 supplement help? Should my husband begin taking this, or does he need to consult with his doctor first? Do you know if the PSA (particle size assessment) blood test is covered by Medicare?


Dear Anon.: CoQ10, also called ubiquinone, is a vitaminlike compound that is used in the metabolism of some, but not all, statin drugs. The decrease in body levels may, in theory, increase the likelihood of muscle symptoms in people taking statins, especially simvastatin and atorvastatin.

However, in practice, it isn’t clear that CoQ10 supplementation works to either prevent or treat muscle side effects. I don’t recommend it in people who have no trouble taking statins. I have had patients who used it for muscle aches associated with taking a statin, sometimes with success, but it isn’t clear whether this is a placebo response. Since CoQ10 is safe, it’s not unreasonable to try it. Pravastatin and Fluvastatin do not use the same pathway for metabolism and do not deplete CoQ10; however, they are not as potent at lowering cholesterol as atorvastatin is.

Your second question is about particle size. There is fair evidence that smaller LDL particles are worse in terms of causing damage to blood vessels. If someone had an unusual proportion of small LDL, it would make sense to treat him or her at lower levels of cholesterol than would otherwise be recommended, or possibly to use a more-intensive treatment. However, in practice, the number of people whose recommendations would change by knowing their particle size is relatively few.

In your husband’s case, being 66 and diabetic, being on a statin is very likely to have more benefit than harm in almost all levels of cholesterol, so I don’t see the indication, in his particular case, to get an LDL particle size test. It is reasonable in someone for whom a clinician is undecided about whether to give a statin. In these cases, I also consider family history and the use of HS-CRP, another marker that predicts coronary risk independent of cholesterol.

I do not believe Medicare covers the test, at the time of this writing.

Dear Dr. Roach: When someone gets an arm or leg amputated, how does the blood that goes into where the arm/leg was, get back into circulation? Why don’t the blood vessels/arteries swell up with blood, since they are no longer connected to the “loop” that brings the blood back to the heart?


Dear A.W.: After an amputation, or when an organ is removed, the artery supplying blood to that area is tied off by the surgeon, who has to be sure there is still enough blood flow to the area to allow it to heal. The body is very adaptable, and the veins and smaller vessels will adapt themselves to the new needs of that part of the body.

Medical students spend a lot of time learning about how well the body works and how many ways it can fail. Still, it is an amazing system, and we shouldn’t lose the ability to wonder at how magnificently it works, most of the time, under an incredible amount of stress.

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