Heart Disease Is the Biggest Killer of Women: What You Need to Know About Statins and CoQ10

By SISTERLY Nutritionist Georgie Murphy MSc DipNt mBANT mNTOI

The Key Takeaways

• Heart disease is the leading cause of death in women, often under-recognised due to atypical symptoms.
  
• Statins lower cholesterol but have the potential to reduce CoQ10 levels also, sometimes causing muscle pain or fatigue.
  
• CoQ10 supplementation may help manage statin-related muscle issues and support heart health.
  
• Women-focused heart health relies on nutrition, movement, stress management, sleep, and hormonal support.
  
• Micronutrients like magnesium, B vitamins, vitamin D, and CoQ10 play key roles in energy, vascular function, and inflammation.
  
• At SISTERLY, The Elevator delivers essential nutrients - including 150mg CoQ10, vitamin D, magnesium, and B vitamins- to support energy, resilience, and cardiovascular health.
  

Heart disease remains the leading cause of death in women globally, yet it is still under-recognised, under-researched, and often misunderstood in female health conversations. According to Dr Robert Kelly, Consultant Cardiologist & Lifestyle Medicine Physician at Beacon Hospital Dublin, Ireland (www.drrobertkelly.com), one in four women die from heart attack each year, yet many are more concerned about their risk of breast cancer. 

Women are more likely to be misdiagnosed and to present with less typical symptoms such as shortness of breath, nausea, indigestion, fatigue, anxiety, or sleep disturbance - which can delay diagnosis and treatment compared to men.^1-5

Despite this, cardiovascular disease is still widely perceived as a “male condition.” Historically, much of what we know about heart disease has been based on male populations, meaning women’s symptoms, risk patterns, and responses to treatment have often been overlooked. This has contributed to gaps in prevention and care, with real consequences for women’s health outcomes.^{5,10, 11}

As conversations around women’s heart health continue to evolve, there is growing interest in understanding the sex-specific impacts of both conventional treatments and supportive nutritional approaches, including statins and Coenzyme Q10 (CoQ10).

How Do Statins Work?

Statins are cholesterol-lowering medications that work mainly in the liver, where most cholesterol is produced. They slow down an enzyme involved in cholesterol production, which signals the liver to pull more LDL cholesterol out of the bloodstream.

By lowering circulating LDL, statins reduce one of the contributors to plaque formation in the arteries - a process known as atherosclerosis - a progressive and chronic, inflammatory disease of the arteries.^6,12

Is LDL Cholesterol the Whole Story?

While higher LDL cholesterol plays a role in heart disease, it is not the whole story. What matters more is how LDL behaves in the body and the health of the artery walls themselves.

LDL particles are more likely to cause harm when:

• They become damaged or oxidised
• They are small and dense
• The lining of the arteries is already inflamed or injured

When blood vessels are inflamed - often due to factors such as blood sugar imbalance, smoking, chronic stress, poor sleep, or nutrient deficiencies - the artery walls become more “leaky”. This allows LDL particles to move into the vessel wall, where they are more likely to become damaged and trigger an immune response. Over time, this inflammatory process drives plaque buildup.^12,17,18

Statins and CoQ10

Statins work by slowing a pathway in the body called the mevalonate pathway. This pathway produces cholesterol - but it also produces other important substances, including Coenzyme Q10 (CoQ10).

CoQ10 is essential for:

• Energy production in cells, particularly muscle cells
• Supporting mitochondrial (cellular energy) function
• Protecting cells from oxidative stress

Studies show that statin therapy can reduce circulating CoQ10 levels by 16–54%, depending on the statin and dose used.⁷ 

Statins and Muscle Symptoms

By affecting the mevalonate pathway, statins may reduce CoQ10 and compounds involved in vitamin D metabolism. In people with inflammation, metabolic dysfunction, or low vitamin D levels, this may increase vulnerability to muscle symptoms. Vitamin D deficiency itself is associated with muscle pain and weakness and may be a modifiable risk factor for statin intolerance.^12,13

Muscle pain, weakness, cramps, or fatigue - known as statin-associated muscle symptoms (SAMS), are the most commonly reported side effects with statin use.⁹ Reported rates vary widely, from <1% in clinical trials to 10–25% in independent studies and up to ~60% in observational research, and can often lead to dose reduction or discontinuation. ^{8, 25, 26}

CoQ10 and Statin Muscle Symptoms

CoQ10 has been widely studied for statin-associated muscle symptoms (SAMS). While earlier reviews reported mixed findings - often reflecting smaller trials and differences in study design - more recent, higher-quality evidence suggests a clearer signal of benefit.

A large, rigorous meta-analysis of 12 randomised, placebo-controlled trials (575 participants) found that CoQ10 supplementation significantly reduced muscle pain, weakness, cramps, and fatigue, concluding it may be a useful complementary approach in statin-induced myopathy.⁸

A recent systematic review by Ahmed et al. (2024) supports these findings, reporting improvements in muscle pain, fatigue, and functional capacity in some statin-treated individuals. While results are not uniform across all studies, variability likely reflects differences in dosing, duration, and individual characteristics, suggesting CoQ10 may be most helpful in those with lower baseline nutrient status, higher oxidative stress, or greater metabolic strain. ²³ 

Taken together, this positions CoQ10 as a targeted, complementary approach - an important consideration given that around one in five statin users discontinue therapy within a year, most commonly due to muscle-related symptoms. ²⁴

CoQ10 and Heart Health More Generally

Beyond statin use, CoQ10 has been studied for its role in heart health, particularly in conditions where the heart’s ability to produce energy is compromised.

The heart is one of the most energy-demanding organs in the body, relying heavily on healthy mitochondria to generate the constant supply of energy required to beat over 100,000 times a day. CoQ10 plays a central role in this process by supporting mitochondrial energy production (ATP) and helping protect heart cells from oxidative stress.

Research suggests CoQ10 may support heart health through several mechanisms: ^16-20

• Improving cellular energy production in heart muscle
• Supporting efficient heart muscle contraction
• Reducing oxidative stress and inflammation
• Supporting endothelial function and blood vessel health
  

Table: Statins and CoQ10: Benefits, Side Effects, and How They Work Together

A Whole-Body, Women-Centred Approach to Heart Health

Heart health is not just about cholesterol. A functional, integrative approach includes:

• Anti-inflammatory, fibre-rich nutrition
• Blood sugar and insulin balance
• Regular movement and strength training
• Stress regulation and restorative sleep
• Supporting gut and hormonal health across life stages

These foundations play a powerful role in shaping long-term cardiovascular risk - especially for women.

Dr Robert Kelly advises that, “Adopting lifestyle pillars such as diet, supplements, exercise, sleep, stress reduction, not smoking, and spending time with friends, will help to reduce and even prevent you from developing premature heart disease. Start small, like walking for 10 minutes after dinner each day. Even that alone can reduce your risk of a heart attack. A healthy diet can cut the risk by 50%”.

Supporting Women’s Heart Health with Micronutrients

From a nutrition perspective, optimal heart health is built on micronutrient sufficiency, not just medication or single supplements. Nutrients such as magnesium, B vitamins, selenium, zinc, vitamin D, antioxidants, and CoQ10 play essential roles in energy production, vascular function, inflammation regulation, and metabolic resilience - all highly relevant to women across different life stages.

At SISTERLY, we recognise that women’s needs are distinct, influenced by hormonal transitions, stress load, gut health, and modern dietary patterns. That’s why our women-focused multi-nutrient, The Elevator, is designed to provide foundational nutritional support including 150mg of CoQ10, 30mcg vitamin D, magnesium and the important B vitamins to name a few. Designed to complement lifestyle, dietary, and medical approaches, helping to support energy, resilience, and long-term cardiovascular health as part of a whole-body approach.

Final Thoughts

Heart disease is not a male problem, it is the number one cause of death in women worldwide. 

For women, the future of heart health lies in personalised, evidence-based care that addresses inflammation, metabolic health, nutrient status, and lifestyle - alongside conventional medical tools when needed.

References

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2. Mosca L, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women. Circulation. 2011;123(11):1243–1262. https://www.ahajournals.org/doi/10.1161/cir.0b013e31820faaf8

3. Canto JG, et al. Symptom presentation of women with acute coronary syndromes. Arch Intern Med. 2007;167(22):2405–2413. https://pubmed.ncbi.nlm.nih.gov/18071161/

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12. Gupta A, et al. Association of vitamin D levels with statin-induced myalgia: a preliminary report. Indian J Endocrinol Metab. 2014;18(4):518–522. https://www.researchgate.net/publication/281457071_Association_of_Vitamin_D_with_Statin_Induced_Myalgia

13. Bischoff-Ferrari HA, et al. Vitamin D and muscle function. Curr Opin Clin Nutr Metab Care. 2012;15(6):546–552. https://pubmed.ncbi.nlm.nih.gov/11991436/

14. Libby P. Inflammation in atherosclerosis. Nature. 2002;420(6917):868–874.

15. Krauss RM. Lipoprotein subfractions and cardiovascular disease risk. Curr Opin Lipidol. 2010;21(4):305–311.

16. Littarru GP, Tiano L. Clinical aspects of coenzyme Q10: an update. Nutrition. 2010;26(3):250–254. https://pubmed.ncbi.nlm.nih.gov/19932599/

17. Tsai KL, et al. Coenzyme Q10 supplementation attenuates oxidative stress and inflammation in coronary artery disease patients.Nutrients. 2012;4(8):1115–1126.

18. Lee BJ, Tseng YF, Yen CH, Lin PT. Effects of coenzyme Q10 supplementation on inflammation and oxidative stress in patients with coronary artery disease. Nutrition. 2013;29(2):328–333.

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20. Rosenfeldt FL, et al. Coenzyme Q10 in the treatment of hypertension: a meta-analysis of the clinical trials. J Hum Hypertens. 2007;21(4):297–306. https://pubmed.ncbi.nlm.nih.gov/17287847/

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22. Stroes ES, Thompson PD, Corsini A, et al. Statin-associated muscle symptoms: impact on statin therapy—European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management. Eur Heart J. 2015;36(17):1012–1022.

23. Ahmed, K., et al. (2024) Effectiveness of coenzyme Q10 supplementation in statin-induced myopathy: a systematic review. Cureus.

24. Zhang, H., et al. (2013) Discontinuation of statins in routine care settings: a cohort study. Annals of Internal Medicine, 158(7), pp. 526–534. https://pubmed.ncbi.nlm.nih.gov/23546564/