Effects of statins (hydroxymethylglutarate (HMG) coenzyme A reductase inhibitors) on synthesis of ubiquinone (coenzyme Q10, CoQ10). Effects of statins (hydroxymethylglutarate (HMG) coenzyme A reductase inhibitors) on synthesis of ubiquinone (coenzyme Q10, CoQ10). Between the inhibition of HMG coenzyme A reductase and cholesterol are many intermediate metabolites. By the same action that lowers levels of low-density lipoprotein cholesterol, statins also lower levels of CoQ10; this may lead to mitochondrial dysfunction contributing to myopathy and insulin resistance/diabetes (reproduced by permission of Vanderbilt University Press from: Spence).29 J David Spence et al. Stroke Vasc Neurol 2016;svn-2016-000016 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/