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Statins inhibit the mevalonate pathway, lowering endogenous CoQ10 levels, which may contribute to statin-associated muscle symptoms (SAMS) ( 3.2 Clinical evidence in heart failure The Q-SYMBIO trial (n = 420)administering 300 mg/day of CoQ10demonstrated improvements in New York Heart Association (NYHA) class, reductions in major adverse cardiovascular events (MACE) (HR 0.50, 95% CI 0.320.80), and lower all-cause mortality in patients with moderate-to-severe heart failure (Mortensen et al., 2014)