Statins inhibit 3-hydroxy-3-methylglutaryl coenzyme A reductase, thereby reducing production of farnesyl pyrophosphate, an intermediate in the mevalonate pathway. The mevalonate pathway ultimately produces both cholesterol and coenzyme Q10 (CoQ10), a protein important for mitochondrial function. This knowledge has prompted the hypothesis that reductions in plasma CoQ10 concentrations contribute to statin-associated muscle symptoms (SAMS). Consequently, CoQ10 is popular as a form of adjuvant therapy for the treatment of SAMS. Clinical trial evidence evaluating the efficacy of CoQ10 supplementation has been equivocal. A meta-analysis suggests that CoQ10 supplementation is effective, but meta-analyses are dependent on the quality of the included studies and the best study did not demonstrate a CoQ10 benefit in subjects with verified SAMS. CoQ10 supplementation may be useful, however, perhaps as a placebo, in some patients.