Synopsis: There are important gaps in our understanding of the pathogenesis and management of statin-associated myalgia. Data suggest that statins block the production of CoQ10, an essential component in electron transport during oxidative phosphorylation leading to mitochondrial dysfunction. Preliminary data suggest that CoQ10 dietary supplements may improve statin-associated muscle symptoms; however, correlation with plasma CoQ10 and objective tests to assess statin-associated myalgia and response to treatment are lacking.