Written by Marcia J. Egles, MD. Study concludes that long-term CoQ10 supplementation (100 mg three times daily) is safe, improves symptoms, and reduces major adverse cardiovascular events in chronic heart failure patients.
A multi-center, long-term clinical trial has reported that coenzyme Q10, when added to the standard medical treatment of chronic heart failure, can safely improve symptoms and can reduce major adverse cardiovascular events. Chronic heart failure, which affects over 5.8 million Americans, is the leading cause of hospitalization of persons over the age of 65 (2) with yearly hospital costs of over 10 billion dollars (3). Heart failure is an inability of the heart to pump enough blood to meet the body’s demands. Coronary heart disease is a frequent cause of heart failure.
Coenzyme Q10 (“Co- Q-ten”) is a vitamin-like substance found in the electron transport chain of the mitochondria, the energy producing part of the cell. The heart, with its high energy requirements, has a higher concentration of coenzyme Q10 than less active parts of the body. A reduced heart tissue-content of coenzyme Q10 has been demonstrated in patients with heart failure. The degree of reduction correlates with the severity of the failure (4).
In theory, supplying additional coenzyme Q10 to hearts that are metabolically starving for energy might seem like a promising treatment possibility. However, previous studies have generally not found a value in this approach (5). The recent Q-SYMBIO trial is the first recognized trial to strongly endorse (1) the addition of coenzyme Q10 to the therapy of heart failure.
At seventeen medical centers in Europe, Asia and Australia, a total of 420 patients with moderate to severe heart failure were enrolled from 2003 to 2010. In addition to standard heart failure medications, the patients were randomly assigned to either coenzyme Q10, 100mg three times per day, or placebo capsules in a double-blind fashion for a two-year trial period. At sixteen weeks into the study, the participants were assessed for changes in New York Heart Association (NYHA) functional classification, a 6-minute walk test, and levels of N-terminal pro-B type natriuretic peptide which is a serum measure of heart failure. At two years, a long-term endpoint was determined using a composite of major cardiovascular events by a time to first event analysis.
At 16 weeks, no significant differences between the coenzyme Q10 receiving group and the placebo group were found. However, at the two-year mark, only 15 % of the patients in the coenzyme Q10 group had reached a major cardiovascular adverse event as compared with 26% of the placebo group ( hazard ratio:0.50, 95% confidence interval:0.32 to 0.80; p=0.003). Cardiovascular death rate was lower in the coenzyme Q10 group (9% versus 16 % in the placebo group, p= 0.026). All cause mortality was less in the coenzyme Q10 group (10% versus 18%, p= 0.018). The number of hospital stays for heart failure was lower in the coenzyme Q10 group (N=17, 8%) as compared to the placebo group (N=31, 14%), p= 0.033. In addition, a significant improvement of NYHA class was found in the coenzyme Q10 group after 2 years ( p=0.028).
Q-SYMBIO concludes that supplemental long-term coenzyme Q10 treatment (dosage of 100 mg three times daily) of patients with chronic heart failure receiving medical therapy is safe, improves symptoms, and reduces major adverse cardiovascular events. These results are in contrast to shorter, more limited studies of coenymeQ10 in heart failure patients. It of course remains to be seen if future studies will confirm these encouraging results. The Q-SYMBIO authors noted difficulty in obtaining research funding for coenzyme Q10, a “nonpatentable substance”.
Source: Mortensen, Svend A., et al. “The effect of coenzyme Q 10 on morbidity and mortality in chronic heart failure: results from Q-SYMBIO: a randomized double-blind trial.” JACC: Heart Failure 2.6 (2014): 641-649.
© 2017 Elsevier B.V. or its licensors or contributors
Posted March 3, 2015.
References:
- Mortensen, Svend A. et al. ,The Effect of Coenzyme Q10 on Morbidity and Mortality in Chronic Heart Failure, JACC: vol. 2, no.6, Dec. 2014:641-9.
- Rosamond W, Flegal K, Furie K, et al. (January 2008). “Heart disease and stroke statistics–2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee”. Circulation 117 (4): e25–146. doi:10.1161/CIRCULATIONAHA.107.187998. PMID 18086926
- Torio CM, Andrews RM. National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2011. HCUP Statistical Brief #160. Agency for Healthcare Research and Quality, Rockville, MD. August 2013.
- Folkers K. et al. Biochemical rationale and myocardial tissue data on the effective therapy of cardiomyopathy with coenzyme Q10. Pro Natl Acad Sci USA 1985:82:901-4.
- Madmani, M.E.; Yusuf Solaiman, A.; Tamr Agha, K.; Madmani, Y. et al. (2 June 2014). “Coenzyme Q10 for heart failure”. Heart Group. Cochrane Database of Systematic Reviews (John Wiley & Sons) (6): Art. no. CD008684. doi:10.1002/14651858.CD008684.pub2
