Coenzyme Q10 supplementation and coronary artery disease

Elevated total cholesterol levels and/or elevated low-density lipoprotein (LDL) cholesterol levels are associated with increased risk of coronary artery disease, which is the most common form of heart disease. Now, a meta-analysis shows that CoQ10 supplementation significantly improves total cholesterol and HDL-cholesterol in coronary artery disease patients.

Coenzyme Q10 adjuvant treatment of heart failure patients significantly improves the symptoms and survival of chronic heart failure patients [Mortensen; Morisco; Munkholm].

How does it look with Coenzyme Q10 supplementation and coronary artery disease?

Coronary artery disease is caused by hardening and narrowing of the coronary arteries that bring blood to the heart muscle? Coronary artery disease is also known as ischemic heart disease, which is heart disease characterized by reduced flow of blood containing oxygen to the heart muscle.

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Coenzyme Q10 adjuvant therapy for chronic heart failure

Dr. Svend Aage Mortensen (right), pictured here with Dr. Karl Folkers, was the lead researcher on the Q-Symbio study of the effects of Coenzyme Q10 adjuvant therapy for chronic heart failure patients. Now, Dr. Anne Louise Mortensen has focused in on the European patients in the international Q-Symbio study.

There are positive outcomes from an analysis of the European sub-group of chronic heart failure patients (n = 231 out of a total of 420 patients) in the international multi-center Q-Symbio study.  Two years of adjuvant treatment with 3 times 100 milligrams of ubiquinone Coenzyme Q10 daily in addition to conventional heart failure treatment reveals [Mortensen 2019]:

  • significantly fewer patients suffering major adverse cardiovascular events (= death due to heart attack or heart failure or hospitalization due to acute heart failure or pulmonary embolism) compared to placebo
  • significantly fewer heart disease deaths and all-cause deaths compared to placebo
  • significantly more improvements of the patients’ NYHA classifications compared to placebo
  • significantly improved ejection fraction compared to placebo

What was the Q-Symbio study of CoQ10 and heart failure?

The Q-Symbio study was an international multi-center randomized, double-blind, placebo-controlled study that demonstrated that daily treatment with 3 times 100 milligrams of a pharmaceutical-grade ubiquinone Coenzyme Q10 preparation for two years in addition to conventional treatment significantly improved the symptoms and survival of chronic heart failure patients [Mortensen 2014].

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Coenzyme Q10 and selenium supplementation for senior citizens

One of Sweden’s leading cardiologists, Professor Urban Alehagen, Department of Cardiology, Linkoping University Hospital, led the KiSel-10 research team. Dr. Alehagen conceived the idea of combining the essential trace element selenium and the vitamin-like substance Coenzyme Q10 to improve the heart health of senior citizens.  In so doing, he and his team of  researchers reduced the cardiovascular mortality of live-at-home senior citizens by over 50 per cent and improved heart function.

Let’s take a close look at the KiSel-10 clinical trial of the effect of combined selenium and Coenzyme Q10 supplementation on the heart health of senior citizens.

Who? Senior citizens.

Senior citizens … aged 70 – 88 years … average age 78 years … still living at home … generally in good health … in a clinical trial conducted by Dr. Urban Alehagen and a team of researchers from Linköping University, Linköping, Sweden …

What? Combined selenium and Coenzyme Q10 supplementation.

The KiSel-10 study enrolling 443 study participants in a four-year randomized, double-blind, placebo-controlled trial … the study name KiSel-10 is derived from the name of the municipality Kinda, the trace element selenium, and the Coenzyme Q10 … the Coenzyme Q10 used in the KiSel-10 study is the same pharmaceutical-grade Coenzyme Q10 preparation that was used in the Q-Symbio study of adjuvant treatment of chronic heart failure patients with 300 milligrams of Coenzyme Q10 (3 times 100 milligrams daily) … the Coenzyme Q10 used in both the KiSel-10 study and the Q-Symbio study was the ubiquinone form, the most tested and documented form and the most stable form …

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Coenzyme Q10 for fibromyalgia patients

Fibromyalgia is a serious complaint that affects women more frequently than men and occurs more frequently if there is a family history of the complaint. Fibromyalgia patients and chronic fatigue syndrome patients have similar symptoms: pain is perhaps the more common symptom for fibromyalgia patients while fatigue is often the predominant symptom in chronic fatigue syndrome. In both groups, there is a high probability of Coenzyme Q10 deficiency and a high probability that CoQ10 supplementation will alleviate symptoms.

Fibromyalgia is a chronic pain syndrome affecting an estimated 5% of people worldwide.  It is characterized by the following symptoms:

  • cognitive complaints related to concentration and memory
  • fatigue and a feeling of being tired much of the time
  • mood issues including anxiety and depression
  • muscle stiffness and soreness
  • sleep disorders

What it is that triggers fibromyalgia is not known with certainty and can vary from individual to individual.  Researchers hypothesize that fibromyalgia affects the ways in which the brain processes pain signals [Mayo Clinic].

Low Coenzyme Q10 associated with fibromyalgia

If we round up the usual suspects in our investigation of fibromyalgia, we end up making a connection between Coenzyme Q10 deficiency and fibromyalgia.

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How Coenzyme Q10 supplements protect us

Dr. William V. Judy, Founder and President of SIBR Research, has done basic and clinical research into the safety, absorption, and health effects of Coenzyme Q10 supplementation for 40 years. His research has documented significant health benefits of CoQ10 supplements in patients with heart failure, chronic fatigue syndrome, and heart surgery.

As we get older, the risk of heart disease increases.  There are two basic explanations for this increasing risk:

  • Mitochondrial dysfunction
  • Oxidative stress

Mitochondrial dysfunction

The mitochondria are the tiny “powerhouses” in our cells.  They are organelles with their own DNA.  They produce almost all the energy that our cells need to live and work.

A slow degeneration of the quality of the mitochondria seems to be a cause of ageing and a cause of many of the degenerative diseases that come with ageing [Know 2018].

It is in the mitochondria that the food we eat is processed together with the oxygen we breath to make cellular energy, ATP energy.

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Absorption and Transport of Coenzyme Q10

Oxidation. We know it from rusting cars and rancid butter. It is the loss of electrons in chemical reactions. The opposite process is called reduction. Reduction is the gain of electrons. Coenzyme Q10 molecules are redox molecules. That means, we can take CoQ10 supplements in their oxidized form, ubiquinone, and be confident that it will be converted to the reduced form, ubiquinol, which is the form that acts as an antioxidant and protects against the oxidation of cells and fats and proteins and DNA.

Coenzyme Q10 supplements are not all the same.  Some give a much better absorption than others. To get real value for the money we spend on CoQ10 supplements, we need to seek out and buy a product with documented good absorption.

A randomized controlled study done in 2018 has shown that a patented ubiquinone Coenzyme Q10 supplement gives significantly better absorption than a patented ubiquinol supplement [Lopez-Lluch 2018].

Dissolving Coenzyme Q10 crystals to single molecules

The Coenzyme Q10 raw material is a crystalline powder.  These crystals cannot diffuse into the intestinal absorption cells.  The crystals will pass right through the intestinal tract and will be eliminated in the feces.

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Choosing a ubiquinone Coenzyme Q10 supplement

Professor Guillermo Lopez-Lluch and a research team tested seven different CoQ10 supplement formulations containing 100 mg of CoQ10 in 14 young, healthy individuals. The researchers measured CoQ10 bio-availability as area under the curve of plasma CoQ10 levels over 48 hours after the ingestion of a single dose. They repeated the measurements in the same group of 14 volunteers in a double-blind crossover design with a minimum of 4-week washout between intakes. The research results showed that there were statistically significant variations in the bio-availability of the CoQ10 formulations. The best absorbed CoQ10 formulation was a formulation containing ubiquinone (oxidized CoQ10) dissolved in a soy oil matrix.

The first-ever head-to-head comparative bio-availability study has shown that a patented ubiquinone Coenzyme Q10 preparation gives a significantly better absorption and bio-availability than a patented ubiquinol product.

That is what happened in the double-blind, cross-over study conducted by researchers at the Pablo de Olavide University in Sevilla, Spain, in 2018 [Lopez-Lluch 2019].  

This is important for several reasons:

Until this study in 2018, there had never been a head-to-head comparison study of the bio-availability of a ubiquinone CoQ10 supplement and a ubiquinol supplement [Judy 2018].

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Coenzyme Q10 and pregnancy

Normally, in this blog we focus on clinical research into the effects of Coenzyme Q10 supplementation of heart failure patients, senior citizens, patients with high blood pressure, patients with diabetes, and so on. Today, we have summarized a randomized controlled trial of Coenzyme Q10 supplementation of pregnant women.

What about Coenzyme Q10 supplements for pregnant women and breastfeeding mothers, you ask.  Well, yes, that seems to be a logical question.  

Coenzyme Q10 is an essential factor in the cellular process of energy production.  It plays an important role in antioxidant protection of the cells. It helps to maintain good endothelial cell function [Littarru 2010].

And, pregnancy is certainly a time when women need extra energy.  Ditto when they are breastfeeding.  

Similarly, pregnancy and breastfeeding are times of increased oxidative stress and thus increased need for antioxidant protection.  Pre-term mothers and infants, in particular, need extra antioxidant defense [Abuhandan 2015].

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Big new Coenzyme Q10 in heart failure study proposed in the UK

The thickened heart muscle makes it more difficult for the heart to pump out adequate quantities of blood. Source: staff (2014). “Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2).

Researchers in the United Kingdom are developed the methodology for a new randomized controlled trial of the efficacy of Coenzyme Q10 adjunctive treatment of heart failure patients.

Two earlier randomized controlled studies have produced results suggesting that daily supplementation with Coenzyme Q10 substantially reduces the morbidity and mortality in patients who are at risk for or have been diagnosed with heart failure.

Q-Symbio Study: Daily supplementation with 300 milligrams of Coenzyme Q10 for two years significantly improved the symptoms, quality of life, and survival of chronic heart failure patients [Mortensen 2014].

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Documented safety of Coenzyme Q10 supplementation

Yes, the raw material Coenzyme Q10 and the manufactured Coenzyme Q10 supplements are documented as safe and well-tolerated. However, the efficacy of the various CoQ10 supplements available on the US market varies considerably. It is wise to purchase a CoQ10 supplement that is supported by scientific documentation. For example, the CoQ10 supplement used in the Q-Symbio study, the KiSel-10 study, and the Gulf War Illness study has been evaluated in randomized controlled clinical trials. There is documented evidence that it is effective.

The nutritional supplement Coenzyme Q10 is non-toxic and without any noteworthy safety concerns [Hathcock; Ikematsu].

  • Coenzyme Q10 is very well-tolerated, and it does not cause any notable adverse effects at daily dosages as high as 1200 milligrams per day [Hathcock].
  • Studies of healthy individuals and studies of individuals with kidney impairment and liver impairment have not shown any potential for an adverse effect of CoQ10 supplementation on the kidneys or on the liver [Watson; Mabuchi; Farhangi].
  • A randomized, double-blind, placebo-controlled study enrolling healthy study participants showed no dose-related changes in hematology, blood biochemistry, and urinalysis [Ikematsu].
  • Moreover, plasma CoQ10 concentrations after an 8-month period of withdrawal from CoQ10 supplementation were nearly the same as before the supplementation [Ikematsu].

Importance of CoQ10 nutritional supplements

Note: Coenzyme Q10 is arguably the most important nutritional supplement for healthy individuals above the age of 40.  Cellular bio-synthesis of CoQ10 begins to slow down once we are past our 20s and lessens then with increasing age [Kalén].

  • CoQ10 in its oxidized form (ubiquinone form) is an essential co-factor in the process of cellular energy production.
  • CoQ10 in its reduced form (ubiquinol form) is an important fat-soluble antioxidant, protecting the cells against free radical damage.
  • CoQ10 is associated with significant improvement in endothelial function [Gao].
  • Coenzyme Q10 is a necessary supplement for patients taking statin medications as the use of statin medications inhibits the bio-synthesis of CoQ10 [Okuyama].

Daily supplemental dosages of CoQ10

  • A typical daily nutritional supplement dosage is 100 milligrams per day.
  • A typical therapeutic dosage for adjuvant treatment of chronic heart failure is 300 milligrams a day, taken as 3 times 100 milligrams with meals [Mortensen].
  • Coenzyme Q10 dosages of 300 milligrams per day have proven efficacy as an adjunctive treatment for chronic heart failure patients and patients with high blood pressure [Mortensen; Rosenfeldt].

No reports of potential overdose of CoQ10

There are no reports in the bio-medical literature of any potential for an acute intoxicating overdose in humans.

  • The estimated observed safe level of daily CoQ10 intake for adults is set at 1200 milligrams per day [Hathcock].
  • The few adverse effects reported in conjunction with Coenzyme Q10 supplementation – primarily nausea and other minor gastrointestinal effects – have been no more common at 1200 milligrams per day than at 60 milligrams per day [Hathcock].
  • 1200 milligrams per day is four times the daily amount of CoQ10 supplementation that resulted in the significantly improved symptoms and survival of chronic heart failure patients [Mortensen] and six times the amount that helped reduce the risk of death from heart disease in healthy senior citizens [Alehagen].
  • The highest daily dose of CoQ10 that has been investigated is 3600 milligrams per day for 12 weeks [Hyson].
Dr. William Judy, SIBR Research Institute, has seen a very low incidence of mild adverse effects of Coenzyme Q10 supplementation in his 30-year management of heart failure study.  Moreover, it is not clear that the few adverse effects that get reported are caused by the CoQ10 supplement. The same adverse effects occur in patients taking the placebo preparation.

Very low rate of mild adverse effects of CoQ10 supplementation

A 2003 survey of 13 randomized controlled studies of CoQ10 supplementation of heart failure patients as well as of open-label studies in heart failure showed that 200 milligrams of CoQ10 per day for 6–12 months and 100 milligrams per day for up to 6 years resulted in no major side effects.  The survey showed a rate of mild adverse effects at less than one-half of one percent [Mortensen].

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