People who have heart failure – people whose heart is no longer able to provide an adequate flow of blood to the rest of the body – produce two proteins that can be measured in the blood. These proteins can be used as biological markers for the existence of heart failure and for the worsening of heart failure. The two proteins go by the names B-type natriuretic peptide (BNP) and N-terminal-pro-BNP (NT-pro-BNP). The levels of these proteins in plasma or serum tell the cardiologist whether your symptoms are caused by heart failure, and they tell the cardiologist whether your heart failure condition is worsening. The BNP blood test is the test that tells the cardiologist whether the patient’s fatigue and shortness of breath and limited physical exertion are caused by heart failure rather than by some other condition .
Standard care plus NT-pro-BNP better than the standard-of-care guidelines alone
In 2011, Dr. Januzzi and colleagues at Massachusetts General Hospital in Boston, Massachusetts, reported on the results of a study comparing heart failure therapy guided by standard care guidelines and heart failure therapy guided by concentration levels of NT-pro-BNP proteins. The results of the study showed that heart failure therapy focused on a goal of reducing NT-pro-BNP protein levels was superior to standard-of-care treatment alone.
The NT-pro-BNP oriented treatment regimen resulted in reduced rates of adverse events, improved quality of life for patients, and greater improvements in left ventricular ejection fraction and left ventricular end-systolic and diastolic volume indexes. In other words, heart failure patients whose treatment focused on lowering the levels of NT-pro-BNP proteins in their blood ended up pumping blood more efficiently than the standard-of-care patients did. The results of the Januzzi study were published in the prestigious Journal of the American College of Cardiology .
Coenzyme Q10 and the bio-markers for heart failure
In the four-year KiSel-10 study of daily supplementation of elderly Swedish citizens with a combination of 200 milligrams of Coenzyme Q10 and 200 micrograms of selenium, Dr. Urban Alehagen and his team of researchers from Linköping University monitored the participants’ levels of NT-proBNP . The KiSel-10 study data showed that supplementation with Coenzyme Q10 and selenium significantly reduced both NT-pro-BNP levels and incidence of cardiovascular death compared with placebo.
In the two-year Q-Symbio study, daily supplementation of heart failure patients with 300 milligrams of Coenzyme Q10 (100 milligrams three times a day, with meals) for two years showed a trend toward beneficial effects of Coenzyme Q10 in patients with patients who had NTproBNP levels equal to or greater than 300 picograms per milliliter .
The Cleveland Clinic has provided the following reference numbers for patients’ BNP levels :
- BNP levels below 100 pg/mL = do not have heart failure
- BNP levels in the 100-300 pg/mL range = at risk of heart failure
- BNP levels above 300 pg/mL = mild heart failure
- BNP levels above 600 pg/mL = moderate heart failure
Statins and bio-markers for heart failure
Dr. Suzuki and colleagues at the University of Toyama in Japan investigated the effects of statin medications on blood levels of Coenzyme Q10 and BNP. In their study, 10 patients were taking pravastatin, and 10 patients were taking fluvastatin while 9 patients were not yet exposed to a statin medication. The study data showed that the statin medications induced reductions in plasma Coenzyme Q10 levels and that the reductions in Coenzyme Q10 levels were significantly associated with the increasing levels of BNP in patients with coronary artery disease.
Dr. Suzuki concluded that long-term use of statin medications might result in increased plasma levels of BNP, the bio-marker for heart failure. It is well-documented that the use of statin medications results in reductions of Coenzyme Q10 produced in the body .
Dr. Harumi Okuyama and Dr. Peter H. Langsjoen have expressed concern that the use of statin medications to reduce the number of heart attacks may be stimulating increases in the incidence of heart failure and atherosclerosis in the United States and may be causing the worsening of heart failure conditions for many patients . The mechanisms that concern Drs. Okuyama and Langsjoen are the statin-induced inhibition of the body’s production of Coenzyme Q10, the statin-induced inhibition of the body’s vitamin K2 production, and the statin-induced inhibition of the body’s production of selenium containing proteins.
- The levels of the proteins B-type natriuretic peptide (BNP) and N-terminal-pro-BNP (NT-pro-BNP) in plasma or serum serve as bio-markers for the presence of heart failure.
- Supplementation with Coenzyme Q10 and selenium is positively associated with reductions in the levels of these bio-markers for heart failure.
- There is a vital relationship between Coenzyme Q10 and selenium that affects the optimal functioning of human cells.
- Statin medications are known to reduce the blood Coenzyme Q10 levels and the production of selenium containing proteins.
- The reductions of Coenzyme Q10 and selenium containing proteins are, in turn, associated with increasing levels of the bio-markers for heart failure.
- Alehagen, U., Johansson, P., Björnstedt, M., Rosén, A., & Dahlström, U. (2013). Cardiovascular mortality and N-terminal-proBNP reduced after combined selenium and coenzyme Q10 supplementation: a 5-year prospective randomized double-blind placebo-controlled trial among elderly Swedish citizens. International Journal of Cardiology, 167(5), 1860-1866.
- B-type Natriuretic Peptide (BNP) Blood Test. (2016). Cleveland Clinic. Retrieved from http://my.clevelandclinic.org/services/heart/diagnostics-testing/laboratory-tests/b-type-natriuretic-peptide-bnp-bloodtest.
- Heart Failure and the BNP Blood Test. (2016). WebMD. Retrieved from http://www.webmd.com/heart-disease/heart-failure/bnp-blood-test.
- Januzzi, J. J., Rehman, S. U., Mohammed, A. A., Bhardwaj, A., Barajas, L., Barajas, J., & Semigran, M. J. (2011). Use of amino-terminal pro-B-type natriuretic peptide to guide outpatient therapy of patients with chronic left ventricular systolic dysfunction. Journal of The American College Of Cardiology, 58(18), 1881-1889.
- Johansson, P., Dahlström, Ö., Dahlström, U., & Alehagen, U. (2013). Effect of selenium and Q10 on the cardiac biomarker NT-proBNP. Scandinavian Cardiovascular Journal: SCJ, 47(5), 281-288.
- Mortensen, S. A., Rosenfeldt, F., Kumar, A., Dolliner, P., Filipiak, K. J., Pella, D., & Littarru, G. P. (2014). The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: results from Q-SYMBIO: a randomized double-blind trial. JACC. Heart Failure, 2(6), 641-649.
- Okuyama, H., Langsjoen, P. H., Hamazaki, T., Ogushi, Y., Hama, R., Kobayashi, T., & Uchino, H. (2015). Statins stimulate atherosclerosis and heart failure: pharmacological mechanisms. Expert Review of Clinical Pharmacology, 8(2), 189-199.
- Suzuki, T., Nozawa, T., Sobajima, M., Igarashi, N., Matsuki, A., Fujii, N., & Inoue, H. (2008). Atorvastatin-induced changes in plasma coenzyme q10 and brain natriuretic peptide in patients with coronary artery disease. International Heart Journal, 49(4), 423-433.
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