Adiponectin is a circulating protein that plays a role in glucose metabolism and in the breakdown of fatty acids.  Plasma adiponectin concentrations are a known bio-marker for the extent of insulin resistance.  Adiponectin attenuates the inflammatory response of the immune system. Low adiponectin levels are associated with most of the negative aspects of type 2 diabetes and metabolic syndrome. Studies have shown that Coenzyme Q10 supplementation is associated with increased adiponectin levels.

Adjunct treatment:

Also called adjuvant treatment and adjunctive treatment, adjunct treatment is additional treatment together with conventional medical treatment.  Adjunct treatment is the use of daily Coenzyme Q10 supplementation together with conventional medical treatment for heart failure, diabetes, hypertension, degenerative diseases, and low-energy syndrome diseases.

Alehagen, Urban, M.D., Ph.D.:

Professor Urban Alehagen, Linköping University, Sweden, is the lead researcher on the KiSel-10 study. He has written extensively about the special biological interrelationship of Coenzyme Q10 and selenium in the prevention of heart disease.


Antioxidants are substances that protect the cells and lipoproteins against the harmful effects of free radicals. They are substances that prevent the oxidation of other molecules and compounds. There are two broad categories of antioxidants: enzymatic and non-enzymatic.
Non-enzymatic antioxidants are substances like Coenzyme Q10, vitamin C, vitamin E, glutathione, and various carotenoids. Prominent enzymatic antioxidants include catalase, glutathione peroxidase, glutathione reductase, and superoxide dismutase.


Atherosclerosis is the thickening of the artery walls brought about by the build-up of plaque (plaque is made up of cholesterol and other fatty substances and waste products and calcium and fibrin) and the subsequent slowing of the flow of blood through the clogged arteries. More research is needed into the role of Coenzyme Q10 in the prevention and adjunct treatment of atherosclerosis.

ATP (adenosine triphosphate):

ATP molecules are the high-energy molecules with easily broken phosphate bonds that release energy to the energy-requiringprocesses in the cells. Coenzyme Q10 is essential to the process of ATP production.
CABG surgery: CABG surgery is coronary artery bypass graft surgery. Studies have shown that pre-surgery treatment with Coenzyme Q10 supplements improves the clinical outcomes of the surgery as compared with placebo.

Cell membranes:

The cell membranes, sometimes called plasma membranes, are the physical barrier that protects the contents of the cells from everything that is outside the cells. The cell membranes also regulate what can move in and out of the cells. Coenzyme Q10 is present in all cell membranes in the body except in the red blood cells. It helps to prevent the peroxidation of cell membrane lipids.


Cholesterol is one of the major fat-soluble compounds that is found in animal plasma membranes. It is necessary for life and is found throughout the body. It is carried from the liver to the tissues where it is needed by lipoproteins of which it is a component. Much of the cholesterol is transported in Low density lipoproteins (LDL). High levels of LDL lipoproteins are associated with increased risk of coronary heart disease.
Cholesterol is transported back to the liver from the tissues as a component of High density lipoproteins (HDL). Low levels of HDL lipoproteins are associated with increased risk of coronary heart disease.
One theory of heart disease holds that cholesterol builds up inside the arteries whenever there is too much cholesterol in the blood. The cholesterol attaches itself to the inner walls of the arteries as a component of plaque. The build-up of plaque inside the arteries leads to a diminished supply of blood to the heart. See atherosclerosis.
Cholesterol-inhibiting medications, called statins, inhibit not only the body’s synthesis of cholesterol but also the body’s synthesis of Coenzyme Q10, making Coenzyme Q10 supplementation especially important for people taking a statin medication.

Chronic heart failure:

see Heart failure

Coenzyme Q10:

Coenzyme Q10 molecules are fat-soluble molecules that are both bsynthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol.
Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical way by changes in diet.
Coenzyme Q10 molecules are found everywhere in the body except in the red blood cells. This ubiquity is a good example of how important Coenzyme Q10 is to human health.
Coenzyme Q10 molecules are redox molecules, i.e. they convert back and forth between an oxidized form (known as ubiquinone) and a reduced form (known as ubiquinol).
Coenzyme Q10 supplementation using the ubiquinone form has been used successfully as an adjunct treatment for chronic heart failure patients.
Clinical studies have shown that Coenzyme Q10 supplementation has significant beneficial health effects for heart failure patients, healthy elderly citizens (aged 70 + years), low-energy syndrome patients, Gulf War veterans, hypertension patients, and heart surgery patients.
Coenzyme Q10 supplementation confers health benefits through its role in energy production, its function as an antioxidant, its role in improving endothelial function, and its role in reducing chronic low-grade inflammation.

Congestive heart failure:

see Heart failure

Crane, Frederick, L., Ph.D.:

Dr. Crane (1925-2016) is credited with the discovery and isolation of Coenzyme Q10 from beef heart mitochondria in 1957.
Dr. Crane sent samples of the new substance to Dr. Karl Folkers at the Merck Research Labs, and Dr. Folkers determined the chemical structure of the substance in 1958. At the end of his life, Dr. Crane was searching for evidence for a role for Coenzyme Q10 in the treatment of autism.C-reactive protein (CRP): C-reactive protein is a protein produced in the liver in response to inflammation. High levels of C-reactive protein in the blood are bio-markers for inflammation. Clinical studies have shown that Coenzyme Q10 supplementation is associated with reduced levels of C-reactive protein and thus with reduced levels of inflammation.

Diabetes mellitus:

Diabetes is a metabolic disease characterized by high blood sugar levels. Diabetes is caused by the body’s failure to produce sufficient insulin (type 1 diabetes) or by the body’s failure to respond to the available insulin (type 2 diabetes).
The high blood sugar levels that are characteristic of diabetes are associated with increased risk of heart attack, stroke, and coronary artery disease.
Decreased plasma Coenzyme Q10 concentrations have been observed in cases of diabetes. Clinical research has shown that patients with type 1 and type 2 diabetes can safely take Coenzyme Q10 supplements.

Drug interactions:

Numerous drugs interfere with the bio-synthesis or the absorption or both of Coenzyme Q10. Coenzyme Q10 is not known to inhibit the action of other drugs. There is research showing that Coenzyme Q10 supplementation does not interfere with the clinical effects of warfarin. However, anyone taking an anti-coagulant medication will want to discuss the benefits of taking Coenzyme Q10 with his or her physician.
The drug interaction that must always be considered is the inhibiting effect of statin medications on the bio-synthesis of Coenzyme Q10. Statins effectively limit the body’s production of cholesterol. In so doing, they also limit the body’s production of Coenzyme Q10.

Electron transport chain:

The electron transport chain is the pathway in the mitochondria in which nutrients are oxidized and converted to generate the energy that used to produce ATP energy. The mitochondria require optimal supply of Coenzyme Q10 in the form of ubiquinone to generate ATP energy.


the layer of cells that line the surface of the inside of the arteries and veins, the heart, and lymph vessels.The endothelium releases molecules, e.g. nitric oxide, angiotensin II, etc., that help to expand (dilate) or contract (constrict) the blood vessels and thus raise or lower blood pressure. The cells of the endothelium release substances (called factors) that help to maintain heart and blood vessel wall tone and that help to inhibit platelet aggregation and inflammation.
Why is this important? Coenzyme Q10 supplementation has been shown to improve endothelial function.

Folkers, Karl August, Ph.D., 1906-1997:

While working at the Merck Research Laboratories, Dr. Folkers determined the chemical structure of the Coenzyme Q10 molecule. In 1968, he founded the Institute for Bio-Medical Research in Austin, Texas. From the Institute, he encouraged and supported research into the safety, absorption, and health benefits of Coenzyme Q10 supplements. Dr. Folkers’ closest colleagues and co-researchers in the field of Coenzyme Q10 research were Dr. William V. Judy (Indiana), Dr. Per Langsjoen (Texas), Dr. Gian Paolo Littarru (Italy), Mr. Sven Moesgaard (Denmark), and Dr. Svend Aage Mortensen (Denmark). For his achievements, Dr. Folkers was awarded the Priestley Medal of the American Chemical Society (1986) and the President’s National Medal of Science (1990).


Free radicals are unstable and highly reactive molecules that are produced in the body during normal oxygen metabolism. They are also known as reactive oxygen species. Free radicals play both helpful and harmful roles in the body. Free radicals steal electrons from other substances in order to become stable. In so doing, the free radicals oxidize those other molecules. When the quantity of free radicals greatly exceeds the quantity of antioxidants, the free radicals can cause chain reactions and can cause much cell and tissue damage.
Free radical is the name for the broad category of atoms and molecules with unpaired electrons. The more specific category of free radicals that is of special interest in human health is the category of reactive oxygen species, which are free radicals derived specifically from oxygen: superoxides, peroxides, and hydroxyl radicals.Coenzyme Q10, vitamins C and E, and glutathione peroxidase are some of the notable antioxidants that protect the cells and tissues against oxidative stress and damage.

Glucose metabolism:

The glucose metabolism is the process by which the body processes and uses sugars in the diet to produce energy. In patients with diabetes, the body’s tolerance and processing of sugars is impaired or damaged.
Clinical studies have shown that the use of Coenzyme Q10 supplements does not impair the body’s glucose metabolism.

Gulf War Veterans study:

The Gulf War Veterans study tested the efficacy of Coenzyme Q10 supplementation for veterans diagnosed with Gulf War Illness.
The results from the study showed that the Coenzyme Q10 supplementation was associated with improved physical function, improved cognitive function, and reduced fatigue.
Dr. Beatrice A. Golomb was the lead researcher on the Gulf War Veterans study. Heart failure: sometimes known as congestive heart failure, sometimes known as chronic heart failure, heart failure is the condition when the heart does not pump sufficient blood to the rest of the body to provide adequate quantities of oxygen and nutrients
Typical symptoms of heart failure include shortness of breath, fatigue and weakness, swelling of the ankles, feet, and legs, and swelling of the abdomen.

The Mayo Clinic defines heart failure, also known as congestive heart failure and/or chronic heart failure, as the failure of the heart muscle to pump blood to the body adequately.  In other words, heart failure is not a heart attack, and it is not death from heart disease, which its name might seem to imply.

Heart failure is a condition characterized by some or all of the following symptoms: shortness of breath, difficulty exercising, swelling in the lower extremities, and palpitations. The New York Heart Association (NYHA) has devised a widely used classification system based on these symptoms.  The heart failure classes range from 1 (mildest form) to 4 (most severe form).

Heart failure can be of various types: left-sided heart failure in which fluid backs up in the lungs, right-sided heart failure in which fluid backs up in the abdomen and lower extremities, systolic heart failure in which the left ventricle does not pump out the blood sufficiently, and diastolic heart failure in which the left ventricle does not fill up with blood adequately.

Common causes of heart failure are coronary artery disease caused by atherosclerosis, a survived heart attack, high blood pressure, faulty heart valves, heart muscle damage caused by disease or infection, virus-caused inflammation of the heart muscle, and abnormal heart rhythms.

In the Q-Symbio study, adjunct treatment with 300 milligrams of Coenzyme Q10 significantly improved the symptoms and survival of chronic heart failure patients.


Hypertension is abnormally high blood pressure, usually defined as adult systolic blood pressure above 140 mm Hg or adult diastolic blood pressure above 90 mm Hg. Systolic blood pressure is blood pressure measured during the contracting (pumping) of the left ventricle of the heart. Diastolic blood pressure is blood pressure measured during the relaxation of the left ventricle.
A meta-analysis of studies of Coenzyme Q10 supplementation for hypertension has shown that Coenzyme Q10 supplementation reduces high blood pressure moderately but significantly.


Inflammation is an immune system response to an injury to cells or tissues. It is the body’s attempt to defend against invaders such as bacteria andviruses and to mend the damage done by invaders. Typically, inflammation manifests itself in the form of fever and swelling, in the swarming of white blood cells and the release of cytokines to fight against and repair injury, and in metabolic responses.
Chronic systemic inflammation has implications for the development and progression of heart disease, diabetes, and cancer. Several studies have indicated an anti-inflammatory role for Coenzyme Q10, but the exact mechanisms of action remain unidentified.


Ischemia is the lack of adequate blood supply to tissues, e.g. to the heart muscle tissues. In the case of ischemia, the tissues are not getting enough oxygen. Reperfusion, then, is the damage caused to the tissues when the blood supply is restored to the tissue, and, suddenly, there is a re-oxygenation of the tissues as, for example, in cases of heart attack or heart surgery. Clinical studies have shown that pre-treatment and post-operative treatment with Coenzyme Q10 attenuates the extent of ischemia reperfusion injury.

Ischemic heart disease:

Ischemic heart disease is heart disease caused by reduced blood flow to the heart. Ischemic heart disease is, in most cases, coronary artery disease. Blockage of the coronary arteries reduces the flow of blood and oxygen to the heart.

Judy, William V., Ph.D.:

Dr. Judy is the founder and president of the SIBR Research Institute, a former professor of physiology and bio-physics at the Indiana University College of Medicine, and a long-time Coenzyme Q10 researcher. His research has focused on the absorption and bioavailability of Coenzyme Q10 and on the efficacy of adjuvant Coenzyme Q10 treatment for heart failure patients, cancer patients, and low-energy syndrome patients.

KiSel-10 study:

The KiSel-10 study was a four-year randomized, double-blind, placebo-controlled study of 443 Swedish citizens aged 70 to 88 who received either a combined daily supplementation of high-selenium yeast and Coenzyme Q10 or matching placebos. The elderly Swedish citizens who received the active treatment of selenium and Coenzyme Q10 had significantly reduced risk of death from heart disease, significantly better heart function as recorded onechocardiograms, and significantly lower levels of a bio-marker indicating an increased risk of heart failure.

Langsjoen, Per, M.D., F.A.C.C.:

Dr. Langsjoen (pronounced “Lang-shin”) was the cardiologist, working together with Dr. Karl Folkers, who championed the clinical effects of adjuvant treatment of heart failure patients with Coenzyme Q10 supplements and who carried out the first long-term human double-blind, controlled heart failure study with Coenzyme Q10 in the United States.
The data from Dr. Langsjoen’s eight-year study, 1985-1993, showed that Coenzyme Q10 supplementation is safe and effective as an adjunctive treatment for a broad range of cardiovascular diseases.
Dr. Langsjoen’s son, Dr. Peter H. Langsjoen, has continued his father’s work in cardiology.


See lipoproteins.


Oxidation is the chemical reaction of a substance with oxygen. Peroxidation is the extreme form of oxidation that results from free radicals’ stealing electrons from lipids, either in the cell membranes or in the lipoproteins.
The final product of lipid peroxidation is highly reactive malondialdehyde, a bio-marker for oxidative stress and damage.


Lipoproteins are particles comprised of protein and lipids, with a core of triglycerides and cholesterol esters and an outer layer of phospholipids.
Lipoproteins transport lipids through the bloodstream.
LDL-lipoproteins carry cholesterol from the liver to the body tissues. HDL- lipoproteins carry cholesterol back to the liver from the body tissues.
LDL-lipoproteins also bind and transport Coenzyme Q10 molecules, predominately in their reduced form, from the absorption cells in the small intestine through the lymph and the blood to the tissues.
Coenzyme Q10 helps to prevent the peroxidation of lipoprotein lipids in the blood circulation.Littarru, Gian Paolo, M.D., Ph.D.: Dr. Littarru was a post-doctoral fellow at Dr. Folkers’ Institute for Biomedical Research and then a professor of biochemistry at the University of Ancona Medical School (Italy). His primary research interest was Coenzyme Q10 in its role in bio-energetics, in its role as a fat-soluble antioxidant, and in its effect on endothelial function.

Malondialdehyde (MDA):

Whenever free radicals react with and degrade polyunsaturated fats, malondialdehyde is formed. It is a highly reactive organic compound that may have the capability of changing the DNA of organisms.
Malondialdehyde levels in the blood are used as a bio-marker for oxidative stress and damage. Some studies have shown that supplementation with Coenzyme Q10 results in lower levels of malondialdehyde.

Metabolic syndrome:

Metabolic syndrome is the medical term for a cluster of conditions such as excess body fat around the waist, high blood sugar, high blood pressure, high cholesterol or triglyceride levels. Metabolic syndrome is associated with increased risk of diabetes, heart disease, and stroke. Individuals with metabolic syndrome are at higher risk of heart disease, diabetes, and stroke and have, therefore, a greater need for Coenzyme Q10 supplements.

Mevalonate pathway:

The mevalonate pathway is the biological pathway that produces the building-block molecules that the body needs for its synthesis of cholesterol, Coenzyme Q10, Vitamin K, and all steroid hormones. As such, the mevalonate pathway is the target of the statin medications that inhibit the body’s production of cholesterol and Coenzyme Q10.
Mevalonic acid is the precursor to the mevalonate pathway. Mevalonate is the salt or the ester of mevalonic acid.

Mitchell, Peter, Ph.D.:

Dr. Mitchell did not discover Coenzyme Q10 – Dr. Fred Crane first discovered the substance, and Dr. Karl Folkers first determined its chemical structure – but Dr. Mitchell’s work explained the role of Coenzyme Q10 role in the electron transport chain that provides the energy for the efficient cellular conversion of nutrients to ATP energy molecules.
In 1978, Dr. Mitchell was awarded the Nobel Prize for Chemistry for his contributions to our understanding of the nature of cellular energy transfer.Mitochondrion (plural: mitochondria): the bean-shaped membrane-bounded organelles in the cells. It is in the mitochondria that ATP energy molecules are produced during the process of cellular respiration. Coenzyme Q10 in its oxidized form, the form known as ubiquinone, is essential for the production of ATP energy in the mitochondria.

Mortensen, Svend Aage, M.D., Ph.D.:

Dr. Mortensen was the lead researcher on the Q-Symbio study of the effect of Coenzyme Q10 on morbidity and mortality in chronic heart failure. He argued that Coenzyme Q10, a natural substance, should be a guideline-directed adjunctive therapy in heart failure.

Myocardial infarction:

Myocardial infarction is the medical term for heart attack. Coenzyme Q10 supplementation is associated with improved recovery and less risk of re-hospitalization following a heart attack.

Neuro-degenerative diseases:

Neuro-degenerative diseases are diseases resulting from the degeneration of the nerve cells (also called neurons). Alzheimer’s disease, Huntington’s disease, and Parkinson’s disease are the names of well-known neuro-degenerative diseases.
Coenzyme Q10 supplementation has received attention for its potentially preventive and/or therapeutic role in the neuro-degenerative diseases, especially with respect to Coenzyme Q10 antioxidant role in protecting the mitochondria and the neurons against oxidative stress and damage.

Oxi-reductase enzymes:

Oxi-reductase enzymes are the enzymes that stimulate the conversion of ubiquinone to ubiquinol in the lymph, blood, and cell mitochondria. Free radicals and super-oxides stimulate the conversion of ubiquinol back to ubiquinone.


Oxidation is the chemical process in which an atom or a molecule gives up (loses) one or more electrons to another substance. Burning is an example of a rapid process of oxidation. Rusting is an example of a slow process of oxidation.
Oxidative stress and oxidative damage: structural damage to cell components such as proteins, lipids, and DNA that is caused by chain reactions set off by harmful free radicals. The chain reactions can be terminated by antioxidants such as Coenzyme Q10.


See lipid peroxidation.

Q-Symbio study:

Q-Symbio is the abbreviated name for the two-year multi-center, randomized, double-blind, placebo-controlled study of Coenzyme Q10 supplements as an adjunct treatment of chronic heart failure patients. The name reflects the focus of the study on the SYMptoms, BIomarker status (BNP), and long-term Outcomes (hospitalizations and mortality) of the supplementation.
The data from the Q-Symbio study show that long-term supplementation with 300 milligrams per day is safe, improves symptoms and survival, and reduces the risk of major adverse cardiovascular events.

Reactive oxygen species:

see free radicals.


Redox is the abbreviated term for reduction-oxidation.  Coenzyme Q10 molecules are redox molecules.   Redox refers to the oxidation state of the molecule.  Oxidized Coenzyme Q10 molecules, called ubiquinone (CoQ10), are Coenzyme Q10 molecules that can accept (take on) two electrons and thus become reduced Coenzyme Q10 molecules called ubiquinol.

Reduced Coenzyme Q10 molecules, called ubiquinol (CoQH2), are Coenzyme Q10 molecules that can donate (lose or give up) two electrons and thus become oxidized Coenzyme Q10 molecules called ubiquinone.

The highly unstable intermediate state of Coenzyme Q10 molecules is the ubisemiquinone molecule, which has lost one electron and stands to lose the second electron.  It is the redox nature of the Coenzyme Q10 molecules that make them valuable both as components of cellular bio-energetics and antioxidant defense.

Redox reactions take place simultaneously.  One atom or molecule donates an electron (becomes oxidized), and, at the same time, another atom or molecule accepts the electron (becomes reduced).

Redox ratio:

Redox ratio refers to the ratio of ubiquinol (CoQH2) to ubiquinone (CoQ10) in the plasma, serum, platelets, or tissue.  The Coenzyme Q10 redox ratio varies with a person’s age and degree of oxidative stress.  Increased Coenzyme Q10 redox ratio is associated with the symptoms of metabolic syndrome.


see ischemia-reperfusion.


Selenium (symbol Se, atomic number 34) is a trace element that is an essential nutrient and an essential component of some of the most important antioxidants in the body, in particular the selenoproteins glutathione peroxidase, thioredoxin reductase, and selenoprotein P. Selenium is involved in the optimal functioning of the immune system.
Professor Alehagen has pointed out that there exists a special interrelationship between selenium and Coenzyme Q10 that can be exploited for clinical benefit in cases of heart disease. Adequate selenium must be available for the cells to achieve optimal concentrations of Coenzyme Q10, and, similarly, adequate levels of Coenzyme Q10 are necessary for the cells to achieve optimal function of selenium.


Statins are a class of medications that effectively block the body’s synthesis of cholesterol. In so doing, statins also block the body’s synthesis of Coenzyme Q10.

TBARS (Thio-barbituric acid reactive substances):

TBARS are substances produced as a by-production of the degradation of lipids in the process of lipid peroxidation. As such, TBARS are a useful bio-marker of the extent of oxidative stress and damage. Clinical research has shown that Coenzyme Q10 supplementation is associated with reduced levels of TBARS, indicating an effective antioxidant effect of the Coenzyme Q10 supplements.Ubiquinol: Ubiquinol, the reduced form of Coenzyme Q10, expressed as QH2, is an important antioxidant in cell membranes and lipoproteins. It has not been tested much in clinical trials. There is research evidence that ubiquinol, taken in supplement form, will be converted to the ubiquinone form in the stomach and small intestine before it reaches the absorption cells.


Ubiquinone, the oxidized form of Coenzyme Q10, expressed as Q10 or CoQ10, is absolutely essential for the mitochondrial ATP energy production process. Ubiquinone is the form of Coenzyme Q10 that the body synthesizes, and ubiquinone is the form of Coenzyme Q10 that has been extensively tested for safety, absorption, and efficacy in clinical trials.


see redox molecule.

Vitamin E:

Vitamin E is a fat-soluble vitamin that plays an important role as an antioxidant in the body. Vitamin E neutralizes harmful free radicals. Coenzyme Q10 regenerates Vitamin E after the vitamin E has neutralized free radicals.