Coenzyme Q10 Adjuvant Therapy for Heart Failure

Coenzyme Q10 as an adjuvant therapy to the conventional medication for heart failure patients = an idea whose time has come.

Chambers of the human heart
Patients with the symptoms of heart failure — fatigue, palpitation, shortness of breath, limited physical activity — have lower quality of life and reduced survival. CoQ10 therapy can improve symptoms and survival.

Followers of evidence-based medicine will want to use the ubiquinone form of Coenzyme Q10 in the same dosage and administration (3 times 100 mg daily with meals) as it was used in the Q-Symbio Study of the effect of Coenzyme Q10 on morbidity and mortality in chronic heart failure [Mortensen 2014; Mortensen 2019].

Q-Symbio Study: Coenzyme Q10 and Heart Failure

Adjuvant therapy with Coenzyme Q10 in the ubiquinone form – 300 mg daily for two years – was associated with the following heart health benefits, compared to placebo [Mortensen 2014]:

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International CoQ10 Association Conference May 12-15, 2022

CoQ10 research. Every three years, the International Coenzyme Q10 Association (ICQA) holds an international conference. Speakers at the 10th conference of the ICQA held in Hamburg, Germany, May 12-15, 2022, made the following presentations:

Urban Alehagen
Prof. Urban Alehagen lecturing at the Hamburg conference in May 2022. He emphasized the effect of combined CoQ10 and selenium supplementation for elderly individuals with low intakes of both substances.

Coenzyme Q10 and Ageing

  • An ageing-related decrease in growth hormone and insulin-like growth factor 1 result in an increase in sub-clinical inflammation. Coenzyme Q10 levels in organs, except in the liver, decline by approximately 50% in elderly individuals. The decrease in growth hormone and IGF-1 and the decline in Coenzyme Q10 in organs are inter-related [K. Brismar].
  • The biological mechanisms underlying the reduction in cardiovascular mortality and the improvement in heart function seen in senior citizens supplemented with a combination of Coenzyme Q10 and selenium in the KiSel-10 Study include the following [U. Alehagen]:
  1. reduced systemic inflammation
  2. improved endothelial dysfunction
  3. reduced fibrosis
  • Research has confirmed that combined CoQ10 and selenium supplementation is associated with longer telomere length, compared to placebo supplementation [U. Alehagen]. Note: Telomere length is a bio-marker for ageing.

Coenzyme Q10 and Bioavailability

The comparison of the results from different CoQ10 absorption and bioavailability studies is ill-advised because the results are based on different study protocols, different study groups, different formulations and different dosages of Coenzyme Q10, different modes of administration (fasting/non-fasting), different blood sampling techniques, and different observation times [I. Pravst].

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Heart Failure and Coenzyme Q10 as Adjuvant Therapy

Heart failure – it sounds scary. It is scary, but the medical term heart failure does not mean that your heart stops beating. No, instead, it means that your heart can’t pump enough blood and oxygen to your body.

Dr. William Judy
In the 30-year study of the management of congestive heart failure patients, Dr. Judy found that CoQ10 therapy in addition to conventional medication is more effective than conventional medication alone; however, the patients’ response to the CoQ10 adjunctive treatment is fairly slow, with peak improvements coming within 8 – 12 months. The conventional medication plus CoQ10 therapy is safe; it improves long-term survival compared to conventional medication alone.

Heart failure may develop because the heart muscle has weakened or has become thicker and stiffer. Your heart muscle can compensate for a period, but, eventually, you will need treatment.

The thing to remember is that the heart tissue is muscle tissue. As such, it needs a constant supply of ATP energy, and Coenzyme Q10 is essential to the process of ATP energy generation [Crane 2001]. Furthermore, the heart muscle tissue needs protection against the oxidative damage caused by harmful free radicals, and Coenzyme Q10 in its reduced form is an important antioxidant [Crane 2001].

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Combined Coenzyme Q10 and Selenium Supplementation

There is a special biological interrelationship between Coenzyme Q10 and selenium. From a cardiologist’s perspective, there is a theoretical advantage in using both substances to prevent heart disease if the patients’ intakes are sub-optimal [Alehagen & Aaseth 2015a].

Heart chambers
Four years of daily supplementation of senior citizens with a combination of Coenzyme Q10 and selenium resulted in reduced risk of death from heart disease and in improved heart function.

This advantage has been demonstrated in the outcomes of the KiSel-10 Study, a randomized controlled trial that enrolled elderly community dwelling Swedish citizens, average age 78 years, with known low serum selenium status (mean: 67.1 mcg/L) [Alehagen 2013; Alehagen 2016a; Alehagen 2016b].

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Dr. Judy: Coenzyme Q10 Supplements Against Heart Failure

Here, below, is what I have learned about Coenzyme Q10 over the years. CoQ10 is a naturally occurring redox compound that is essential for life in all humans. Dr. Karl Folkers called it “an essential bio-nutrient.”

  • Coenzyme Q10 in its ubiquinone form, its oxidized state, plays an essential role in the production of ATP energy. It is needed in optimal quantities for cellular bio-energetics in heart muscle and skeletal muscle tissue.
  • In its ubiquinol form, its reduced state, Coenzyme Q10 functions as a lipophilic antioxidant, scavenging harmful free radicals and providing protection against oxidative damage.
  • CoQ10 supplementation has been shown to improve endothelial function [Belardinelli 2008]. The endothelial cells line the inside of the heart and the blood vessels. They are the cells that release substances that regulate the contraction and relaxation of the blood vessels, and they release enzymes that regulate blood clotting and platelet adhesion. They are very important for good heart health.
  • In clinical trials, CoQ10 supplementation has been associated with anti-inflammatory effects. A meta-analysis of 17 clinical trials has shown that CoQ10 status is associated significantly with reduced levels of the inflammatory mediators C-reactive protein, interleukin-6, and tumor necrosis factor-α [Fan 2017].
Dr. William Judy lecturing
In addition to doing clinical research into the efficacy of Coenzyme Q10 supplementation for some 40 years, early on in my career, I developed and refined a method of bio-electrical impedance measurement. I was able to use this non-invasive method to evaluate heart function in Black Lung Disease patients, in participants in the NASA Apollo program, and in open heart surgery patients in recovery. My message: use Coenzyme Q10 to ward off heart problems.

Blood and Tissue Deficiencies of Coenzyme Q10

  • Blood and tissue CoQ10 deficiency can occur because of ageing and because of the effect of medications such as statins.
  • Blood and tissue CoQ10 deficiency have been associated with statin-associated muscle symptoms (muscle aches and pains, severe cramps, muscle weakness) and with some of the symptoms of patients with heart failure and chronic fatigue syndrome (tiredness, fatigue, lack of energy).
  • Evidence from a 2016 meta-analysis supports the use of supplemental Coenzyme Q10 in patients with statin-associated muscle symptoms [Qu 2016].
  • The randomized controlled trial, the Q-Symbio Study, provides evidence for an adjunctive role for Coenzyme Q10 in the treatment of patients with chronic heart failure [Mortensen 2014].
  • A 2013 meta-analysis has shown that supplementation with Coenzyme Q10 resulted in significantly improved ejection fraction and improved NYHA functional class [Fotino 2013].

CoQ10 Supplementation of Patients with Statin-Associated Muscle Symptoms

Writing in February, 2021, in a special issue of one of the leading cardiology journals: Journal of the American College of Cardiology, Texas cardiologists Albert E. Raizner and Miguel A. Quiñones, conclude that it seems “reasonable and justifiable” for cardiologists to use Coenzyme Q10 supplements with patients diagnosed with statin-associated muscle symptoms [Raizner & Quiñones 2021].

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Coenzyme Q10 and Selenium Lower Cardiovascular Mortality in an Elderly Swedish Population

In the KiSel-10 project, our research group has reported that daily supplementation of elderly community living Swedish citizens with a combination of 200 micrograms of organic selenium and 200 milligrams of Coenzyme Q10 for four years is associated with the following statistically significant heart health outcomes [Alehagen 2013: Johansson 2015]:

  • reduced risk of death from heart disease
  • reduced blood levels of a protein bio-marker for heart failure
  • improved heart function shown on echocardiograms
  • improved health-related quality of life
Professor Urban Alehagen
Low intakes of selenium are associated with the increased risk of death from heart disease. Supplementation with selenium and Coenzyme Q10 reduce the risk by reducing oxidative stress, systemic inflammation, fibrosis, and endothelial dysfunction [Alehagen 2018].

Possible Mechanisms for the Positive Clinical Outcomes

Thus far, our research group has published sub-analyses from the KiSel-10 Study that illuminate possible mechanisms to explain the positive clinical effects of the combined supplementation:

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Dr. Judy Shares Some Coenzyme Q10 Case Reports

Over the years, many physicians have worked with SIBR Research by entering their patients into clinical trials conducted by SIBR Research. Many of these physicians, after seeing the benefits that Coenzyme Q10 gave to their patients, requested Coenzyme Q10 for their families or for themselves. In this article, I will relate some of their successes and failures.

Dr. William Judy in the lab
I have had two pacemakers over a 20-year interval. My mother has had four pacemakers in 40 years. We have taken CoQ10 for 30 and 49 years respectively. At SIBR Research, we have seen no problems in pacemaker patients taking CoQ10. In fact, CoQ10 seems to stabilize the heart cell membranes and to prevent cells other than the A-V and V pacemaker nodes from initiating ventricular systoles.

A physician requested CoQ10 for his mother

In 2002, a heart surgeon called our office and asked about our experiences in supplementing heart failure patients with Coenzyme Q10. I had previously met this physician in 1966 when he was a surgical fellow at Methodist Hospital in Houston, and I was a fellow in the department of Physiology at Baylor School of Medicine. We met at a lecture given by Dr. Karl Folkers on the biochemistry of CoQ10 in heart failure.

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Coenzyme Q10 and Selenium Protect Against Heart Disease

In 2013, Professor Urban Alehagen and a team of researchers reported on the beneficial effects of daily supplementation of elderly Swedish citizens with a combination of 200 mg of Coenzyme Q10 and 200 mcg of selenium, in divided doses with meals, over a four-year period.

Professor Jan Aaseth
I am Jan Aaseth, a Norwegian medical doctor and university professor and researcher. In my career, I have specialized in medical biochemistry and in internal and occupational medicine. Much of my research focuses on the importance of micronutrient status throughout all stages of life. In recent years, I have investigated the role of selenium and coenzyme Q10 deficiency in the development of cardiovascular disease, with particular emphasis on oxidative stress and low-grade systemic inflammation.

Compared to the study participants in the placebo group, the KiSel-10 study participants who received the active treatment had significant heart health benefits [Alehagen 2013]:

  • reduced risk of death from heart disease
  • better heart function as shown on echocardiograms
  • lower blood levels of the NT-proBNP protein, a bio-marker for the risk of heart failure

In 2015, Professor Alehagen and I analyzed what we knew, as clinicians, about selenium and Coenzyme Q10 and heart disease [Alehagen & Aaseth 2015]. We asked ourselves why that combination had protected against heart disease in elderly people.

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When can we say: “now we have evidence”?

Urban Alehagen
The researcher and cardiologist, Professor Urban Alehagen, asks the question: how much more clinical evidence of the beneficial heart-related health effects of a combo Coenzyme Q10/Selenium supplementation within an elderly Swedish population do we need? He points to the results looking at 18 publications from the set of data based on the randomized controlled trial, the KiSel-10 Study.

As a professor and cardiologist at Linköping University and the Linköping University Hospital in Sweden, I was one of the researchers in the multi-center Q-Symbio Study of the effect of Coenzyme Q10 adjuvant therapy on morbidity and mortality in chronic heart failure. In that randomized controlled trial, we gave 420 patients 3 x 100 mg of Coenzyme Q10 in divided doses taken with meals or matching placebos daily for two years.

The trial outcomes showed that the CoQ10 treatment added on to the patients’ conventional heart failure medication was associated with a significant reduction in the symptoms and a significant improvement in the survival of the heart failure patients [Mortensen 2014].

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What is a CoQ10 Deficiency?

Dr. William V. Judy
Dr. William V. Judy, founder and president of SIBR Research, writes as a guest columnist for Dr. Judy has done clinical research in the Coenzyme Q10 adjuvant treatment of patients with heart failure, chronic fatigue syndrome, and prostate cancer. He has supported Prader-Willi children with Coenzyme Q10 therapy. He is the author of the 2018 book Coenzyme Q10: An Insider’s Guide, which is available on ISBN 978-87-7776-186-7.

The question that I get asked about the most is whether there is any benefit from supplementing with Coenzyme Q10 if a person does not have a diagnosed CoQ10 deficiency?

Yes, I think there is a benefit. We should not be waiting until an obvious CoQ10 deficiency manifests itself. Instead, we should be giving people in their 40s and above the following advice:

  1. Your cells’ bio-synthesis of Coenzyme Q10 will decline with increasing age. Taking various medications, statin medications in particular, will also inhibit your body’s own production of Coenzyme Q10.
  2. The heart muscle cells need sufficient Coenzyme Q10 to produce enough ATP energy. To prevent the development and worsening of heart disease, you need to take daily CoQ10 supplements to get your plasma CoQ10 levels above 2.0 mcg/mL. If you already have symptoms of heart disease, you probably need to get your plasma CoQ10 levels above 2.5 mcg/mL [Langsjoen 2014].
  3. Taking 2 or 3 times 100 mg of Coenzyme Q10 daily, together with a meal, for 12 to 24 weeks, should get your plasma CoQ10 levels up to the target level. Firstly, taking more than 100 mg at a time will not bring much extra benefit. Secondly, taking the Coenzyme Q10 together with some fat in a meal will improve the absorption of the Coenzyme Q10.
  4. You must continue to take CoQ10 supplements even after you reach a plasma concentration of 2.0 mcg/mL. If you stop taking the CoQ10 supplement, your blood levels will decline. Moreover, the Coenzyme Q10 will not go from the blood into the tissue cells unless you have a higher concentration of CoQ10 in the blood.

What is a CoQ10 Deficiency?

In the USA, the normal level of plasma CoQ10 is quoted to be 0.45 to 1.50 mcg/mL. I feel that the 0.45 – 0.60 mcg/mL plasma levels are found in individuals with clinical conditions.

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