What does the clinical evidence show about Coenzyme Q10 supplementation and heart failure?
Good heart health depends in part on adequate bio-synthesis of and adequate intake of the vitamin-like substance Coenzyme Q10.
Answer: The existing evidence shows that CoQ10 supplementation has the following beneficial effects for patients with heart failure [Xu 2024]:
- reduces all-cause mortality risk
- reduces hospitalization for heart failure
- reduces the brain natriuretic peptide level – a biomarker for heart failure
- improves the New York Heart Association (NYHA) functional classification
- improves left ventricular ejection fraction
- improves the 6-minute walk test result
Moreover, the evidence from clinical trials shows that CoQ10 supplementation does not cause any major adverse effects [Xu 2024].
What is the best meta-analysis of supplementary CoQ10 and heart failure to date?
Answer: In 2024, Xu et al. conducted a systematic review and meta-analysis of the efficacy and safety of CoQ10 as an adjunct to conventional therapy for adults with heart failure.
Their review included 33 randomized controlled trials enrolling 3,763 patients with heart failure (1,898 administered CoQ10 and 1,845 assigned to control).
Compared to control, CoQ10 supplementation was associated with significant improvements [Xu 2024]:
- CoQ10 reduced all-cause mortality by 36%
- CoQ10 reduced hospitalization for heart failure by approximately 50%
- CoQ10 increased walking distance by an average of 31.7 meters during the 6-minute walk test
How safe is supplementary CoQ10 as an adjunctive therapy for heart failure patients?
Answer: In the 33 randomized controlled trials of CoQ10 supplementation, Xu et al found no evidence that CoQ10 increased the rate of adverse events compared with control treatment.
The researchers concluded that CoQ10 supplementation seems to be a safe adjunctive therapy.
What is the best CoQ10 and heart failure randomized controlled trial to date?
Answer: The 2014 Q-SYMBIO trial
Dr. Svend Aage Mortensen, 1942-2015, was the lead researcher on the Q-SYMBIO study of adjunctive CoQ10 therapy for chronic heart failure.
The Q-SYMBIO study was an international, randomized, double-blind, placebo-controlled study. The study evaluated whether CoQ10 adjuvant therapy could improve outcomes in patients with moderate to severe chronic heart failure.
The study enrolled 420 patients with New York Heart Association (NYHA) class III or IV heart failure in 17 centers in Europe, Asia, and Australia. The heart failure patients received either CoQ10 100 mg three times daily (300 mg/day) or matching placebos for two years together with their conventional heart failure medications [Mortensen 2014].
Then, after two years, Dr. Svend Aage Mortensen and the team of researchers measured significantly better clinical outcomes in the CoQ10 group:
- fewer major adverse cardiovascular events
- fewer heart failure hospitalizations
- lower cardiovascular and all-cause mortality
- improved NYHA functional class
In addition, the researchers recorded that the adjuvant CoQ10 treatment was safe and well tolerated.
What does the 2019 follow-up to the Q-SYMBIO study show?
In 2019, Anne-Louise Mortensen et al examined the data from only the European participants in the original Q-SYMBIO trial. They used data from 231 patients from six European countries (108 administered CoQ10 and 123 administered placebo). All of the patients had moderate-to-severe chronic heart failure. They all received either CoQ10 3 times 100 mg/day or placebo for two years in addition to their standard heart failure medications [Mortensen 2019].
After two years of supplementary CoQ10, the patients in the European cohort showed significant health benefits [Mortensen 2019]:
- fewer major adverse cardiovascular events
- lower cardiovascular and all-cause mortality
- fewer hospitalizations for heart failure
- improved NYHA functional class
Moreover, the European cohort showed significant improvement in left ventricular ejection fraction (LVEF) [Mortensen 2019].
The analysis of the data from the European patients confirmed the original Q-SYMBIO findings. Even in patients receiving more consistent guideline-directed heart failure therapy, the CoQ10 adjuvant therapy was beneficial [Mortensen 2019].
Conclusion: CoQ10 as adjunctive therapy for heart failure patients
CoQ10 supplementation reduces the risk of all-cause mortality and heart failure hospitalizations.
Likewise, supplementary CoQ10 provides modest improvements in cardiac function and functional capacity.
Adjunctive CoQ10 therapy is a valuable addition to conventional heart failure management.
Sources
Mortensen SA et al. 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. 2014;2(6):641-649.
Mortensen AL et al. Effect of Coenzyme Q10 in Europeans with chronic heart failure: A sub-group analysis of the Q-SYMBIO randomized double-blind trial. Cardiology Journal. 2019;26(2):147-156.
Xu J et al. Efficacy and safety of coenzyme Q10 in heart failure: a meta-analysis of randomized controlled trials. BMC Cardiovasc Disord. 2024;24:592.
The information presented in this review article is not medical advice. The reader should not use this information as medical advice.
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