Coenzyme Q10 Meta-analyses Summarized

Dr. William V. Judy, founder and president of the SIBR Research Institute, has written about the clinical aspects of CoQ10 supplementation in his 2018 book entitled Coenzyme Q10: An Insider’s Guide. The book is highly recommended.  It is available from

Coenzyme Q10 is a bio-nutrient essential to the process of ATP energy generation in the cells.  It is also an important fat-soluble antioxidant.  It helps to maintain proper endothelial function  regulating vascular contraction and relaxation and regulating the enzymes that control blood clotting, immune function, and platelet adhesion.  It has anti-inflammatory properties [Littarru 2010].  Our primary source of Coenzyme Q10 is our bodies’ bio-synthesis of the substance.  Our food contributes considerably less Coenzyme Q10.

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Coenzyme Q10 and Fibrosis and Ageing

Dr. Urban Alehagen, professor emeritus, Linköping University in Sweden, is the lead researcher on the KiSel-10 study of the effects of combined Coenzyme Q10 and selenium supplementation on the heart health of senior citizens. Senior citizens who took CoQ10 and high-selenium yeast supplements for four years had significantly better heart function and significantly reduced heart mortality compared to senior citizens who took matching placebos. One possible explanation is that there was significantly less fibrogenic activity in the treatment group than in the placebo group and that the reduced levels of fibrosis are related to the improved heart function and reduced cardiovascular mortality in the treatment group.

Daily supplementation with the ubiquinone form of Coenzyme Q10 and selenium-enriched yeast has significant health benefits for senior citizens:

  • The combination of the two supplements reduces the levels of bio-markers for fibrosis in senior citizens [Alehagen 2018].
  • The combination of the two supplements improves cardiovascular function and reduces the risk of cardiovascular mortality [Alehagen 2013].
  • The combination of the two supplements provides a means of correcting a dietary shortage to which senior citizens may be subject [Hargreaves & Mantle].

Fibrosis and the Ageing Process

Fibrosis is the bio-medical term for the formation of fibrous connective tissue, much of which is collagen.

  • Fibrosis is a normal process for wound healing and tissue repair.
  • In senior citizens, there is a greater risk of uncontrolled continuation of the formation of fibrous connective tissue, resulting in tissue scarring and loss of function in organs such as the heart, lungs, liver, and kidneys [Hargreaves & Mantle].
  • Progressive fibrosis and loss of function in vital organs is a known symptom of ageing [Hargreaves & Mantle].
  • Organ fibrosis has been estimated to be a factor in up to 50% of all-cause human deaths [Hargreaves & Mantle].
  • Effective treatments for fibrosis in senior citizens are not available at present [Hargreaves & Mantle].

Coenzyme Q10 and Senior Citizens

Coenzyme Q10 has important biological roles in humans:

  • Coenzyme Q10 is an essential co-factor in the cellular process of ATP energy generation [Belardinelli].
  • Coenzyme Q10 is an important fat-soluble antioxidant, neutralizing the harmful effects of free radicals in lipid environments and reducing the extent of oxidative stress [Belardinelli].
  • Coenzyme Q10 has a beneficial effect on the endothelial cells that regulate the contraction and relaxation of the blood vessels and regulate such processes as blood clotting, immune function, and platelet adhesion [Belardinelli].
  • Coenzyme Q10 reduces the blood levels of bio-markers for inflammation, indicating that Coenzyme Q10 may have anti-inflammatory properties [Hargreaves & Mantle].

Decreasing CoQ10 Bio-Synthesis with Increasing Age

The major source of Coenzyme Q10 in humans is the endogenous bio-synthesis of the substance.

  • Once we humans reach our 20s, most of us begin to synthesize less Coenzyme Q10 as we get older [Hargreaves & Mantle].
  • It is impossible to make up the ageing-related loss of bio-synthesized Coenzyme Q10 by eating more food or by eating more wisely [Hargreaves & Mantle].
  • Daily supplementation is necessary [Hargreaves & Mantle].
  • Not all CoQ10 supplements are equally well formulated.  The formulation of the CoQ10 supplement plays a vital role in CoQ10 absorption and bio-availability [Lopez-Lluch].

Cardiovascular Fibrosis and Senior Citizens

Post-mortem analysis has revealed that, in the normal ageing process, the collagen content providing structural support for heart muscle’s contractile cells increases approximately 50% from the third decade to the seventh decade of life [Hargreaves & Mantle].

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Coenzyme Q10 Crystals and Coenzyme Q10 Absorption

The Coenzyme Q10 raw material is a yellow or orange crystalline powder produced by a yeast fermentation extraction process. The CoQ10 crystals are fat-soluble. They are practically insoluble in water, and any attempt to make them water-soluble will rob them of their CoQ10 characteristics. Coenzyme Q10 is soluble in lipids, but keeping the Coenzyme Q10 molecules from re-crystallizing inside the supplement capsules is difficult.  And humans cannot absorb CoQ10 crystals, only single CoQ10 molecules.

Absorption of the Coenzyme Q10 in commercial nutritional supplements varies considerably.  The dissolution of the CoQ10 crystals and the absorption of the Coenzyme Q10 molecules depend upon the composition of the oil matrix and the formulation of the CoQ10 nutritional supplement.  The manufacturer of a CoQ10 supplement must deal with raw material that is very difficult to work with.

Coenzyme Q10 Soluble in Lipids at Higher Temperatures

Coenzyme Q10 is practically insoluble in water but is soluble in lipids; however, no individual lipids have been found in which 100 milligrams of Coenzyme Q10 can be dissolved so that the dissolved Coenzyme Q10 molecules inside the nutritional supplement capsules will not re-crystallize at normal storage temperatures: typically, between 60 and 75 degrees Fahrenheit.

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Coenzyme Q10 Ameliorates Statin-Associated Muscle Symptoms

In his 2018 book entitled Coenzyme Q10: An Insider’s Guide, Dr. William V. Judy describes the complicated relationship between Coenzyme Q10 and statin medications. Please see pages 80-85. The book is available from

A 2018 meta-analysis and systematic review has shown that Coenzyme Q10 supplementation significantly ameliorates statin-induced muscle symptoms [Qu]:

  • reduces muscle pain
  • reduces muscle weakness
  • reduces muscle cramping
  • reduces muscle fatigue

The positive results of the meta-analysis suggest that Coenzyme Q10 supplementation may be a complementary approach to the management of statin-induced myopathy [Qu].

Why Do You Need Coenzyme Q10 Supplements with Statin Medication?

Statin medications are drugs widely prescribed in order to lower patients’ levels of total cholesterol and the so-called “bad” ldl-cholesterol.  Statins are used to protect against heart attack and stroke; however, they do have adverse effects.

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Coenzyme Q10 Absorption, Efficacy, and Safety

A significant reduction in the rate of CoQ10 biosynthesis has been associated with the aging process and aging-related diseases [Hernandez-Camacho 2018]. It is not possible to make up for this loss of Coenzyme Q10 by eating more selectively. Supplementation with a well-formulated CoQ10 preparation is necessary. (Graph compliments of SIBR Research Institute)
The active substance in the best Coenzyme Q10 nutritional supplements is a natural substance extracted from a yeast fermentation process; it is not a synthetic substance.

The CoQ10 molecules in the best nutritional supplements are the same molecules as the CoQ10 molecules synthesized inside the mitochondria in human cells.

Absorption and Bio-availability of Coenzyme Q10

Similar to vitamin E, Coenzyme Q10 in food and in nutritional supplements has a low absorption and bio-availability.  In the case of Coenzyme Q10, the difficult absorption is attributed to the relatively large size and the lipid soluble nature of the CoQ10 molecules.

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Coenzyme Q10 and Systemic Inflammation

Professor Urban Alehagen, Linköping University, has reported that daily supplementation with Coenzyme Q10 and high selenium yeast significantly reduces the blood concentrations of known bio-markers for systemic inflammation. This anti-inflammatory effect may be one of the mechanisms by which Coenzyme Q10 supplementation protects the cardiovascular system.

Coenzyme Q10 supplementation with 100 – 300 milligrams daily promotes good heart health [Alehagen, Mortensen].  Supplementation is important because most of the body’s supply of Coenzyme Q10 comes from endogenous bio-synthesis, not from the diet, and, as we get older, our bodies produce less Coenzyme Q10 [Kalén].

The primary functions of Coenzyme Q10 are bio-energetic and antioxidant.  Coenzyme Q10 is an essential co-factor in the cellular production of ATP energy.  It is also an important fat-soluble antioxidant protecting the cells against oxidative damage caused by harmful free radicals [Littarru].

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Coenzyme Q10 and Longevity

Metaphorically speaking, CoQ10 supplementation is our umbrella protecting against the risk of chronic degenerative diseases. Studies indicate that 100-300 milligrams of daily Coenzyme Q10 supplementation can reduce the risk of cardiovascular disease, type-2 diabetes, kidney disease, and liver disease.

We all want to live longer, with good health and good energy in our senior years.  One factor that enhances our chances of living longer and better is our ability to avoid chronic degenerative diseases such as cardiovascular disease, diabetes, kidney disease, and liver disease.  Coenzyme Q10 supplements can help.

The rationale for using CoQ10 supplements to enhance our chances for a long and healthy life is based on the role of Coenzyme Q10 in the production of cellular energy.  In addition, Coenzyme Q10 has known antioxidant and anti-inflammatory effects [Mantle & Hargreaves].

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Therapeutic Value of Coenzyme Q10 Treatment for Chronic Heart Failure Patients

Dr. Anne Louise Mortensen, lead author of the European sub-group analysis of the Q-Symbio Study of CoQ10 adjunctive treatment of chronic heart failure patients, pictured together with Dr. and Mrs. William Judy. Dr. Mortensen suggests that one reason for the enhanced effectiveness of the CoQ10 treatment in the European sub-group might be better compliance on the part of the patients. CoQ10 supplements can work only if they are taken as they should be: daily, with meals containing some fat, and in divided doses.

The therapeutic efficacy of Coenzyme Q10 adjunctive treatment of chronic heart failure patients – 3 times 100 milligrams daily for two years – was demonstrated in the original Q-Symbio Study (n = 420) published in the JACC specialty journal Heart Failure [Mortensen 2014].

Now, an analysis of just the European portion of the Q-Symbio Study participants (n = 231) has shown that the benefits of Coenzyme Q10 supplementation were enhanced in the more rigorously guidelines-treated European patients [Mortensen 2019].

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Coenzyme Q10 and the Heart Muscle

Coenzyme Q10 supplementation is associated with improved left ventricular ejection fraction in more than a dozen randomized controlled studies.

What does Coenzyme Q10 do for the heart?  Quite a lot, it turns out.

Coenzyme Q10 supplementation has been shown in clinical trials to have the following effects with benefit for the heart:

  • improves left ventricular ejection fraction
  • improves endothelial function
  • improves NYHA class
  • improves contractility
  • inhibits platelet aggregation
  • compensates for statin medication

Let’s look more closely at these effects of CoQ10 supplementation.

CoQ10 Supplementation Improves Left Ventricular Ejection Fraction

Ejection fraction is the percentage of the blood that the heart muscle is able to pump out with each heart beat [Cleveland Clinic].

  • In the healthy heart, the ejection fraction should be in the range from 55% to 70%.
  • An ejection fraction of 35% to 40% is indicative of mild heart failure.
  • An ejection fraction below 35% indicates moderate to severe heart failure.

A 2013 meta-analysis of 11 heart failure clinical trials showed that CoQ10 supplementation resulted in a pooled mean net increase in the patients’ ejection fraction [Fotino].

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Coenzyme Q10 and Metabolic Syndrome

Metabolic syndrome, also known as syndrome X, is the name for a cluster of conditions – high blood pressure, high blood sugar, insulin resistance, increased risk of blood clots, abnormal cholesterol – that are dangerous themselves and can lead to heart disease and type 2 diabetes.  Coenzyme Q10 supplementation can improve the associated mitochondrial dysfunction and reduce oxidative stress.

Coenzyme Q10, the essential bio-nutrient, has properties that are germane to the treatment of several of the risk factors associated with the umbrella term “metabolic syndrome” [Casagrande].

These properties include the following:

  • a bio-energetics role in the cellular production of ATP energy [Casagrande]
  • a role as a fat-soluble antioxidant protecting against oxidative damage by harmful free radicals to cells and lipids [Casagrande]
  • an anti-inflammatory effect [Zhai]
  • a role in the protection and improvement of endothelial function [Gao]

What Factors Reduce Plasma Coenzyme Q10 Levels?

Typically, we expect to find plasma Coenzyme Q10 concentrations ranging from 0.6 to 1.0 micrograms per milliliter in unsupplemented healthy individuals.  With daily supplementation, it is possible to raise the plasma Coenzyme Q10 levels above the 2.5 micrograms per milliliter level needed for a therapeutic effect in heart disease and above the 3.5 micrograms per milliliter level needed for a therapeutic effect in neurodegenerative disease [Langsjoen].

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