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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Dr. Judy Writes About Coenzyme Q10

Dr. William V. Judy
Dr. William V. Judy, founder and president of SIBR Research, writes as a guest columnist for Q10facts.com. 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 amazon.com. 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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Low Coenzyme Q10 Status and Increased Heart Disease Risk

Dr. William Judy
Long-time Coenzyme Q10 researcher Dr. William Judy says that there is considerable individual variation in blood CoQ10 concentrations. Generally, though, he regards a plasma or serum CoQ10 level below 0.60 micrograms per milliliter as a warning sign.

Japanese cardiologists have reported a significant connection between low Coenzyme Q10 status and the risk of death from heart disease and other causes [Shimizu 2020].

  • The researchers collected and examined blood samples from 242 men and women admitted to Juntendo University Hospital’s coronary care unit in Tokyo.
  • They followed the heart disease patients for a three-year period.
  • 58 of the 242 patients (24%) died during the follow-up period from heart disease, cancer, infection, and other causes.
  • The patients who died had an average blood CoQ10 concentration of 0.48 micrograms per milliliter. The patients who survived had a higher average blood CoQ10 concentration of 0.58 micrograms per milliliter.
  • Overall, the researchers found that patients with a “higher” blood CoQ10 concentration of 0.46 or greater micrograms per milliliter had a 52% lesser likelihood of dying from all causes than did the patients with blood CoQ10 concentrations below 0.46 micrograms per milliliter.
  • Nota bene: The patients with the low CoQ10 blood levels were the patients with the higher dosages of statin medications.

Why Low CoQ10 Levels are Associated with Heart Disease Mortality

Book Insider's Guide to Coenzyme Q10
In his book Insider’s Guide to Coenzyme Q10, Dr. Judy discusses the effects of increasing age, malnutrition, and statin medications on blood Coenzyme Q10 levels and the consequent effect on heart function. Available from amazon.com. ISBN: 978-87-7776-186-7.

This research shows that heart disease patients with lower blood CoQ10 levels are at greater risk of dying sooner than heart disease patients with higher blood CoQ10 levels [Shimizu 2020].

  • Statin medications are known to inhibit the body’s endogenous production of Coenzyme Q10; logically, every heart patient taking a statin medication will need adjunctive Coenzyme Q10 treatment. Okuyama et al [2015] have explained the mechanisms by which statin medication may increase the risk of developing atherosclerosis and heart failure.
  • Lower blood CoQ10 levels are also associated with greater age [Shimizu 2017]. Malnutrition among senior citizens may be contributing to low CoQ10 status; this is another argument for supplementation.
  • Adequate levels of Coenzyme Q10 are associated with reduced levels of blood bio-markers for inflammation, in particular interleukin 6, C-reactive protein, and tumor necrosis factor alpha [Fan 2017].

Evidence from CoQ10 Supplementation and Heart Disease Studies

  • Professor Urban Alehagen’s KiSel-10 Study has shown that daily supplementation of senior citizens with Coenzyme Q10 and selenium-enriched yeast for four years cuts the risk of heart disease in half [Alehagen 2013].
  • Professor Svend Aage Mortensen’s Q-Symbio Study has shown that adjunctive treatment of chronic heart failure patients with Coenzyme Q10 for two years significantly reduces the risk of death from heart disease and of death from all causes [Mortensen 2014; Mortensen 2019].

Bottom Line: CoQ10 Status and Cardiovascular Disease risk

Adequate levels of Coenzyme Q10 are essential to the cells’ production of ATP energy; moreover, Coenzyme Q10 is an important lipid-soluble antioxidant that scavenges harmful free radicals [Shimizu 2017].

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CoQ10 for Dogs and Cats

King Charles Spaniel
Myxomatous mitral valve disease is the most common heart disease in dogs. It often leads to congestive heart failure. The Cavalier King Charles Spaniel is especially at risk of developing mitral valve disease at an early age. From the onset of congestive heart failure in dogs with mitral valve disease, the median survival time is less than a year even with medical therapy [Christiansen 2020]. Applied early enough, Coenzyme Q10 supplements may increase the life expectancy and quality of life for dogs at risk of heart disease.
Increasingly, people are feeding their dogs CoQ10 supplements. The CoQ10 supplementation is used provide dogs and cats the following health benefits [Gollakner 2020; Puotinen CJ 2019]:

  • improved cellular energy production
  • enhanced antioxidant protection against lipid peroxidation
  • anti-inflammatory effects
  • reduced endothelial dysfunction

Typically, the CoQ10 supplement is given by mouth as a capsule or as a liquid. It is possible, of course, to squeeze the CoQ10 filling out of a capsule onto the dog food.

Pharmacokinetics Study of Repeated Oral CoQ10 Dosing of Spaniels

Now, a research team in Denmark has investigated the pharmacokinetics of oral dosing of Cavalier King Charles Spaniels over a three-week period [Christiansen 2020].

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A Pharmacist Looks at CoQ10 Supplements

Dr. Ross Pelton
Dr. Ross Pelton brands himself as The Natural Pharmacist; he is also a certified clinical nutritionist. He is currently the Scientific Director for Essential Formulas. Dr. Pelton is the author of The Drug-Induced Nutrient Depletion Handbook. For a FREE copy of Dr. Pelton’s Quick Reference Guide to Drug-Induced Nutrient Depletions, go to naturalpharmacist.net/dind.

In the April/May 2020 issue of the journal IMCJ: Integrative Medicine: A Clinician’s Journal, pharmacist Dr. Ross Pelton reviews the most important developments in Coenzyme Q10 clinical research:

• The Q-Symbio Study in which researchers gave chronic heart failure patients 3 x 100 mg of Coenzyme Q10 or placebo daily as an adjuvant treatment together with conventional heart failure medications for two years. The outcome was significantly improved symptoms, quality of life, and survival in the CoQ10 treatment group compared to the placebo group [Mortensen 2014].

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Coenzyme Q10 for Adjunctive Treatment of Heart Failure

Blood circulation
Heart failure does not mean that the heart has stopped working. It means that the heart is not pumping as much blood out to the rest of the body as it should. The consequence is that the body organs and tissues do not get as much oxygen and as many nutrients as they need. Clinical trials show that treatment with Coenzyme Q10 in addition to conventional Heart failure medication is beneficial.

Adjunctive treatment of chronic heart failure patients with 3 times 100 milligrams of Coenzyme Q10 daily for two years gave the following significant results compared with placebo treatment [Mortensen 2014]:

  • reduced number of deaths from heart disease
  • reduced number of deaths from all causes
  • reduced number of Heart failure related hospitalizations
  • improved NYHA class

Absorption and Bioavailability of the CoQ10 Supplement

CoQ10 supplements are very different from one another. The CoQ10 supplement that gave the beneficial heart health outcomes listed above is a specially formulated CoQ10 preparation, specially formulated with respect to the carrier oils in which the Coenzyme Q10 raw material is dispersed and with respect to the heating and cooling process used in the manufacture of the supplement. It has documented absorption and bioavailability.

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