For as long as I have been writing this blog, I have been wondering why cardiologists are not prescribing Coenzyme Q10 for certain classes of heart disease patients. Two classes of patients come to mind immediately: 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... Read more about this term patients and patients taking statin medications. Let’s look at the evidence for heart failure patients. (We can talk about patients on statin medications next week.)
Coenzyme Q10 and chronic heart failure
Chronic heart failure. Heart failure. It sounds scary. It is scary. The words “heart failure” do not mean that the heart has stopped working. What heart failure means is some combination of the following conditions:
- The heart is weaker at pumping blood to deliver the needed oxygen and nutrients to the body’s other organs.
- There is more pressure on the heart muscle. The heart has to work harder and harder.
- There is retention of fluid (called edema) in the feet and legs, arms, liver, intestine, and lungs (often referred to as 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... Read more about this term).
- There is decreased quality of life: feeling tired, being short of breath, being able to walk only short distances, having difficulty breathing while lying down.
Extent of chronic heart failure in the United States
Between 5 and 6 million Americans suffer from chronic heart failure. Half of the patients who develop chronic heart failure die within the next five years [Mozzafarian]. Adding up the costs of hospitalization and medical care, medications, and lost work days caused by heart failure leads to an estimate that heart failure costs the American society nearly 30 billion dollars a year [Heidenreich]. Each year. Year after year.
If we could cut down the number of hospitalizations and re-hospitalizations and the length of the hospital stays and the number of adverse cardiovascular events by using Coenzyme Q10 as an adjunctive treatment for heart failure, then we could improve the quality of life for many older Americans, and we could reduce health care costs considerably.
Treatment of chronic heart failure with Coenzyme Q10
Conventional medical treatment, listed below, does not seem to overcome the heart failure patients’ problems with fatigue and inability to exercise. What are these conventional treatments?
- ACE inhibitors to lower blood pressure
- Aldosterone antagonists to help remove excess sodium through the urine
- Angiotensin receptor blockers to relax the blood vessels and to lower blood pressure
- Beta blockers to slow the heart rate and to lower the blood
- Digoxin to make the heart beat more powerfully
- Diuretics to reduce fluid buildup in the lungs and feet and ankles
Adjuvant treatment with Coenzyme Q10
Treatment with Coenzyme Q10 in addition to conventional medical therapy has been shown to have the following beneficial health effects:
- Reduces the incidence of cardiovascular death [Mortensen]
- Reduces the need for mechanical support or heart transplant [Mortensen]
- Reduces the need for hospitalization [Mortensen and Morisco]
- Reduces the incidence of pulmonary edema (excess fluid in the lungs) and cardiac asthma [Morisco]
Treating the energy-starved heart with Coenzyme Q10
One theory about the underlying cause of heart failure is that the heart muscle is suffering from energy starvation. The heart muscle cells are not producing enough energy. Coenzyme Q10 has been shown to play a vital role in the production of energy in the cells [Littarru].
A second theory about the role of Coenzyme Q10 in preventing and alleviating heart disease is that Coenzyme Q10 functions as a powerful antioxidant neutralizing harmful Free radicals are unstable and highly reactive molecules that are produced in the body during normal oxygen metabolism. Free radicals derived from oxygen are 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... Read more about this term in cell membrane lipids and in serum 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... Read more about this term [Mohr].
A third theory about the role of Coenzyme Q10 in heart disease is that Coenzyme Q10 improves endothelial function. The The endothelium is 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)... Read more about this term is the thin layer of cells on the inside of arteries. The endothelium needs to stay smooth and pliable. If its cells become hard and if plaque builds up on them, narrowing the passageway through the arteries, then the risk of heart disease increases considerably [Tsai].
Coenzyme Q10 has been shown to be safe, free of any dangerous interactions with other heart disease medications, and effective at improving the symptoms and survival of heart failure patients. It is affordable.
There is no good reason not to take a good Coenzyme Q10 supplement starting in one’s 40s because we know that our bodies produce less Coenzyme Q10 as we get older. And, honestly, if you are a heart failure patient or know someone who is, be sure to mention the 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... Read more about this term to the cardiologist.
Surely it is time for cardiologists to add adjuvant treatment with Coenzyme Q10 to the guidelines for the treatment of chronic heart failure?
Next week, we need to look at the evidence for taking Coenzyme Q10 in conjunction with statin medications.
Heidenreich, P.A., Trogdon, J.G., Khavjou, O.A., Butler, J., Dracup, K., & Ezekowitz, M.D. (2011). Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation, 123(8):933–44.
Littarru, G. P., & Tiano, L. (2007). Bioenergetic and antioxidant properties of coenzyme Q10: recent developments. Molecular Biotechnology, 37(1), 31-37.
Mohr, D., Bowry, V. W., & Stocker, R. (1992). Dietary supplementation with coenzyme Q10 results in increased levels of ubiquinol-10 within circulating lipoproteins and increased resistance of human low-density lipoprotein to the initiation of 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.... Read more about this term. Biochimica et Biophysica Acta, 1126(3), 247-254.
Morisco, C., Trimarco, B., & Condorelli, M. (1993). Effect of coenzyme Q10 therapy in patients with congestive heart failure: a long-term multicenter randomized study. The Clinical Investigator, 71(8 Suppl), S134-S136.
Mortensen, S. A., Rosenfeldt, F., Kumar, A., Dolliner, P., Filipiak, K. J., Pella, D., & Littarru, G. P. (2014). The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: results from Q-SYMBIO: a randomized A double-blind study is a study in which neither the investigators nor the study participants know which participants are receiving the active treatment and which participants are receiving the control treatment until the study has been completed and the seal on the code has been broken.... Read more about this term trial. JACC. Heart Failure, 2(6), 641-649.
Mozzafarian D, Benjamin E.J., & Go A.S. (2016). Heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation, 133:e38-e360.
Tsai, K., Huang, Y., Kao, C., Yang, D., Lee, H., Chou, H., & Chiou, S. (2012). A novel mechanism of coenzyme Q10 protects against human endothelial cells from oxidative stress-induced injury by modulating NO-related pathways. The Journal of Nutritional Biochemistry, 23(5), 458-468.
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