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Alleviating Congestive Heart Failure with Coenzyme Q10

February 2008

By Peter H. Langsjoen, MD, FACC

Absorption of CoQ10

Figure 3. Two Forms of Coenzyme Q10:
Ubiquinone and Ubiquinol
Absorption of CoQ10
Until recently, all supplemental CoQ10
was in the oxidized, or ubiquinone form.
Today, it is possible to obtain dietary supplements
containing ubiquinol, the reduced form of CoQ10.
Ubiquinol is more bioavailable than ubiquinone.

From the beginning of our experience with CoQ10 in heart failure, we have observed poor absorption of CoQ10 in patients with advanced congestive heart failure. This is extremely frustrating, because the patients who are the most ill and have the lowest plasma CoQ10 levels show minimal improvement because of their inability to absorb CoQ10. It has been our assumption that the fluid retention or edema in the intestine and liver in these critically ill patients has been responsible for this poor absorption. Up until approximately one year ago, all supplemental CoQ10 in the world has been in its oxidized or ubiquinone form. In this oxidized state, CoQ10 is stable, bright orange in color, and fat-soluble. It is this property of being fat-soluble that is responsible for the difficulty with CoQ10 absorption.

A Better Form of CoQ10

After ingestion, immediately after CoQ10 crosses into the first cells lining the small intestine, it is enzymatically converted to its reduced, or ubiquinol, form. So, when we measure plasma CoQ10, approximately 98-99% of the CoQ10 is in this reduced ubiquinol form (see figure 3). Kaneka Corporation of Japan has succeeded in making a stable ubiquinol formulation that we have been carefully studying since October 2006. Ubiquinol is a white powder rather than orange and is less fat-soluble, making it better absorbed.

Our first patient to be treated with ubiquinol had severe heart failure with a 15% ejection fraction (a measurement of the amount of blood pumped out with each heartbeat, which is normally 60-65%). This gentleman had a sub-therapeutic plasma CoQ10 level of 2.2 mcg/mL on 450 mg per day of ubiquinone. His plasma level on 450 mg per day of ubiquinol increased dramatically to 8.5 mcg/mL and over the subsequent 10 months, his ejection fraction increased to 60% with a corresponding dramatic and perhaps life-saving clinical improvement (see figure 4). We now have a total of seven patients with advanced congestive heart failure and low plasma CoQ10 levels, despite taking as much as 600 mg per day of ubiquinone (the oxidized form of CoQ10) who have been changed over to the ubiquinol (the reduced form) formulation. Our preliminary observations have been very favorable, and it is my strong opinion that supplemental ubiquinol represents a major scientific advance in the 50-year history of CoQ10 research.

Supplementing with CoQ10

Figure 4. Plasma CoQ10 Levels Correlate
with Severity of Congestive Heart Failure
Supplementing with CoQ10
Chromatogram of plasma extract from a patient
with severe heart failure. This patient had an ejection
fraction of 15% and plasma level of reduced (ubiquinol)
CoQ10 of 2.2 mcg/mL on 450 mg/day ubiquinone.
Choosing a CoQ10 Formulation and Dosage
Chromatogram of plasma extract from the same heart
failure patient following supplementation with ubiquinol.
Ten months of ubiquinol 450 mg/day increased
plasma level of reduced (ubiquinol) CoQ10 to
8.5 mcg/mL and improved ejection fraction to 60%.

I would like to make a few practical comments based on 24 years of treating thousands of heart failure patients with supplemental CoQ10 in addition to standard prescription medications. We have seen no side effects and no drug interactions from supplemental CoQ10, but we have observed a gradual lessening of the requirement for many cardiac medications that occurs with an improvement in heart muscle function. For example, we have observed a significant decrease in the need for diuretics, because of a reduced tendency for fluid retention as heart function improves. Also, we have noted a gradual improvement in hypertension that occurs as heart function improves, which may require a gradual decrease in antihypertensive medications such as angiotensin-converting enzyme (ACE) inhibitors, a class of blood pressure-lowering medicines frequently used in heart failure patients. Patients with heart disease should be followed by their physicians, particularly when there are any changes in activity, diet, prescription drugs, or over-the-counter supplements.

I have treated hundreds of patients with CoQ10 and have never observed an interaction with warfarin (Coumadin®). There have been anecdotal reports that the combination may increase the risk of bleeding. Individuals who use warfarin should always consult a physician before using CoQ10.28,29

Choosing a CoQ10 Formulation and Dosage

Most commercially available CoQ10 supplements comprise ubiquinone. Recommended daily dosages of this type of CoQ10 range from 100 mg to 600 mg.

The most advanced CoQ10 formulas now contain ubiquinol, the reduced form of CoQ10, which is definitely better absorbed into the bloodstream.30-32 Recommended daily dosages of ubiquinol range from 100 mg to 300 mg.

Because we know that CoQ10 levels tend to decrease with age and we live in a society that consumes very little food rich in CoQ10 (organ meats like heart, liver, and kidney), it makes sense to supplement with a modest amount of CoQ10 (ubiquinone or ubiquinol) beginning in middle age. Those who suffer from congestive heart failure or who use statin medications should aim to consume higher doses of CoQ10 (ubiquinone or ubiquinol).


Coenzyme Q10’s ability to fundamentally improve the production of energy and the antioxidant defense in every cell of the body has brought about many remarkable and unexpected improvements in all aspects of human health. This extraordinary molecule has dramatically changed my own practice of medicine and has brought joy to the treatment of previously devastating cardiovascular diseases.

If you have any questions on the scientific content of this article, please call a Life Extension Health Advisor at 1-800-226-2370.


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