Life Extension Magazine®

Issue: Jul 2018

CoQ10 and Heart Failure

The New England Journal of Medicine reports a 44% decrease in sudden death of heart failure patients from 1995 to 2014. Improved conventional care is partly responsible, but overlooked is explosive growth of CoQ10 supplementation that occurred during this time frame.

By William Faloon

William Faloon
William Faloon

The number of Americans with heart failure is projected to rise by 46% over the next twelve years.1

The result will be 8 million people in the United States suffering from a condition in which their heart is too weak to pump blood throughout the body.

One reason for the increase in failing hearts is that more people are surviving heart attacks. Damage inflicted by heart attacks can create heart failure in later life.

Growing epidemics of obesity and diabetes along with the aging population are contributing to this heart failure epidemic.

Encouraging news was published last year in the New England Journal of Medicine. A review of clinical trials spanning the period of 1995 to 2014 found a 44% decline in sudden death rates among heart failure patients.2

What you need to know

An urgent need exists to combat the heart failure epidemic in the United States. Research on CoQ10’s importance in decreasing heart failure risk and death has been rising. A recent meta-analysis showed that CoQ10 supplementation decreased mortality among heart failure patients by 31 percent. Results such as these explain why 71 percent of cardiologists are recommending CoQ10 for its cardiovascular benefits.

The authors of this study attribute this striking 44% decrease to improvements in conventional treatment. We at Life Extension® agree that there have been remarkable advances in conventional protocols.

What the analysis published in the New England Journal of Medicine overlooked is the explosive growth in coenzyme Q10 use that occurred during the period corresponding with the 44% decrease in heart failure death rates.

To put this into perspective, a survey published in March 2015 found that 71% of cardiologists recommend coenzyme Q10 to at least some of their patients. This same survey showed that CoQ10 was the top supplement suggested overall by cardiologists.3

Tying this together was a study published in December 2014 showing that when CoQ10 was added to conventional therapy, there was a 44% reduction in cardiovascular mortality amongst heart failure patients.4

To summarize, the New England Journal of Medicine published a study in 2017 showing remarkable reductions in heart failure mortality, but failed to mention that CoQ10 is rapidly emerging as part of standard therapy.

This article will review data that further validate the importance of CoQ10 in maintaining heart health.

Human research involving CoQ10 has surged in recent years based on findings that it may spare hundreds of thousands of Americans from premature death.

These studies seek to identify specific mechanisms by which CoQ10 protects against cardiovascular risk factors.

One such study was conducted on patients admitted to the Coronary Care Unit of Juntendo University hospital in Japan.

This study measured CoQ10 blood levels within 24 hours of admission. Patients who died in the hospital had 22% lower CoQ10 levels compared to those who survived. This study also found:5

  • Low CoQ10 was an independent predictor of in-hospital death;
  • Lower CoQ10 levels were associated with higher C-reactive protein;
  • Patients taking statins had 21% lower CoQ10 levels.

A separate interventional study was done on patients undergoing elective stenting therapy for coronary artery occlusion. Fifty of these patients received 300 mg of CoQ10 twelve hours before the procedure and 50 received placebo.

There was a significant reduction in C-reactive protein levels in the CoQ10 group relative to the placebo arm of this study.6

C-reactive protein is an inflammatory factor that can serve as a marker for post-surgical complications. This is especially relevant to newly stented coronary arteries that are inflamed from atherosclerosis and invasive stenting to reopen them.

Preserving Cognitive Function

Heart failure patients suffer diminished blood flow to the brain, along with other pathologies that impede cognitive functions.

An observational study analyzed blood samples from 40 healthy controls and 36 heart failure patients and found:

  • Heart failure patients had worse attention and executive function.
  • Lower CoQ10 blood levels predicted worse performance on attention tests.

The authors of this study speculated that:

“…increasing plasma CoQ10 levels may be a reasonable first step in improving cognitive function in older HF [heart failure] patients.”7

Combatting Insulin Resistance

Combatting Insulin Resistance  

Normal aging, diabetes, and obesity contribute to cellular resistance to insulin. The result is chronically elevated glucose and insulin blood levels.

Excess glucose and insulin contributes to virtually every degenerative disorder.

In a randomized controlled trial of overweight and diabetic patients with coronary heart disease (aged 40 - 85 years), 30 patients received 100 mg of CoQ10/day for eight weeks and 30 received placebo.

The results showed that CoQ10 supplementation reduced serum insulin levels and improved insulin resistance.

Pancreatic beta-cell function also improved in the CoQ10 arm of the study which enables more efficient insulin production.8

Reducing Lipoprotein (a)

There are sophisticated blood tests that measure types of cholesterol beyond LDL and HDL.

One such test is lipoprotein (a).

The Copenhagen City Heart Study found that individuals with plasma lipoprotein (a) above 104 nmol/L had an increased risk for heart attack.9,10

In a systematic review of seven randomized controlled trials, CoQ10 supplementation led to statistically significant reductions in lipoprotein (a) levels.11

This review also found that higher CoQ10 doses corresponded with greater lipoprotein (a) lowering.

CoQ10 and Selenium

During a four-year trial, 219 elderly individuals received daily supplementation with 200 mg of CoQ10 and 200 mcg of selenium.

These CoQ10-selenium supplemented individuals were compared with 222 participants that received placebo and 227 participants that received no treatment.

In participants with the lowest baseline selenium levels, supplementation with CoQ10 and selenium cut cardiovascular mortality by 50%.12

Heart Transplant Patients

The advent and improvement of heart transplant technology has given new leases on life to those with end-stage heart failure.

Yet heart transplant surgery involves life-long complications from immune suppressing drugs and other side effects. There are not enough donor hearts to meet the rising needs of heart failure patients.

A growing volume of data suggests that heart failure patients can gain precious life-years by boosting their coenzyme Q10 blood levels.

An interesting study analyzed tissue from patients undergoing heart transplant surgery versus tissue from non-failing donor hearts.

Tissue from failing hearts showed significantly lower CoQ10 levels compared with non-failing donor hearts.13

While these findings are not surprising, they add to the wealth of clinical data supporting the benefits of coenzyme Q10 in those suffering with congestive heart failure.

Results From Huge Meta-Analysis

A meta-analysis of 14 randomized controlled trials involving 2,149 heart failure patients revealed that CoQ10 supplementation decreased mortality by 31% compared with placebo.14

This same analysis showed that exercise capacity improved more in the CoQ10 subjects than in the placebo group.

Ejection fraction did not improve in this analysis. One reason may be data we published in 2008 showing that heart failure patients require higher doses of the ubiquinol form of CoQ10 to improve this measure of heart pumping capacity (i.e., ejection fraction).15

Robust Improvements in Cardiac Function

Robust Improvements in Cardiac Function  

The ejection fraction test assesses how much blood is pumped after each beat compared with the amount of blood remaining in the heart.16

Healthy people have an ejection fraction of 55%-75%, while heart failure patients often have values of 20%-40% (or less).16,17

In a study we reported on ten years ago, mean ejection fraction improved from a low 22% up to 39% in ubiquinol-treated patients who had follow-up echocardiograms.15 This finding represented a recovery of up to 77% in this measure of cardiac output.

To obtain these results, the study author (Peter Langsjoen, MD) identified heart failure patients with suboptimal CoQ10 levels and supplementing with an average dose of 450 mg per day of ubiquinone. Patients were then switched to an average dose of 580 mg per day of ubiquinol to maintain higher levels.

In response to these higher CoQ10 blood levels, increases in ejection fraction were accompanied by remarkable clinical improvements in advanced heart failure patients. Based on these findings, the Dr. Langsjoen’s study group concluded:15

“Ubiquinol has dramatically improved absorption in patients with severe heart failure and the improvement in plasma CoQ10 levels is correlated with both clinical improvement and improvement in measurement of left ventricular function.”

What CoQ10 Dose Should Healthy Aging People Take?

What CoQ10 Dose Should Healthy Aging People Take?  

Peter Langsjoen, MD, is one of the world’s foremost experts in the use of CoQ10 to treat cardiac disease. He conducts his research and clinical practice in Tyler, Texas, and is a long-standing member of our Scientific Advisory Board.

What makes Dr. Langsjoen unique among cardiologists is that he measures his patients’ CoQ10 blood levels to ensure they are absorbing enough of the CoQ10 he prescribes to induce a clinical response.

For healthy older people who are not supplementing with CoQ10, Dr. Langsjoen suggests starting off with 300-400 mg per day for the first month to fully saturate your cells. People can then back down to a daily maintenance dose of 100-200 mg per day to maintain high cellular CoQ10 levels.

Dr. Langsjoen prefers ubiquinol as it absorbs far better into the bloodstream than ubiquinone.

For optimal absorption, take your CoQ10 with the heaviest meal of the day as either form of CoQ10 absorbs much better in the presence of a fatty meal.

Why CoQ10 Initially Confused Cardiologists
Why CoQ10 Initially Confused Cardiologists

Physicians are used to drugs that provide immediate effects.

For instance, if a statin drug (such as Lipitor®) is prescribed, there is almost always a sharp drop in a patient’s LDL cholesterol. Antihypertensive drugs usually provide a quick blood pressure-lowering effect. Anticoagulant drugs (like warfarin) quickly thin a patient’s blood.

These kinds of fast-acting drugs are what doctors and the FDA are accustomed to evaluating.

When CoQ10 came along, it seldom met mainstream medicine’s expectation of a pronounced and immediate effect, especially in patients with congestive heart failure.

So the initial reaction by the mainstream was that CoQ10 had no meaningful clinical benefit.

A study published in December 2014 showed that it takes considerable time (up to two years) for conventional CoQ10 supplements to build up in the heart for significant clinical benefits to occur, such as a 42% reduction in all-cause mortality.4

This is why cardiologist Peter Langsjoen often prescribes high doses (600 mg/day) of ubiquinol to his heart failure patients, as they don’t have the luxury of waiting to build optimal levels of this critical cell energy factor.

We at Life Extension® long ago discovered that low-dose CoQ10 administered to people with chronic disease does not provide needed benefit. The evidence clearly indicated that higher doses of more absorbable forms of CoQ10 are required.

CoQ10 Wars

Before we published an article about CoQ10 in 1983, Americans had no idea that it was widely used in Japan to treat heart disease.

The FDA reacted to our publication and subsequent sales of coenzyme Q10 with armed raids and threats of substantial jail time. FDA was determined to ban all Americans access to this life-saving nutrient.

If you enter the terms “coenzyme Q10 and heart failure” into www.pubmed.gov, you can read several hundred published papers that attest to its efficacy.

A majority of cardiologists now recommend CoQ10 to certain patients and it can be widely found on pharmacy store shelves.

We won the battle to keep CoQ10 (and other nutrients) legally available. Most Americans, however, do not know how to optimally use CoQ10, especially as it relates to reversing clinical measures of heart failure.

Readers of Life Extension Magazine®, on the other hand, are kept informed on peer-reviewed published scientific studies that go unreported by the mainstream media.

The information provided in this article should enable many more healthy life-years in those stricken with heart failure.

For longer life,

For Longer Life

William Faloon, Co-Founder

Life Extension Buyers Club

References

  1. Available at: https://news.heart.org/heart-failure-projected-to-increase-dramatically-according-to-new-statistics. Accessed April 25, 2018.
  2. Shen L, Jhund PS, Petrie MC, et al. Declining Risk of Sudden Death in Heart Failure. N Engl J Med. 2017;377(1):41-51.
  3. Available at: https://www.nutraceuticalsworld.com/contents/view_online-exclusives/2016-04-07/more-education-needed-to-bolster-coq10-market. Accessed April 25, 2018.
  4. Mortensen SA, Rosenfeldt F, Kumar A, 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 Fail. 2014;2(6):641-9.
  5. Shimizu M, Miyazaki T, Takagi A, et al. Low circulating coenzyme Q10 during acute phase is associated with inflammation, malnutrition, and in-hospital mortality in patients admitted to the coronary care unit. Heart Vessels. 2017;32(6):668-73.
  6. Aslanabadi N, Safaie N, Asgharzadeh Y, et al. The randomized clinical trial of coenzyme Q10 for the prevention of periprocedural myocardial injury following elective percutaneous coronary intervention. Cardiovasc Ther. 2016;34(4):254-60.
  7. Kure CE, Rosenfeldt FL, Scholey AB, et al. Relationships Among Cognitive Function and Cerebral Blood Flow, Oxidative Stress, and Inflammation in Older Heart Failure Patients. J Card Fail. 2016;22(7):548-59.
  8. Raygan F, Rezavandi Z, Dadkhah Tehrani S, et al. The effects of coenzyme Q10 administration on glucose homeostasis parameters, lipid profiles, biomarkers of inflammation and oxidative stress in patients with metabolic syndrome. Eur J Nutr. 2016;55(8):2357-64.
  9. Nordestgaard BG, Chapman MJ, Ray K, et al. Lipoprotein(a) as a cardiovascular risk factor: current status. Eur Heart J. 2010;31(23):2844-53.
  10. Available at: https://www.lipid.org/sites/default/files/5-_nordestgaard_final.pdf. Accessed April 27, 2018.
  11. Sahebkar A, Simental-Mendia LE, Stefanutti C, et al. Supplementation with coenzyme Q10 reduces plasma lipoprotein(a) concentrations but not other lipid indices: A systematic review and meta-analysis. Pharmacol Res. 2016;105:198-209.
  12. Alehagen U, Alexander J, Aaseth J. Supplementation with Selenium and Coenzyme Q10 Reduces Cardiovascular Mortality in Elderly with Low Selenium Status. A Secondary Analysis of a Randomised Clinical Trial. PLoS One. 2016;11(7):e0157541.
  13. Sheeran FL, Pepe S. Posttranslational modifications and dysfunction of mitochondrial enzymes in human heart failure. Am J Physiol Endocrinol Metab. 2016;311(2):E449-60.
  14. Lei L, Liu Y. Efficacy of coenzyme Q10 in patients with cardiac failure: a meta-analysis of clinical trials. BMC Cardiovasc Disord. 2017;17(1):196.
  15. Langsjoen PH, Langsjoen AM. Supplemental ubiquinol in patients with advanced congestive heart failure. Biofactors. 2008;32(1-4):119-28.
  16. Available at: https://www.hrsonline.org/patient-resources/the-normal-heart/ejection-fraction. Accessed April 25, 2018.
  17. Available at: https://my.clevelandclinic.org/health/diseases/17069-heart-failure-understanding-heart-failure/ejection-fraction. Accessed April 25, 2018.

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