Is Coenzyme Q10 effective for heart disease?


The hypothesis that supplementing with Coenzyme Q10 is beneficial to the heart is mainly based on the following inference:

1) Impaired myocardial function is the root cause of many heart failure cases.
2) The normal operation of cardiomyocytes is inseparable from energy. Coenzyme Q10 is an important biochemical substance involved in the energy production of cardiomyocytes.
3) As the symptoms of patients with heart failure worsen, the level of coenzyme Q10 in the patients' myocardial cells will decrease. Although there is coenzyme Q10 in food (red meat, plants, and fish), the amount of food intake is not enough to affect patients' low levels.

Coenzyme Q10

Therefore, additional supplement of Coenzyme Q10, so that the coenzyme Q10 in the myocardium reaches a normal level, can increase the energy output of myocardial cells, and may improve heart function.

Is there data to support this inference?

The existing data are:

01 Existing data 1 The preventive effect of coenzyme Q10: only a few studies

02 Existing data 2 for the adjuvant treatment of coenzyme Q10: A study published in 2014 called Q-SYMBIO is worth noting. Researchers from Europe randomly divided 420 patients with moderate to severe heart failure into two groups. In addition to standard treatment, one group took 100 mg of coenzyme Q10 three times a day, and the other group took a placebo. After 16 weeks, some functional indicators were measured; the trial was terminated two years later. The clinical endpoint is any major adverse cardiovascular event (MACE), including unplanned hospitalization due to heart failure, death due to cardiovascular disease, and the need for organ transplantation. The researchers also compared total mortality.

The results of coenzyme Q10 are surprisingly good. Although there was no significant difference in short-term (16 weeks) taking, after two years, the incidence of MACE in the coenzyme Q10 group was 15%, compared to 26% in the placebo group. This difference reached statistical significance (p = 0.003). The all-cause mortality rate also improved. The all-cause mortality rate in the coenzyme Q10 group was 10%, compared with 18% for placebo (p = 0.08). In addition, patients taking coenzyme Q10 have significantly reduced mortality due to cardiovascular events and fewer other adverse events.

However, this experiment also has some major methodological flaws:

• The biggest problem is that the number of patients participating in the study is still not large enough, and there are many clinical trial centers in different countries participating in this trial, which also means that in a particular clinical center, the number of patients that can be randomly assigned is very small . Because the overall incidence of adverse events (MACE) is relatively low, the observations may still be random events. In other words, the remarkable effect observed in the experiment may be just because by coincidence...

• Second, the number of patients with moderate to severe heart failure in this trial who died in two years was much less than what is usually observed. It is not clear what caused this. However, in view of the small number of patients participating in the trial and the low number of deaths, from a statistical point of view, the trial's estimation of the risk of reducing mortality is not accurate. This inaccurate estimation is often difficult to repeat in the final large-scale experiment.

• This experiment started before 2003 and is expected to end in 2008. Why was it not published until 2013, and only published this seemingly uncomplicated, two-year trial in 2014?

• Finally, this trial was funded by two companies (Kaneka Nutrient and Pharma Nord) that produce Coenzyme Q10 health products and the International Coenzyme Q10 Association. The main author Mortensen is one of the founders of the International Coenzyme Q10 Association. This will inevitably bring some "bias" into the process of experiment design and data analysis. Researchers subconsciously hope that the result is to prove the effectiveness of Q10. Therefore, there is no conclusive conclusion about the role of coenzyme Q10 in adjuvant therapy in heart failure. We need more studies with other rigorous designs, including more different populations. At present, the American College of Cardiology Foundation/American Heart Association Task Force does not recommend additional coenzyme Q10 supplementation for patients with heart failure.

03 Existing data 3 has evidence that Coenzyme Q10 can reduce the risk of complications caused by heart surgery. Finally, if you are taking the anticoagulant warfarin (warfarin), perhaps you should not take coenzyme Q10. The Mayo Clinic in the United States pointed out that Coenzyme Q10 and warfarin may have drug interactions

Although many compounds were thought to have drug interactions with warfarin at first, they were later overturned by pharmacokinetic studies, but it is better to be careful before thorough research.