Co-enzyme Q10 in cardiovascular and metabolic disease

Adapted from Co-enzyme Q10 in Cardiovascular and Metabolic Diseases: Current State of the Problem, by Vladlena I Zozina et al. Current Cardiology Reviews 2018 Aug: 14(3) 164-174.

Co-enzyme Q10 (CoQ10) is an essential compound of the human body. There is growing evidence that it is tightly linked to cardiometabolic disorders. Supplementation can be useful in a variety of chronic and acute disorders. This review article discusses its role in hypertension, ischemic heart disease, myocardial infarction, heart failure, viral myocarditis, cardiomyopathies, cardiac toxicity, dyslipidaemia, obesity, type 2 diabetes mellitus, metabolic syndrome, cardiac procedures and resuscitation.

CoQ10 is made in the inner membrane of the mitochrondia. These are the little batteries which power your cells. It exists as ubiquinone which is oxidised and ubiquinol which is does not have oxygen attached. It is a key component of electron transfer in ATP production, which is how cellular energy is generated.

It is also an intercellular anti-oxidant. It also plays a role in cell growth and differentiation. There are many diseases and degenerative states associated with CoQ10 deficiency such as type 2 diabetes, atherosclerosis, hypertension, dyslipidaemia, muscular dystrophy, Alzheimer’s disease and Parkinson’s disease.

Administration of selenium and CoQ10 in a group of elderly people over 4 years resulted in significantly reduced cardiovascular mortality over the next ten years. This new review aims to sum up current possibilities in a variety of conditions with an analysis of the impact on health and quality of life.

CoQ10 is found in all organs but the highest concentrations are in the heart, kidneys, liver and muscles.

Three out of four patients with heart disease have low levels of CoQ10, particularly in ischaemic heart disease and cardiomyopathy.

In 2010 31% of all adults had hypertension. This rate is rising, particularly in low income countries.

CoQ10 has a direct effect on the lining of blood vessels, the endothelium, which dilates the blood vessels in hypertensive people and so reduces blood pressure. It also has a blood pressure lowering effect via the angiotensin effect in sodium retention and lowers aldosterone. Blood pressure can be lowered as far as normal levels with CoQ10 and has been measured as reducing systolic bp by 11 mmHg and diastolic by 7mmHg.

Giving 300mg daily of CoQ10 has been shown to reduce inflammatory markers and raise anti-oxidant enzyme activity. It is well known that a pro-inflammatory effect is a major component of chronic disease.

In 2013 cardiovascular diseases were a worldwide leading cause of death causing about a third of all deaths. A randomised study showed that in patients with myocardial infarction and hyperlipidaemia, supplementation resulted in lower blood pressure and a beneficial rise in HDL. After primary angioplasty after a heart attack, patients with higher levels of CoQ10 had better ventricular performance at 6 months follow up.

In rat studies infusion of CoQ10 results in less cardiac damage when their cardiac vessels are occluded to provoke cardiac ischaemia.

Heart failure causes less blood to be pumped out of the heart with every heart beat. This can be from a combination of structural and functional heart problems. HF is the cause of a huge amount of hospitalisation and cardiac impairment. Deaths from HF range from 10% to 50% per year. The plasma level of CoQ10 has been found to predict mortality in HF patients. Supplementation has been found to be beneficial in raising the level and decreasing mortality rates.

CoQ10 helps the heart muscle beat with more power. 100mg given three times a day to HF patients showed a reduction in cardiovascular mortality (9% v 16%), all cause mortality (10% v 18%) and number f hospital stays. Exercise tolerance was improved at the end of 2 years observation.

In those patients on the waiting list for heart transplants, CoQ10 users had a significant improvement in functional status, clinical symptoms and quality of life. Although the drugs for HF are still essential, there can be some additional benefits to CoQ10 supplementation.

Atrial Fibrillation is increasing worldwide year on year and is associated with symptoms and mortality. Supplementation has been found to reduce arrhythmias after surgery or drugs to stimulate the heart muscle after surgery.

In mice studies survival rate was higher in those given CoQ10 than those who were not when they had viral myocarditis. In humans both CoQ10 and trimetazidine have been found to be effective.

Cardiomyopathy is associated with a high mortality and poor quality of life. It is linked to increased oxidative stress. Supplementation has been found to improve both cardiac structure and function. Fatigue and breathlessness improved. These studies have been done in both adults and children.

Cardiac toxicity is an unwelcome side effect for certain cancer drugs used in chemotherapy. CoQ10 and L-carnitine together have been found to be cardio-protective.

Supplementation has been found to reduce side effects of statins in heart failure patients. This is because statins deplete CoQ10 levels.

Although low CoQ10 has been found in type 2 diabetes patients, supplementation had no effect on glycaemic control, lipid profile or blood pressure. Triglyceride levels were reduced.

In patients with metabolic syndrome had a beneficial effect on insulin levels with supplementation.

Women with polycystic ovarian syndrome had a beneficial effect on glucose metabolism, and cholesterol levels with supplementation.

Studies have been done during and after cardiac surgery and in the management of post cardiac arrest care. In one study hypothermia plus supplementation resulted in considerably improved outcomes compared with hypothermia without supplementation. The three month survival was 68% v 29%.

Supplementation studies have shown a potential role in septic and haemorrhagic shock patients.

Further research needs to be done to establish the optimal doses to give for various conditions and situations.

Levels of 100 -300mg of CoQ10 per day seem to be effective for a wide range of problems.