CoenzymeQ10 and Heart

Disease
Professional Research Presentation

Gemady Langelder, BS
 About Me
Gemady Langfelder
Dietetic Intern with Sodexo
MS Dietetics, University of Rhode Island – 2022
BS Dietetics, University of Hawai’i Manoa – 2021
ACSM Personal Trainer
NASM Certified WLS and WFS

Clinical rotation site: Straub Medical Center

 Ice Breaker Activity
What dietary/herbal supplement(s) are you currently taking?

Trivia: What percentage of US adults above 20 years old have

used a dietary supplement?

Trivia: What are the top three most common types of dietary
supplements used by US adults?

Data from: Mishra S et al. Dietary Supplement Use Among Adults: United States, 2017–2018. NCHS Data
Brief. February 2021; 399. Available at https://www.cdc.gov/nchs/products/databriefs/db399.htm. Accessed
April 3, 2022.
 CoQ10 & Heart
Disease
Why I chose this topic:
Role of inflammation and oxidative stress on development
of chronic disease

Therapeutic potential of antioxidants

NCP – Dietary supplement use

Learning Objectives
Objective 1
Explain the role of inflammation and oxidative stress in the
pathophysiology of heart disease

Objective 2
List the proposed effects of CoQ10 supplementation in heart disease

Objective 3
Examine the evidence on CoQ10 supplementation in patients with heart
disease

Disclosure: I have no conflicts of interest including no sources of

compensation related to the activities/materials
Agenda
01 02 03
Background Overview of Summary
Information Research

04 05
Conclusion Q&A
01
Background
Information
 Heart Disease
• Leading cause of death and
morbidity in the US – 6.7% of
adults over 20, 1 in every 4
deaths1
• Inflammation contributes to
atherogenesis – CRP
• Monocyte & T lymphocytes
promote atherogenesis2
• ROS production & oxidative
stress in cardiac pathology3 Fig. 1 Development of an atheroma2
1. Heart disease facts. CDC. https://www.cdc.gov/heartdisease/facts.htm
2. Libby P. Inflammation in atherosclerosis. Nature. 2002;420:868-874.
3. Peoples JN, Saraf A, Ghazal N, Pham TT, Kwong JQ. Mitochondrial dysfunction and oxidative stress in heart disease. Exp Mol
Med. 2019;51(12):1-13.
 Heart Disease

Fig. 2 T lymphocyte in atherogenesis2

2. Libby P. Inflammation in atherosclerosis. Nature. 2002;420:868-874.

 Coenzyme Q10
• Lipophilic compound synthesized in the mitochondrial
inner membrane
• Oxidized (ubiquinone) or reduced (ubiquinol)
• Electron transport chain – ATP production
• Intercellular antioxidant
• Highest concentration in heart, kidneys, liver Fig. 3 coenzyme Q10
& muscles4
• Affected by chronic disease and aging

4. Zozina VI, Covantev S, Goroshko OA, Krasnykh LM, Kukes VG. Coenzyme Q10 in Cardiovascular and Metabolic
Diseases: Current State of the Problem. Curr Cardiol Rev. 2018;14(3):164-174.
 CoQ10 and Heart Disease
Proposed effects
• 3 out of 4 patients with CVD have low CoQ10 levels
• Antioxidative property – ROS scavenger
• Supports energetic needs of cardiac tissue
• Anti-inflammatory – nitric oxide regulation4

4. Zozina VI, Covantev S, Goroshko OA, Krasnykh LM, Kukes VG. Coenzyme Q10 in Cardiovascular and
Metabolic Diseases: Current State of the Problem. Curr Cardiol Rev. 2018;14(3):164-174.
 Research Questions:

What is the effect of CoQ10 supplementation on CVD symptoms

and CVD-related morbidity and mortality?
 02
Overview of
Research
1. CoQ10 in myocardial infarction prophylaxis
2. CoQ10 in HF with reduced ejection fraction
3. CoQ10 in HF with preserved ejection fraction

4. Meta-analysis: CoQ10 in CAD

5. Review: CoQ10 in SAMS and CHF
 01
“Role of coenzyme Q10 in prophylaxis
of myocardial infarction”
Shah IA, Memon M, Ansari S, Kumar R, Chandio SA, Mirani
SH, Rizwan A. Cureus. 2021.
• Open-label, placebo controlled,
randomized controlled clinical trial
• Single center – hospital in Sukkur, Pakistan
 Methods
Hypothesis
CoQ10 will have beneficial effects in prophylaxis for myocardial
infarction (MI) and cardiovascular mortality
Study Design In social media

• n=892, intervention=408, placebo=417

• CoQ10 200 mg/d with standard therapy
• MI: cardiac markers (troponin), ECG changes
• Eligibility: ACE inhibitors, hydrochlorothiazide,
rosuvastatin, aspirin
Data Collected
• Incidence of fatal and non-fatal MI over 12 months
 Results
• No significant difference between placebo and intervention
• Over half male participants, 1/3 smokers, with comorbidities (25%
diabetes, 65% hypercholesterolemia), almost half with overweight/obesity
• <6% previous acute MI, <3% family history of acute MI
• 38-intervention, 29-placebo lost to follow-up

Table 1. Adverse outcomes in both groups

 Discussion
CVD-related Morbidity & Mortality
• Reduction in non-fatal MI and fatal MI in intervention versus placebo
• Observed in populations with comorbidities and history of MI
Antioxidant & Anti-inflammatory effects
• Not reported in the study – assumed effects

Limitations
• Single-center study
• Unknown demographics of participants with fatal/non-fatal MI
• New MI vs recurrent MI
 02
“Ubiquinol improves endothelial function in patients
with heart failure with reduced ejection fraction:
A single-center, randomized double-blind placebo-controlled
crossover pilot study”
Kawashima C, et al. Am J Cardiovasc Drugs. 2020
• Randomized, double-blind,
placebo-controlled, crossover pilot
• Single center – Yokohama, Japan
(July 2013 – October 2014)
 Methods
Hypothesis
Supplementation of ubiquinol in addition to standard therapy will
improve peripheral endothelial function compared to placebo in
patients with HFrEF.
In social media
Study Design
• n=20 (initial), n=14 (final)
• 400 mg/d ubiquinol for 3 months
In our social media
• 1 month wash-out period
• Eligibility: 20-89 yo, EF <40%, >1 month standard therapy
Data Collected
• B-type natriuretic peptide (BNP), BP, Cr, cystatin C, lipids, CRP, Hs
troponin I, plasma CoQ10
• Reactive hyperemia, reactive hyperemia index (RHI)
 Results
• Age: 70±9, 85.7% male, 60±9 kg, %EF: 35
• Ischemic HD (7), HTN (9), DM (5), dyslipidemia (4)
• Beta-blockers (86%), ACE-inhibitors (100%), statins (71%)
02

06 03

05 04

Figure 1. Changes in endothelial function for Figure 2. RHI values showed improvements with
each group measured in LnRHI ubiquinol but not in placebo
 Discussion
CVD-related Morbidity & Mortality
• Improved endothelial function with ubiquinol supplementation
• LnRHI increased from 0.45-0.55 (0.1 increase = 21% risk reduction)
 Energy metabolism & prevention of oxidative stress in myocardial cells
• No effect on clinical variables – lipid profile, renal function, glucose
Antioxidant & Anti-inflammatory effects
• No effect on BNP, oxidative stress (8-OHdG) and inflammatory markers

Limitations
• Small study – limited statistical power Reduced form more
• Compliance bioavailable
• Short-term vs. long-term effects
 03
“Effects of coenzyme Q10 supplementation on
diastolic function in patients with heart failure
with preserved ejection fraction”
Sobirin MA, Herry Y, Sofia SN, Uddin I, Rifqi S, Tsutsui
H. Drug Discov Ther. 2019.
• Unblinded, randomized controlled clinical trial
• Single center – Semarang, Indonesia
 Methods
Hypothesis
CoQ10 improves left ventricular (LV) diastolic function in patients with
HFpEF
In social media
Study Design
• n=30 (initial), n=28 (final)
• CoQ10 300 mg/d in addition to standard therapy for 30 days
In our social media
• >45 yo, NYHA class 2-3, LVEF >50%, >4 weeks standard therapy
Data Collected
• ECG – LV diastolic function, LV systolic function, LV structure
 Results
• >60 yo, 50% female, BMI 24.8
• T2DM (73%), HTN (93%), CAD (63%)
02

No significant
06 03 difference in
LVEF function

05 04
 Discussion
CVD-related Morbidity & Mortality
• Non-significant improvements in LV diastolic function
• Attributed to standard therapy
• CoQ10 levels from supplement may be lower due to older age,
severity of disease and statin therapy
• No side effects reported – relatively safe and tolerated
Limitations
• Short-duration
• Small sample size
 04
“The effects of coenzyme Q10 supplementation on lipid
profiles among patients with coronary artery disease: a
systematic review and meta-analysis of randomized
controlled trials”
Jorat MV, et al. Lipids Health Dis. 2018
• Systematic review, meta-analysis of RCTs
 Methods
Hypothesis
CoQ10 will improve lipid profiles in CAD

Study Design
• n=8
• Eligibility: human RCT (parallel/crossover), measured lipid profiles at
baseline and post-intervention
Data Collected
• Trial duration, supplement dose, treatment type, mean and SD or
95% CI for lipid profiles: TC, LDL, HDL, Lp(a)
 Results
• 7 parallel, 1 cross-over
• TC (8), LDL (6), TG (4), HDL (5), Lp(a) (3)
• n=21-73, n=267 (total)
02
• Duration between 4-48 weeks
• Dose: 100-300 mg/d

• 06 decrease in TC and increase

Significant 03 in HDL
• No impact on LDL, TG and Lp(a)
• TC reductions – CAD, <150 mg/d, >8 weeks
• HDL reductions – CVD over HF, <150 mg/d
04
 Discussion
CVD-related Morbidity & Mortality
• Significant improvements in some lipids
• Mechanism of how CoQ10 affects lipids is unknown
• Antioxidant against ROS damage?
• Activation of peroxisome proliferator-activated receptor-y (PPAR-
y)  inhibition of adipogenesis?
Limitations
• Various types of supplement and dosages
 05
Coenzyme Q10
Raizner AE. Methodist Debakey Cardiovasc J. 2019.
Review article
 Results
Dosage
• No minimum/maximum effective dose
• 200 mg BID w/ meals – therapeutic blood level
• Cardiac trials: 100-400 mg In social media

Side effects & interactions

• Mild and infrequent – decreased appetite, N/V/D
In our social media
• No interaction w/ warfarin despite one report
 CoQ10 and SAMS
• Statin-associated muscle symptoms: muscle pain, cramps, weakness,
rhabdomyolysis
• Prevalent in women and older adults
• Most common cause for non-compliance
• Unclear mechanism; inhibits mevalonate pathway  reduced
mitochondrial function
• CoQ10 and statins - commonly prescribed together
03
Review of evidence
• RCTs - Conflicting results
• Meta-analysis (2018): CoQ10 may ameliorate SAMS
05 04
Limitations
• Small trials
 CoQ10 and CHF
• Reduction in oxidative stress, enhanced ATP synthesis
• CoQ10 deficiency – correlates with severity of HF

Review of evidence
• Early RCTs (prior to 2013) – benefits in EF
• Q-SYMBIO trial (2014) – at 2 yrs follow-up: fewer MACE,
CVD related deaths and improvement in NYHA 03class in intervention group;
Improvement in LVEF with baseline EF >30%
 Long-term CoQ10 improves CHF symptoms and reduces MACE
Limitations 05 04
• Most from small RCTs
•
03Summary
Numerous studies on CoQ10 as adjunct therapy for CVD
and CVD-associated symptoms
• Small sample size, single-center
• Dose between 150-300 mg/d
• Different effects from different forms of CoQ10
• Conflicting evidence on LVEF in CHF
• Some evidence supporting benefits in some lipids in CAD
• Limited evidence in reducing CVD-related morbidity and mortality
04 Conclusion
• Chronic inflammation and oxidative stress play a
role in CVD pathophysiology
• CoQ10 is a potent antioxidant and ROS scavenger often reduced in CVD
• Over half of US adults use or have used a dietary supplement
• Dietitians gather data on supplement – assess potential effects of
supplement, drug-nutrient interactions,
possible side effects
 References
1. Heart disease facts. CDC. https://www.cdc.gov/heartdisease/facts.htm
2. Libby P. Inflammation in atherosclerosis. Nature. 2002;420:868-874.
3. Peoples JN, Kwong JQ et al. Mitochondrial dysfunction and oxidative stress in
heart disease. Exp Mol Med. 2019;51(12):1-13.
4. Zozina VI, Kukes VG et al. Coenzyme Q10 in Cardiovascular and Metabolic Diseases:
Current State of the Problem. Curr Cardiol Rev. 2018;14(3):164-174.
5. Shah IA, Memon M, Ansari S, Kumar R, Chandio SA, Mirani SH, Rizwan A. Role of coenzyme Q10 in
prophylaxis of myocardial infarction. Cureus. 2021;13(2):e13137.
6. Kawashima C, Kimura K et al. Ubiquinol improves endothelial function in patients with heart failure with
reduced ejection fraction: A single-center, randomized double-blind placebo-controlled crossover pilot
study. Am J Cardiovasc Drugs. 2020;20(4):363-372.
7. Sobirin MA, Tsutsui H et ak. Effects of coenzyme Q10 supplementation on diastolic function in patients
with heart failure with preserved ejection fraction. Drug Discov Ther. 2019;13(1):38-46.
8. Jorat MV, Tabrizi R, Mirhosseini N, et al. The effects of coenzyme Q10 supplementation on lipid profiles
among patients with coronary artery disease: a systematic review and meta-analysis of randomized
controlled trials. Lipids Health Dis. 2018;17(1):230.
9. Raizner AE. Coenzyme Q10. Methodist Debakey Cardiovasc J. 2019;15(3):185-191.
 Thank
You 15-minute Q & A

CREDITS: This presentation template was created by Slidesgo, including icons by

Flaticon and infographics & images by Freepik