Updated October 16, 2007
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What does Jon recommend?
I am not a doctor. CoQ10 is needed in 2 groups of heart failure patients: Anyone taking a statin cholesterol-lowering drug; and anyone newly diagnosed with heart failure (in the past year). If you take a statin drug, I recommend taking 50mg CoQ10 twice a day after meals as long as you take the statin.
     If you are newly diagnosed and not on a statin, I recommend taking 25 to 30mg CoQ10 twice a day after meals for one week, then raising it to 100mg CoQ10 twice a day after meals. If you are very small or very large, adjust the dose. After a year, try cutting the dose in half and see how it goes.

This Page - CoQ10

Dr. P. H. Langsjoen may be reached at 75142.2077@Compuserve.Com

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 CoQ10 Monograph

In the US, nutraceuticals are marketed under the Dietary Supplement and Health Education Act of 1994 (DSHEA). Scientific data supporting claimed benefits are not always available because nutraceuticals are not regulated like drugs. Rigid quality controls are not required so these products can vary a lot in potency and purity.
     CoQ10 (Coenzyme Q10) is involved in many cell activities. It is a fat-soluble antioxidant with a structure similar to vitamin K. It was first isolated from cows' hearts at the University of Wisconsin in 1957. CoQ10 is found naturally in foods, mainly meat and seafood. Natural human CoQ10 levels go down with age. Really low levels of CoQ10 have been seen in people with heart failure, cardiomyopathies, and cancer.
     CoQ10 is a carrier for electron-transfer inside the inner cell membrane. It plays a vital role in ATP production (energy creation). CoQ10 may slightly increase the pumping strength of the heart. The highest natural CoQ10 levels are found in the heart.
     It is possible that an existing CoQ10 deficiency may be necessary to see any benefit from taking it as a supplement. Several studies have documented benefits from taking CoQ10 on heart performance, symptoms, and quality of life in patients with class 2 to class 4 heart failure. However, one double-blind study of 30 patients with ejection fractions less than 35% found no evidence of improved function nor did CoQ10 supplements improve echo measurements of heart function (Watson PS et al. 1999).
     Several case reports have noted a lowered response to warfarin (Coumadin) when CoQ10 is added. This could be due to the similar structure of CoQ10 to vitamin K. Some reports have claimed reduced insulin requirements in patients with diabetes. Cholesterol-lowering drugs have been reported to lower people's CoQ10 levels. Beta-blockers have also been reported to lower CoQ10 levels.
     CoQ10 is generally well tolerated. Insomnia has been reported with higher dosages. Adults with heart failure may take 50 to 200mg in gel form daily with a fatty meal to help absorption. Potency varies from manufacturer to manufacturer. CoQ10 is absorbed and used by the body better if taken with fats. A soybean oil suspension (Bioquinon) had a higher bioavailability than 2 other formulas tested (Weis 1994).
 
Source: GSM, Inc., June 25, 1999

 CoQ10 For Very Low EF Patients

1999 - To confirm the effect of CoQ10 treatment in CHF, we studied 22 patients with an average EF of 26%, average LV internal diameter of 71mm and heart class 2 to 3. The patients took 100mg CoQ10 or placebo twice a day for 12 weeks in a randomized double-blinded, placebo-controlled trial.
     Right heart cath was done before and after the treatment period, including a brief exercise period. Stroke index at rest and at work improved significantly; pulmonary artery pressure at rest and at work went down (significantly at rest); and PCWP at rest and at work decreased. These results suggest improvement in heart function. Patients with congestive heart failure may benefit from treatment with CoQ10.
 
Title:Coenzyme Q10 treatment in serious heart failure
Authors: Munkholm H, Hansen HH, Rasmussen K
Source: Biofactors 1999;9(2-4):285-9
PMID: 10416042, UI: 99344531

 CoQ10 For Heart Failure

December, 1997 - We analyzed 8 controlled clinical trials of CoQ10 for treating heart failure. We found significant improvement of several heart function measurements, including ejection fraction, stroke volume, cardiac output, cardiac index, and end diastolic volume. Based on available results, CoQ10 may have a role as heart failure therapy in a dose of 100 to 200 mg per day.
 
Title: Treatment of chronic cardiac insufficiency with coenzyme Q10, results of meta-analysis in controlled clinical trials
Authors: Soja AM, Mortensen SA
Source: Ugeskr Laeger 1997 Dec 1;159(49):7302-8
PMID: 9417729, UI: 98064805

 CoQ10 For Class 3-4 DCM

June, 1985 - CoQ10 is naturally present in the human heart. We did a double-blind, double-crossover trial by giving CoQ10 and a matching placebo to 2 groups of class 3 or 4 patients. Group A received CoQ10 and then placebo; group B received placebo and then CoQ10. Heart function and blood levels of CoQ10 were checked at study start and 4 weeks, and then at 16 and 28 weeks.
     In group A, increases in CoQ10 blood levels and heart function occurred during CoQ10 treatment and then decreased during crossover to placebo. In group B, there was no change in CoQ10 blood levels and heart function during placebo treatment, but increases in both occurred in crossover to CoQ10.
     These patients generally showed clinical improvement on CoQ10, showing that CoQ10 therapy might extend the lives of class 2 and class 3 heart failure patients.
 
Title: Response of patients in classes III and IV of cardiomyopathy to therapy in a blind and crossover trial with coenzyme Q10
Authors: Langsjoen PH, Vadhanavikit S, Folkers K
Source: Proc Natl Acad Sci U S A 1985 Jun;82(12):4240-4
ID numbers: PMID: 3858877, MUID: 85216668

 Small CoQ10 Trial For CHF

January, 1992 - We treated 11 heart transplant candidates with CoQ10. All patients improved; three improved from class 4 to class 1; four improved from classes 3 and 4 to class 2; and two improved from class 3 to class 1 or 2. This improvement came from CoQ10 correcting heart tissue deficiency of CoQ10.
 
Title: Therapy with coenzyme Q10 of patients in heart failure who are eligible or ineligible for a transplant
Authors: Folkers K, Langsjoen P, Langsjoen PH
Source: Biochem Biophys Res Commun. 1992 Jan 15;182(1):247-53
ID numbers: PMID: 1731784, MUID: 92118020

 One Year CoQ10 trial For DCM

1993 - The main problems in CHF patients are frequent hospitalizations, high number of serious arrhythmia, and filling of the lungs with fluid. We studied the effect of long-term CoQ10 on these events in patients with class 3 and 4 CHF taking standard CHF drugs.
     Three hundred and twenty-two people with an average age of 67 years were given placebo. Three hundred and nineteen people with an average age of 67 years took CoQ10. The dose was 2mg per kilogram (2.2 lbs) of body weight every day for one year.
     The number of patients who needed hospitalization for worsening heart failure was smaller in the CoQ10 group (73) than in the non-CoQ10 group (118). The episodes of lung congestion (20 versus 51 in placebo group) or cardiac asthma (97 vs 198 in placebo group) were also reduced in the CoQ10 group.
     Adding CoQ10 to standard drug therapy reduces hospitalizations for worsening heart failure and the number of serious complications in CHF patients.
 
Title: Effect of COQ10 therapy in patients with congestive heart failure: a long-term multicenter randomized study
Authors: Morisco C, Trimarco B, Condorelli M
ID numbers: PMID: 8241697, MUID: 94060607

 Do Sick Hearts Have Less CoQ10?

1993 - CoQ10 is a natural antioxidant. One biochemical reason for treating heart disease with Coq10 was established years ago by Folkers. I proved this with a study of heart tissue from 45 of my cardiomyopathy patients.
     Levels of CoQ10 found in "advanced" CHF hearts are much lower than CoQ10 levels found in hearts of patients with "mild" CHF. This deficiency might be corrected by oral supplements.
     In this study, taking 100mg CoQ10 daily, nearly 2/3 of patients showed clinical improvement, most pronounced in those with dilated cardiomyopathy. CoQ10 may be a good added treatment in heart failure, with positive effects on patients' outcome, physical activity, and quality of life.
 
Title: Perspectives on therapy of cardiovascular diseases with COQ10
Author: Mortensen SA
Source: Clin Investig 1993;71(8 Suppl):S116-23
ID numbers: PMID: 8241694, MUID: 94060604

 Statins Reduce CoQ10 Level

1994 - The biologic pathway of the CoQ chain is the same as that of cholesterol. We studied whether cholesterol-lowering drugs like Zocor change CoQ10 blood levels. Thirty-four patients with high cholesterol took 20mg of Zocor for 6 months (no-CoQ10 group) or 20mg of Zocor plus 100mg CoQ10 (CoQ10 group). Total cholesterol, HDL, LDL, triglycerides, CoQ10 blood level and more were checked at study start, 45, 90, 135, and 180 days
     In the no-CoQ10 group, total cholesterol and LDL went down and so did blood CoQ10 levels. In the CoQ10 group, CoQ10 blood levels increased while cholesterol reduction was similar to the no-CoQ10 group. CoQ10 in blood cells also decreased in the no-CoQ10 group and increased in the CoQ10 group.
     Zocor lowers LDL blood levels, blood and blood cell levels of CoQ10. Taking CoQ10 prevents both blood and blood cell CoQ10 reductions without affecting the cholesterol lowering action of Zocor.
     If you take a cholesterol-lowering drug like Zocor, you should take extra CoQ10. It won't affect the action of the cholesterol drug. The cholesterol drug is reducing the amount of CoQ10 in your blood and taking extra CoQ10 will make up for it.
 
Title: Exogenous CoQ10 supplementation prevents plasma ubiquinone reduction induced by HMG-CoA reductase inhibitors
Authors: Bargossi AM; Grossi G; Fiorella PL; Gaddi A; Di Giulio R; Battino M
Source: Mol Aspects Med, 1994, 15 Suppl:, s187-93
ID number: 95272323

 The Worse You Are, The Better You'll Get

1990 - We studied CoQ10 use in DCM patients. CoQ10 levels are very low in heart tissue biopsies taken from DCM hearts, compared to normal hearts.
     Thirty DCM patients took 100mg CoQ10 per day for 2 months. Before and after treatment, a clinical exam checked heart class and an echo checked ejection fraction. Heart size and filling capacity were tested. Blood was drawn to check CoQ10 levels.
     Seven patients left the study because of poor compliance. In 47% of patients, symptoms and heart class improved. The average EF improved from 31% to 37%. Heart size went down. The CoQ10 blood levels went up in 95% of patients to 2.27 micrograms/ml. The more a patient's heart lacked CoQ10 before treatment, the more that patient benefited during this study.
     CoQ10 deficiency in DCM may be reversible. The amount of benefit may depend on pre-treatment CoQ10 levels in the blood and heart. CoQ10 should be considered an effective addition to DCM/CHF therapy.
 
Title: Coenzyme Q10 in dilated cardiomyopathy
Authors: Manzoli U; Rossi E; Littarru GP; Frustaci A; Lippa S; Oradei A; Aureli V
Source: Int J Tissue React, 1990, 12:3, 173-8
ID number: 91115533

 Time Till Testing Matters

January, 1996 - CoQ10 H2 is a reduced form CoQ10, and is easily oxidized to CoQ10. How a blood sample to be tested for CoQ10 level is prepared is very important because of this quick oxidizing. Our study shows that CoQ10 H2 is unstable in whole blood, plasma, and isopropanol extracts, so the ratio changes a lot right after a blood sample is drawn. How long before CoQ10 testing the blood was drawn, as well as how the sample was handled, have a huge effect on the accuracy of CoQ10 measurement in the blood sample.
 
Title: Measurement of the ratio between the reduced and oxidized forms of coenzyme Q10 in human plasma as a possible marker of oxidative stress
Authors: Lagendijk J; Ubbink JB; Vermaak WJ
Source: J Lipid Res, 1996 Jan, 37:1, 67-75
ID number: 96417312

 CoQ10 Levels Improve With Supplements

1990 - Energy starvation of heart cells may play a major role in the progression of heart failure. In theory, a lack of substances needed in the heart's energy chain may be helped by taking those substances orally.
     We checked CoQ10 levels in heart patients' blood and in their heart biopsy samples. CoQ10 levels in heart failure patients was significantly lower than levels in healthy people. The worse the patient's CHF, the less CoQ10 was found in their blood and heart biopsy samples. Class 3 and class 4 patients had lower CoQ10 levels than those in class 1 and 2.
     Forty patients in class 3 and 4 CHF took 100mg of CoQ10 daily. Twenty-six patients showed subjective and clinical improvement. Our results suggest that CoQ10 is effective in heart-failure therapy. It appears safe - no adverse effects were seen.
 
Title: Coenzyme Q10: clinical benefits with biochemical correlates suggesting a scientific breakthrough in the management of chronic heart failure.
Authors: Mortensen SA, Vadhanavikit S, Muratsu K, Folkers K
Source: Int J Tissue React. 1990;12(3):155-62
PMID: 2276893, UI: 91115530

 CoQ10 No Help For CHF Here

November, 1992 - We studied the effect of CoQ10 in 25 patients with idiopathic DCM. The study was a placebo-controlled, double-blind cross-over study. The patients were heart class 1, 2 and 3.
     Over 4 months, 15 patients were given 100mg CoQ10 a day, and were then given a placebo during the next 4 months (V/P group). The sequence of treatment was reversed with the remaining 10 patients (P/V group). Benefit was measured by echocardiogram, chest x-ray, and a MUGA exercise test.
     EF was 40% in the P/V group and 38% in the V/P group. Left ventricular end-diastolic diameter was 65mm in the P/V group and 67 in the P/V group. Cardiac output was 5.1 x min-1 in the P/V group and 5.1 x min-1 in the V/P group.
     Treatment with CoQ10 had no influence on heart function, electrocardiogram, ventricular arrhythmias or exercise tolerance. We found no benefit to CoQ10 in patients with idiopathic DCM.
 
Title: Ubiquinone (coenzyme Q10) in the long-term treatment of idiopathic dilated cardiomyopathy.
Authors:Permanetter B, Rossy W, Klein G, Weingartner F, Seidl KF, Blomer H
Source: Eur Heart J 1992 Nov;13(11):1528-1533
PMID: 1464342, UI: 93099902
 
Jon's note: The EFs in these patients were fairly high and none were class 4

 CoQ10 Does Not Help CHF Here

May, 1999 - We studied the effects of oral CoQ on heart function and quality of life in CHF patients. Thirty patients with ischemic or idiopathic DCM and an average EF of 26% were randomized to a double-blind crossover trial of oral CoQ versus placebo, each for 3 months.
     Right heart pressures, cardiac output, and heart size by echo were measured at study start and after each treatment phase. Quality of life was measured with the Minnesota "Living With Heart Failure" questionnaire.
     Twenty-seven patients completed both treatment phases. There was no significant difference in EF, heart size, heart function, or quality of life measures after treatment with CoQ10 or placebo, although blood CoQ10 levels increased.
     In heart failure patients, treatment for 3 months with oral CoQ10 did not improve resting heart function or quality of life despite increased blood levels of CoQ10 to more than twice the starting values.
 
Title: Lack of effect of coenzyme Q on left ventricular function in patients with congestive heart failure
Authors: Paul S. Watson, Gregory M. Scalia, Andrew Galbraith, Darryl J. Burstow, Nicholas Bett, Constantine N. Aroney
Source: J Am Coll Cardiol. 1999 May;33(6):1549-52

 CoQ10 and Cholesterol Drugs

February 23, 2002 - The widespread use of statins - cholesterol lowering drugs - is of concern because they lower natural levels of CoQ10. Since CoQ10 is needed in the chain of events that produces energy (ATP), reduced CoQ10 levels may lower cell energy metabolism. This might show up as cardiomyopathy with exercise intolerance - heart failure.
     The cholesterol-lowering drug gemfibrozil reduced CoQ10 levels in a study of 21 men. Thus, treatment with Baycol (cerivastatin) at high doses or in combination with gemfibrozil might severely lower CoQ10 and lead to heart problems. CoQ10 level should be monitored in patients taking statins.
 
Source: The Lancet, Volume 359, Number 9307 23 February 2002
Author: Iain P Hargreaves, Simon Heales
From: Neurometabolic Unit, National Hospital, London WCIN 3BG, UK

 Cardiomyopathy Caused By Cholesterol Drugs?

July 8, 2002 - After 30 years of propaganda, the medical profession has created a "disease" called "hypercholesterolemia" meaning high blood cholesterol levels. After decades of failing to cure it with low-fat diets, the medical industry found the magic bullet: statin drugs like Zocor, Lescol, Lipitor, Pravachol, and Mevacor. Introduced in 1987, statins are now one of the most widely prescribed drugs in history. Statins do 3 things:

  1. They block the body's ability to make cholesterol, which lowers blood level of cholesterol, which cures people's worry about cholesterol levels - for both doctors and patients. So far, so good
  2. Statins have some anti-inflammatory effect and may stabilize buildup in arteries so it doesn't break loose as easily. So far, so good
  3. Statins kill people and hurt even more. All patients taking statins become depleted in CoQ10. People with a low CoQ10 level to start with - the elderly and heart failure patients - show CoQ10 deficiency in only 6 to 12 months. Younger, healthier people take several years to develop low CoQ10 levels, which cause muscle weakness and soreness, and heart failure

In my practice of 17 years in Tyler, Texas, I have seen a frightening increase in heart failure from statin use, or "statin cardiomyopathy." In the last 5 years, statins have become stronger, are being prescribed in higher doses, and are being used with reckless abandon in the elderly and in patients with "normal" cholesterol levels.
     We are in the midst of a CHF epidemic in the USA, with a dramatic increase over the past 10 years. Are we causing this epidemic through overuse of statins? In large part I think the answer is yes.
     Never before in history has the medical establishment knowingly (Merck has a pair of 1990 patents combining CoQ10 with statins to prevent CoQ10 depletion, so they do indeed know) created a life threatening nutrient deficiency in millions of otherwise healthy people. I see 2 to 3 new statin cardiomyopathies per week in my practice.
     A petition to the FDA was filed May 24, 2002, asking that this drug-nutrient interaction be stated in a black box warning on statin drug inserts. A comprehensive review of trials on the issue was also submitted to the FDA to support the request.
 
Title: Statin-Induced Cardiomyopathy
Author: Dr. Peter H. Langsjoen
Source: Introduction to the citizen's petition on statins from http://www.redflagsweekly.com/features/2002_july08.html.

 CoQ10 Did Not Improve Heart Function Measures

April, 2000 - We studied the effect of CoQ10 use on peak oxygen consumption (Vo2max), exercise duration, and ejection fraction. This was a randomized, double-blind, controlled trial of university and Veterans Affairs hospital patients. All 55 patients were class 3 or class 4 with EF less than 40% and peak oxygen consumption less than 17 ml/kg per minute. (less than 14 qualifies you for transplant)
     All patients were on standard drug therapy. Patients were randomly chosen to take either CoQ10 at 200mg per day or placebo. EF was measured by MUGA. Peak oxygen consumption and exercise duration were measured using an exercise test.
     Blood levels of CoQ10 went up from 0.95 to 2.2 micrograms/ml in patients taking CoQ10. However, ejection fraction, peak oxygen consumption, and exercise duration did not change in either group.
 
Source: Ann Intern Med. 2000 Apr 18;132(8):636-40.
Title: The effect of coenzyme Q10 in patients with congestive heart failure.
Authors: Khatta M, Alexander BS, Krichten CM, Fisher ML, Freudenberger R, Robinson SW, Gottlieb SS.
PMID: 10766682.


All information on this site is opinion only. All concepts, explanations, trials, and studies have been re-written in plain English and may contain errors. I am not a doctor. Use the reference information at the end of each article to search MedLine for more complete and accurate information. All original copyrights apply. No information on this page should be used by any person to affect their medical, legal, educational, social, or psychological treatment in any way. I am not a doctor. This web site and all its pages, graphics, and content copyright © 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, Jon C.

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