Does coenzyme Q10 offer any cardioprotective effect?
Circ Heart Failure published a nice review that looked at CoQ10 and heart failure a few years ago. Check out the summary picture of potential benefits.
Figure 1. Summary of potential mechanistic, physiological, and clinical benefits of Coenzyme Q10. LV indicates left ventricle; and NO, nitrous oxide.
Unfortunately most of the data we have about CoQ10 precedes our current approach to heart failure management for HFrEF, so it's difficult to comment on the value of this supplementation today. A meta-analysis, also attached, of more than 2000 patients from 14 trials found that CoQ10 decreases mortality in heart failure patients.
Figure 2. Forest plot of mortality
It also improved exercise tolerance, but not EF nor NYHA Class. While initially appearing promising, I am still stuck on the age of some of these trials - how much do they really apply to our practice today - and the fact that 14 trials only gave us about 2000 patients. The 2013 AHA/ACC heart failure guidelines said there is not enough data to recommend use of this supplement, and the 2017 update did not re-address.
When CoQ10 is given, a dose between 100 and 300mg daily seems to be the sweet spot, and there may be a slight benefit to the ubiquinol formulation. It is safe and generally well-tolerated at this level, though it can interact with warfarin and theophylline, and levels may be reduced when taken with a statin. The Circ review estimates the annual cost to be somewhere around $200-300.
My take-home is that there is not enough compelling data to actively initiate this supplement for my patients with HFrEF, but, in someone who is interested and can afford it, I am also not getting a big signal of harm. Unfortunately I don't anticipate seeing better data anytime soon. Hopefully these articles help you address this clinical question with your patients, and please do let me know if you have started CoQ10 for anyone in your panel, would appreciate hearing your rationale.
Lei L, Liu Y. Efficacy of coenzyme Q10 in patients with cardiac failure: a meta-analysis of clinical trials. BMC Cardiovascular Disorders. 2017;17(1). doi:https://doi.org/10.1186/s12872-017-0628-9
Sharma A, Fonarow GC, Butler J, Ezekowitz JA, Felker GM. Coenzyme Q10 and Heart Failure. Circulation: Heart Failure. 2016;9(4):e002639.
