Q10 and the standard of treatment for heart failure

Good reason to be happy: “Long-term CoQ10 treatment of patients with chronic heart failure is safe, improves symptoms, and reduces major adverse cardiovascular events” … including … significantly lower cardiovascular mortality, all-cause mortality, and incidence of hospital stays for heart failure.

In March 2015, in a letter addressed to the Journal of the American College of Cardiology, Dr. Svend Aage Mortensen urged that adjunctive treatment with a Coenzyme Q10 supplement become part of the guidelines for treating chronic heart failure. His message was that the results of the 420-patient Q-Symbio study have shown that Q10 supplementation together with conventional therapy will give patients:

• Improved symptoms (= improved quality of life)
• Improved survival rates (= more time with family and friends)
• Fewer hospitalizations (= less expense for patients and health care systems)

Poor prognosis for heart failure patients
Dr. Mortensen pointed out that chronic heart failure is a debilitating condition with a poor prognosis even with the drug therapies and medical device therapies that are currently available.

Please notice: even with the standard of treatment advocated at present by the American College of Cardiology and the American Heart Association for treating patients with heart failure, the prognosis for heart failure patients is poor.

Adequate Q10 supply is vital for normal cell function
Meanwhile, we know that Coenzyme Q10, a natural substance that is produced in the body, is vital for the functioning of all cells and especially for the functioning of the heart muscle cells.  We know that, after reaching a peak at ages 20 – 24 years, the body’s production of Coenzyme Q10 (in the ubiquinone form) decreases with increasing age. We know that statin medications inhibit the body’s production of Coenzyme Q10.  Coenzyme Q10 supplementation restores to the body a supply of a vital natural substance that is needed for cellular energy production and for cellular antioxidant protection.

Q10 shown to be safe in 200 studies
We know, moreover, that Coenzyme Q10 supplementation has been shown to be safe in as many as 200 studies of the use of ubiquinone supplements.

Q10 approved as a medical drug in Hungary
In the European Union, the ubiquinone Q10 preparation (Myoquinon) that was used in the Q-Symbio Study is licensed medicinal drug approved for adjunctive treatment of heart failure by the medical authorities in Hungary.  That means that the Q-Symbio ubiquinone Q10 preparation has been subjected to and has passed the same sort of drug approval process in Hungary, a European Union member state, as is required by the FDA in the United States.

Q10 effect acknowledged in 2005 guidelines
In his 2015 letter, Dr. Mortensen wrote that the 2005 guidelines for the treatment of heart failure promulgated jointly by the American College of Cardiology and the American Heart Association acknowledged that Coenzyme Q10 can have a positive effect in the treatment of heart failure patients.  However, in 2005, the authorities stopped short of recommending Q10 as part of the guidelines for treatment.  They asked for more data.

Robust documentation for Q10 in heart failure treatment
Now, the publication of the statistically significant results of the Q-Symbio study in 2014 — together with the known results from three well-designed meta-analyses of the effect of Q10 (in the ubiquinone form) in heart failure patients —  has given us robust documentation.  Dr. Mortensen considered that it is time to add adjunctive Coenzyme Q10 treatment to the conventional standard of treatment for heart failure patients.

Summary of conventional heart failure guidelines
For those of you who wonder what the conventional standard of treatment is, here is a brief summary. Which of these medications are prescribed will vary according to the needs of the individual patient.

• Beta blockers (used to reduce blood pressure)
• Angiotensin-converting-enzyme (ACE) inhibitors or angiotensin-receptor blockers (used for high blood pressure)
• Diuretics (used if the patient is retaining extra fluid in his body)
• Digoxin (used for some patients to treat a specific type of irregular heartbeat, chronic atrial fibrillation)
• Nitrates and hydralazine in combination (used as a vaso-dilator, particularly for some African American patients; may be used instead of angiotensin-converting enzyme inhibitors if the ACE inhibitors are poorly tolerated)
• Aldosterone antagonists (used for some patients as a form of type of potassium-sparing diuretic)
• Anticoagulants or other types of anti-clotting medications (used to decrease the blood’s ability to clot if, for example, the patient has the heart rhythm abnormality called atrial fibrillation)
• Other medications (used as deemed necessary for the reduction of high cholesterol, high blood pressure, and atrial fibrillation if the heart failure patient has these health problems)

Conventional treatments limit; Q10 supplementation enhances
Please take note of the point that Dr. Mortensen was making in his letter (1).  All of these conventional treatments have as their objective the blocking or the reducing of some activity in the body.

A well-absorbed Coenzyme Q10 supplement, on the other hand, when used as an adjunctive treatment of heart failure, has the effect of enhancing two activities in the body, firstly, the production of energy in the cells, and, secondly, the protection of the cells against oxidative damage.

Q10 to energize the heart muscle
By advocating the use of Coenzyme Q10 as an adjunctive therapy for heart failure patients, Dr. Mortensen was saying that we should help heart failure patients to become more normal in their attempts to produce energy in the heart muscle cells.

What can we do?
If the American College of Cardiology and the American Heart Association continue to be super cautious and hesitate to add Coenzyme Q10 supplementation to the standard of treatment for heart failure patients, we can make our friends and family members aware of the benefits of Q10 supplementation.  We can provide them with the information they need to decide to take a good well-absorbed Q10 supplement on their own.

Dr. Mortensen’s message about Q10 and the failing heart
Yes, of course, our friends and family members should advise their cardiologist that they are taking a Q10 supplement.  They should show the cardiologist the report in the Journal of the American College of Cardiology on the positive effects in the Q-Symbio study.

No drug in the guidelines that does what Q10 does
They should tell their cardiologist that Dr. Mortensen thought that heart failure is an energy starvation condition in the heart muscle.  There is no drug in the current treatment guidelines in the USA that directly affects the energy production in the failing heart.  Coenzyme Q10 should be regarded as a treatment option because it enhances energy production in the failing heart.

Read our key article on CoQ10 as adjuvant therapy for heart failure

Sources:

1. Mortensen, S. A. (2015). Coenzyme Q10: will this natural substance become a guideline-directed adjunctive therapy in heart failure?. JACC. Heart Failure, 3(3), 270-271. doi:10.1016/j.jchf.2014.12.006
2. Mortensen SA, Rosenfeldt F, Kumar A, et al. The Effect of Coenzyme Q10 on Morbidity and Mortality in Chronic Heart Failure: Results From Q-Symbio: A Randomized Double-Blind Trial. JACC. Heart Failure. 2014;():. doi:10.1016/j.jchf.2014.06.008.