315:
Altogether, meta-analyses by Soja et al., Sander et al., and Fotino et al. have found significant improvements in ejection fraction. A total of 21 placebo-controlled trials have evaluated the efficacy of CoQ10 in heart failure, including Q-SYMBIO. Only three of these studies did not find any effects,
113:
and a team of researchers assigned 420 patients with moderate to severe chronic heart failure to
Coenzyme Q10 100 milligrams three times daily or matching placebos in addition to the patients' standard heart failure therapies for two years. The patients in the Coenzyme Q10 adjunctive treatment
335:
There was a significant reduction (p = 0.015) of cardiovascular mortality in the Q10 treatment arm as compared with the placebo group (5.9% vs. 12.6%, a relative reduction of 53%). The long-term supplementation with a combination of 200 mg/day of CoQ10 capsules (Bio-Quinone 100 mg twice
810:
Alehagen, U.; Johansson, P.; Björnstedt, M.; Rosén, A.; Dahlström, U. (2013). "Cardiovascular mortality and N-terminal-proBNP reduced after combined selenium and coenzyme Q10 supplementation: a 5-year prospective randomized double-blind placebo-controlled trial among elderly
Swedish citizens".
278:
patients (again, patients classified NYHA III and IV) randomly in a placebo arm and in a Q10 treatment arm in which the patients received a daily dosage of 2 mg per kilogram of body weight for the period of a year. The study focused on the need of hospitalization and on the incidence of
339:
The significantly reduced mortality from heart disease associated with the combined
Coenzyme Q10 and selenium treatment, compared to the placebo treatment, persisted during 12 years of follow-up. Professor Alehagen and his co-researchers carried out a number of sub-studies to investigate the
294:
The number of patients in the
Morisco study who required hospitalization for worsening heart failure was significantly smaller (p < 0.001) in the Q10 treatment arm (n = 73, 22.8%) than in the control arm (n = 118, 36.6%), a relative reduction of 37.7% in required hospitalizations.
264:
The
European sub-group study provides confirmatory evidence that the treatment with 300 mg/day of Coenzyme Q10 in additional to conventional heart failure therapy is safe, well tolerated, and effective in improving the symptoms and survival of chronic heart failure patients.
324:
It is known that the ability of the human body to synthesize CoQ10 declines with age and that it may therefore be necessary to supplement the diet of senior citizens with Q10. Alehagen et al. have reported on the results of the Kisel-10 study, a five-year prospective randomized
194:(MACE), which was the primary long-term endpoint in the trial, was statistically significantly fewer (p < 0.005) in the Q10 treatment arm (N = 30, 15%) than in the placebo arm (N = 57, 26%), corresponding to a 42.3% relative reduction in risk of MACE events.
298:
Moreover, in the
Morisco study, the number of the episodes of pulmonary edema (20/319, 6.3% versus 51/322, 15.8%) and cardiac asthma (97/319, 30.4% versus 198/322, 61.5%) was significantly reduced (p < 0.001) in the Q10 arm as compared to the control arm.
64:. The results of the Coenzyme Q10 treatment were even more impressive in the European sub-study. Treatment with Coenzyme Q10 300 milligrams per day in addition to conventional heart failure medications was safe, well tolerated, and effective at reducing
851:"Still reduced cardiovascular mortality 12 years after supplementation with selenium and coenzyme Q10 for four years: A validation of previous 10-year follow-up results of a prospective randomized double-blind placebo-controlled trial in elderly"
336:
daily) and 200 μg/day of organic selenium yeast tablets (SelenoPrecise 200 μg) reduced cardiovascular mortality. The positive effects could also be seen in N-terminal pro b-type natriuretic peptide (NT-proBNP) levels and on echocardiography.
222:
The number of hospital stays for heart failure during the 106 weeks was statistically significantly lower (p = 0.033) in the Q10 treatment arm (N = 17, 8%) as compared to the control arm (N = 31, 14%), a relative reduction of 42.8%.
249:
In 2019, AL Mortensen, FL Rosenfeldt, and KJ Filipiak evaluated the treatment effect of
Coenzyme Q10 adjuvant treatment in the European sub-population of the Q-SYMBIO clinical trial. In the European sub-group, ejection fraction and
306:
with CoQ10 in addition to conventional therapy significantly reduced the number of hospitalizations for worsening of heart failure and the incidence of serious complications in patients with chronic congestive heart failure.
340:
mechanisms by which the combined supplementation reduced the risk of heart disease. They identified reduced bio-markers of oxidative stress, inflammation, and fibrosis as possible mechanisms explaining the study results.
273:
The results of the Q-SYMBIO clinical trial build on the earlier results from the multi-center randomized placebo-controlled double-blind clinical trial that was reported in 1993 by
Morisco et al. That study enrolled 641
238:
used in the Q-SYMBIO clinical trial may have resulted in the patients reaching a required "therapeutic threshold in serum and tissue of CoQ10" needed to reduce the number of major adverse cardiovascular events.
114:
group had significantly fewer major adverse cardiovascular events, significantly reduced risk of cardiovascular death and all-cause death, and significantly fewer hospital stays for heart failure complications.
45:
Not until the end of the clinical trial did the researchers and the patients find out which patients were receiving the active
Coenzyme Q10 treatment and which patients were receiving the placebo treatment.
214:
Altogether, there were statistically significantly fewer (p = 0.018) deaths from all causes in the Q10 treatment arm (N = 21, 10%) than in the control arm (N = 39, 18%), a relative reduction of 44.4%.
96:
drug
Coenzyme Q10 on several short-term and long-term endpoints in a total of 420 chronic heart failure patients enrolled in 17 cardiology centers in Europe, Asia, and Australia from 2003 to 2010.
122:
The dosage of CoQ10 administered to the active treatment arm of the Q-SYMBIO trial was 100 milligrams three times daily, a dosage large enough to raise blood serum levels of Q10 significantly.
140:
The mean duration of heart failure was around three years in both arms of the trial, and the baseline ejection fraction and six-minute-walking-time distances were equal between the groups.
154:
The dosages of the medications were only infrequently modified during the trial, so it is unlikely that minor changes in medication should have influenced the outcome of the trial.
60:
A later sub-analysis including only the European segment of the Q-Symbio Study showed that the Coenzyme Q10 therapy was also positively associated with a significant improvement in
511:
Weis, M.; Mortensen, S.; Rassing, M.; Møller-Sonnergaard, J.; Poulsen, G.; Rasmussen, S. (1994). "Bioavailability of four oral coenzyme Q10 formulations in healthy volunteers".
131:
911:
Littarru, G.P. (1994). "Location and function of Coenzyme Q in the respiratory chain. In Energy and Defense: Facts and Perspectives on Coenzyme Q10 in Biology and Medicine".
461:
Folkers, K.; Moesgaard, S.; Morita, M. (1994). "A one year bioavailability study of coenzyme Q10 with 3 months withdrawal period. Molecular Aspects Of Medicine".
170:, and 6MWT (6-Minute Walk Test) in both treatment groups, but there were no significant differences between the groups. There was a trend with a 20% reduction of
89:
21:
177:
Retrospectively, at this time cardiovascular deaths were already significantly lower in the CoQ10 group, but this was not a pre-specified endpoint at week 16.
206:
lower (p = 0.026) in the Q10 treatment arm (N = 18, 9%) than in the control arm (N = 34, 16%), a relative reduction of 43.8% in risk of cardiovascular death.
674:
Sander, S.; Coleman, C.; Patel, A.; Kluger, J.; White, C (2006). "The impact of coenzyme Q10 on systolic function in patients with chronic heart failure".
376:
Additional available Q10 may increase the stability of the "mitochondrial permeability transition pore" and thereby protect the heart muscle against
261:
despite the greater adherence to guideline-directed therapy in the European sub-group than in the entire group of chronic heart failure patients.
257:
The researchers concluded that the evidence from the European sub-group analysis re-affirms the evidence of the therapeutic efficacy of the CoQ10
316:
and the outcome in those three trials could possibly be attributed to low compliance rates in the treatment arm or to flaws in the study design.
373:
Additional available Q10 may increase energy production in the heart muscle cells, thus impeding the "vicious metabolic cycle" in heart failure.
643:
Soja, A.; Mortensen, S. (1997). "Treatment of congestive heart failure with coenzyme Q10 illuminated by meta-analyses of clinical trials".
600:
Morisco, C. (1993). "Effect of coenzyme Q10 therapy in patients with congestive heart failure: a long-term multicenter randomized study".
419:"The Effect of Coenzyme Q10 on Morbidity and Mortality in Chronic Heart Failure: Results From Q-SYMBIO: A Randomized Double-Blind Trial"
191:
134:
functional classes III (marked limitation of physical activity) or IV (unable to carry out any physical activity without discomfort).
920:
544:"Effect of Coenzyme Q10 in Europeans with Chronic Heart Failure: A Sub-Group Analysis of the Q-SYMBIO Randomized Double-Blind Trial"
366:
et al. posit four explanations for the effect of Q10 on the improvement of symptoms and survival of chronic heart failure patients:
332:
trial among Swedish citizens aged 70 to 88. 443 participants given combined supplementation of selenium and CoQ10 or a placebo.
1053:"Coenzyme Q10 therapy before cardiac surgery improves mitochondrial function and in vitro contractility of myocardial tissue"
137:
The age of the patients in years was 62.3 +/- 12. The ratio of male patients to female patients was roughly three to one.
493:
144:
762:
Kalén, A.; Appelkvist, E.; Dallner, G. (1989). "Age-related changes in the lipid compositions of rat and human tissues".
1098:
275:
203:
50:
38: treatment of 100 milligrams three times daily for two years. The other half of the patients got inactive
1010:
Belardinelli, R.; Muçaj, A.; Lacalaprice, F.; Solenghi, M.; Seddaiu, G.; Principi, F.; Littarru, G. (2006).
54:
167:
147:
enzyme inhibitors or angiotensin receptor blockers, and 75% of the patients in the study were receiving
57:
death and death from all causes and significantly fewer hospital stays for heart failure complications.
42:
capsules daily for two years. All of the patients continued their standard heart failure medications.
862:
377:
363:
231:
110:
104:
27:
979:
Haas, R. (2007). "The evidence basis for coenzyme Q therapy in oxidative phosphorylation disease".
383:
Additional available Q10 may improve endothelial function and may protect the heart muscle against
251:
163:
961:
787:
625:
329:
326:
303:
254:
improved significantly, and both all-cause and cardiovascular mortality decreased significantly.
99:
The trial name Q-SYMBIO reflects the focus on the following elements in the clinical trial: Q =
1074:
1033:
992:
953:
916:
890:
828:
779:
744:
691:
656:
617:
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524:
474:
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61:
1064:
1023:
984:
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771:
734:
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683:
648:
609:
565:
555:
516:
466:
430:
280:
258:
93:
92:: Heart Failure in September 2014. The purpose of the study was to assess the effect of the
1051:
Rosenfeldt, F.; Marasco, S.; Lyon, W.; Wowk, M.; Sheeran, F.; Bailey, M.; Pepe, S. (2005).
384:
284:
243:
235:
866:
885:
850:
739:
710:
570:
543:
288:
130:
The patients were selected for the Q-SYMBIO trial if they had chronic heart failure in
85:
17:
949:
652:
1092:
520:
470:
69:
31:
965:
629:
791:
687:
148:
100:
35:
875:
824:
1069:
1052:
352:
202:
The total number of cardiovascular deaths during the 106 weeks of the study was
30:
and a team of researchers enrolled 420 patients with moderate to severe chronic
1028:
1011:
988:
435:
418:
730:
171:
1078:
1037:
996:
957:
894:
832:
748:
695:
579:
444:
783:
660:
621:
560:
528:
478:
359:
Biological Mechanisms Explaining the Improvement of Heart Failure Symptoms
709:
Fotino, A.; Thompson-Paul, A.; Bazzano, L.; Kluger, J.; White, C (2013).
370:
Additional available Q10 may improve the respiratory rate in heart cells.
302:
The Morisco study authors concluded that their results demonstrated that
174:
in the CoQ10 group and a proportional rise of 12% in the placebo group.
849:
Alehagen, Urban; Aaseth, Jan; Alexander, Jan; Johansson, Peter (2018).
775:
613:
234:
et al. hypothesize that the dosage (100 mg three times daily) and
65:
39:
348:
242:
The formulation used in the trial has been demonstrated to have good
84:
study was a multi-center randomized placebo-controlled double-blind
355:
and CoQ10. Oral Coenzyme Q10 supplements replace the lost CoQ10.
936:
Opie, L. (2004). "The metabolic vicious cycle in heart failure".
542:
Mortensen, A.L.; Rosenfeldt, F.; Filipiak, K.J. (March 5, 2019).
1012:"Coenzyme Q10 and exercise training in chronic heart failure"
351:
are known to block the biological pathway that produces both
423:
Journal of the American College of Cardiology, Heart Failure
494:"Coenzyme Q10 adjuvant therapy for chronic heart failure"
311:
Meta-analyses of the Efficacy of Q10 in Heart Failure
49:
The patients in the Coenzyme Q10 treatment group had
16:
The Q-Symbio study was an international multi-center
1057:The Journal of Thoracic and Cardiovascular Surgery
715:supplementation on heart failure: a meta-analysis"
143:90% of the patients in the study were receiving
913:Roma: Casa Editrice Scientifica Internazionale
90:Journal of the American College of Cardiology
22:Journal of the American College of Cardiology
8:
719:The American Journal of Clinical Nutrition
181:Long-Term Effects (106 weeks of treatment)
158:Short-Term Effects (16 weeks of treatment)
1068:
1027:
884:
874:
738:
569:
559:
434:
944:(9447) (364(9447) ed.): 1733–1734.
396:
162:At week 16, there were improvements in
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904:
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7:
595:
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591:
589:
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400:
1022:(22) (27(22) ed.): 2675–2681.
813:International Journal of Cardiology
417:Mortensen, S.A.; Kumar, A. (2014).
192:Major Adverse Cardiovascular Events
186:Major Adverse Cardiovascular Events
72:of chronic heart failure patients.
24:: Heart Failure in September 2014.
819:(5) (167(5) ed.): 1860–1866.
34:. Half of the patients received a
14:
983:. 7 Suppl (7 ed.): 136–145.
107:status , and long-term Outcome .
218:Hospital Stays for Heart Failure
770:(7) (24(7) ed.): 579–584.
1063:(1) (129(1) ed.): 25–32.
688:10.1016/j.cardfail.2006.03.007
1:
950:10.1016/S0140-6736(04)17412-6
653:10.1016/s0098-2997(97)00042-3
645:Molecular Aspects of Medicine
513:Molecular Aspects of Medicine
463:Molecular Aspects of Medicine
876:10.1371/journal.pone.0193120
825:10.1016/j.ijcard.2012.04.156
521:10.1016/0098-2997(94)90038-8
471:10.1016/0098-2997(94)90039-6
1070:10.1016/j.jtcvs.2004.03.034
204:statistically significantly
1115:
989:10.1016/j.mito.2007.03.008
676:Journal of Cardiac Failure
647:. 18 Suppl (18): 159–168.
436:10.1016/j.jchf.2014.06.008
344:Individuals Taking Statins
269:The Morisco Clinical Trial
236:the formulation of the Q10
132:New York Heart Association
602:The Clinical Investigator
227:Discussion of the Results
88:that was reported in the
20:that was reported in the
1029:10.1093/eurheartj/ehl158
276:congestive heart failure
198:Cardiovascular Mortality
731:10.3945/ajcn.112.040741
246:in controlled studies.
103:and SYMBIO = SYMptoms,
1016:European Heart Journal
145:angiotensin-converting
897:– via e0193120.
711:"Effect of coenzyme Q
561:10.5603/CJ.a2019.0022
515:. 15 Suppl: s273-80.
492:Morrill, RL. (2019).
465:. 15 Suppl: s281-5.
378:apoptotic cell death
867:2018PLoSO..1393120A
608:(8 Suppl): S134-6.
252:NYHA classification
210:All-cause Mortality
164:NYHA classification
111:Professor Mortensen
28:Professor Mortensen
776:10.1007/BF02535072
614:10.1007/bf00226854
548:Cardiology Journal
330:placebo-controlled
304:adjuvant treatment
279:life-threatening
62:ejection fraction
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259:adjuvant therapy
244:bio-availability
94:adjuvant therapy
53:reduced risk of
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1099:Clinical trials
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861:(4): e0193120.
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320:Senior Citizens
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285:pulmonary edema
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78:
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11:
5:
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554:(2): 147–156.
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289:cardiac asthma
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190:The number of
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86:clinical trial
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70:survival rates
68:and improving
18:clinical trial
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981:Mitochondrion
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725:(2): 268–75.
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682:(6): 464–72.
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55:heart disease
52:
51:significantly
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32:heart failure
29:
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23:
19:
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498:Q10facts.com
497:
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429:(6): 641–9.
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327:double-blind
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36:Coenzyme Q10
26:
15:
353:cholesterol
281:arrhythmias
391:References
915:: 14–22.
364:Mortensen
232:Mortensen
172:NT-proBNP
168:VAS score
105:BIomarker
1093:Category
1079:15632821
1038:16882678
997:17485245
966:45301156
958:15541431
895:29641571
855:PLOS ONE
833:22626835
749:23221577
696:16911914
630:26973909
580:30835327
445:25282031
126:Patients
82:Q-Symbio
66:symptoms
886:5894963
863:Bibcode
792:4052688
784:2779364
740:3742297
661:9266518
622:8241697
571:8086660
529:7752839
479:7752840
349:Statins
76:Purpose
40:placebo
1077:
1036:
995:
964:
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938:Lancet
919:
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764:Lipids
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443:
287:, and
118:Dosage
962:S2CID
788:S2CID
626:S2CID
1075:PMID
1034:PMID
993:PMID
954:PMID
917:ISBN
891:PMID
829:PMID
780:PMID
745:PMID
692:PMID
657:PMID
618:PMID
576:PMID
525:PMID
475:PMID
441:PMID
80:The
1065:doi
1061:129
1024:doi
985:doi
946:doi
942:364
881:PMC
871:doi
821:doi
817:167
772:doi
735:PMC
727:doi
684:doi
649:doi
610:doi
566:PMC
556:doi
517:doi
467:doi
431:doi
101:Q10
1095::
1073:.
1059:.
1055:.
1032:.
1020:27
1018:.
1014:.
991:.
960:.
952:.
940:.
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