CoQ10 in clinical cardiovascular disease
Myocardial biopsies have confirmed that CoQ10 deficiency is quite common in cardiac patients: congestive heart failure, coronary artery disease, angina pectoris, cardiomyopathy, hypertension, and mitral valve prolapse as well as patients of coronary bypass surgery. All these conditions can share common symptoms such as extreme fatigue, chest discomfort, shortness of breath even when at rest.
CoQ10 can be administered in clinical settings for a wide variety of cardiovascular disease, including:
- Angina pectoris
- Unstable anginal syndrome
- Myocardial preservation during mechanical or pharmacological thrombosis
- Before, during and after cardiac surgery
- Congestive heart failure
- Diastolic dysfunction
- Toxin induced cardiotoxicity
- Essential and renovascular hypertension
- Ventricular arrhythmia
- Mitral valve prolapse
Many studies have shown a strong correlation between low blood levels and tissue levels of CoQ10. As well as the improvement seen with CoQ10 like in the heart’s pumping ability, improved left ventricular function, ejection fraction, exercise tolerance, diastolic dysfunction, clinical outcome and quality of life.
How Coq10 supports the failing heart
More energy is needed to fill the heart than to empty it, this makes CoQ10 a great supplement to improve diastolic cardiac function. Several studies have proven this fact. In one study of 109 patients with hypertension and isolated diastolic dysfunction, CoQ10 supplementation resulted in clinical improvement, lower high blood pressure, enhanced diastolic cardiac function, and decreased myocardial thickness in 53% of hypertensive patients.
In another study, a group of 424 patients with systolic and/or dyastolic dysfunction was administered 240 mg of CoQ10 for an 8 year period. The subjects were followed for 18 months. Only one side effect was noticed only, mild nausea, clearly demonstrating that CoQ10 is safe and effective for a different number of cardiovascular diseases including CHF and dilated cardiomyopathy, systolic and/or diastolic dysfunction in patients with hypertensive heart disease.
Dr Sinatra recommends that if any patient fails to respond to standard levels of CoQ10, it is essential to obtain a blood level of CoQ10. If this is not available, he recommends to double the standard dose of 90-150 mg, even triple it until the desired result happens.
Congestive heart failure (CHF)
CHF, together with dilated cardiomyopathy (end stage CHF), is one of the most challenging issues cardiologists have to deal with today. Most CHF patients have a low quality of life with a low survival rate, and in most cases drug therapy does not provide any relief.
CHF is a condition in which the heart muscle is so weak that is cannot pump effectively to the various areas of the body. This causes the blood to back up in the lungs and lower extremities and the space around the heart causing congestion. A heart like that is literally energy starved and patients experience fatigue and shortness of breath even with minimal exertion. The most common cause of CHF is coronary artery disease and the blockage of the arteries of the heart which can result in heart attacks. Longstanding untreated high blood pressure, toxic drugs, alcohol abuse, valvular heart disease etc can also cause CHF.
Dr. Sinatra treats cases of CHF with CoQ10 because it supports ATP recycling in the mitochondria of the cell, acts as an antioxidant, stabilizes cell membranes, and reduced platelet size.
Several studies have proven the efficacy of CoQ10 for treating CHF. In a study, the administration of CoQ10 decreased edema (fluid retention) by 79%, pulmonary edema by 78%, liver enlargement by 49%, venous congestion by 72%, shortness of breath by 53%, and heart palpitations by 75%. Improvements in at least three symptoms were noted in 54% of patients.
All this is key information that allow us to conclude that CoQ10 alleviates symptoms of CHF and improves quality of life.
A most recent investigation in the treatment of heart failure came out of the Lancisi Heart Institute in Italy. The team of investigators evaluated 21 patients with moderate to severe heart failure. All of them were assigned to four weeks of oral CoQ10 or a placebo with or without exercise training five times a week. They found that when the patients took CoQ10, the heart assessment test results and their ability to exercise without discomfort improved. This study also showed that in participants with heart failure the heart size decreased by 12% while the blood flow to the heart improved by 38% and the protective cholesterol levels increased as well.
The aging heart
Aging increases the death rate by 3 times, specially at the age of 70. CHF is also a bigger concern in these patients because the older the heart is the more prone it is to lack of oxygen and other stressors. What makes the aging heart more vulnerable is the low levels of coQ10., this is because aging depletes CoQ10.
During the first 20 years of life quantities of CoQ10 rise steadily 3 to 5 times, then they plateau if health is good. After the age of 40 there is a gradual decline in the amount of Coq10 a healthy body produces and it falls very rapidly at the age of 80. This is when congestive heart failure is most predominant. Fortunately our brains keep some level of CoQ10 stability so it is not until the age of 90 that CoQ10 levels really plummet, affecting brain functions such as memory, problem-solving ability and coordination.
So to the question, can CoQ10 help the aging heart? The answer was found in a research which demonstrated the overwhelming cardio protective benefit of CoQ10. In one clinical trial, researchers demonstrated that a daily regiment of 300 mg of CoQ10 for two weeks prior to cardiac surgery increased the CoQ10 content in cardiac muscle, mitochondrial energy production and offered myocardial protection during heart surgery.
In another study the same group of researchers demonstrated that in the older heart, CoQ10 helped in the ability of the heart to sustain cardiac workload by 28% compared to non-treated hearts.
All this evidence proves that although the aging heart is very vulnerable to lack of oxygen, it responds very well to CoQ10 supplementation. This includes all those patients recovering from any cardiac procedure, heart attacks. For this reason, even if there is not an evident stressor, anyone after the age of 70 should supplement with CoQ10.
Patients with this condition are particularly more vulnerable to CoQ10 deficiency. Cardiomyopathy is a condition in which the muscle tissue of the heart has become damaged, diseased, enlarged or stretched out, leaving the muscle fibers weakened. Like congestive heart failure, cardiomyopathy is associated with major CoQ10 deficiency.
In a study by the ‘European Journal of Nuclear Medicine’, researchers were able to document and measure a significant therapeutic effect of CoQ10, proving that even small doses can have great implications for some patients with dilated cardiomyopathy.
Other studies done on patients awaiting cardiac transplantation, was done to determine if CoQ10 could improve the pharmacological bridge to transplantation. The results showed three different findings:
- A significant increase in CoQ10 blood levels
- Increases in exercise tolerance and less shortness of breath
- Fewer episodes of nocturnal urination.
Systolic blood pressure reflects the amount of pressure needed to open the aortic valve for each contraction of the heart, and diastolic pressure is a measurement of the pressure (resistance to blood flow) on the other side of the aortic valve against which the heart pumps. Diastolic pressure also reflects the amount of muscle tone in the vascular walls that press the blood through the arteries. Both these pressure levels need to be balanced: high enough for optimum circulation but not so high that excess wear and tear of the cardiovascular system occurs.
Research done in the 1980’s showed that hypertensive patients have low levels of CoQ10. Several years later follow-up studies confirmed that just 100 mg of CoQ10 a day lowered both diastolic and systolic blood pressure following 12 weeks of administration.
In another study, 46 men and 35 women with systolic hypertension and normal diastolic blood pressure underwent a 12 week trial in which they received either a 60 mg/day of hydrosoluble COQ10 Gel containing 150 IU of vitamin E or a placebo containing only vitamin E. Some subjects without hypertension were enrolled as controls and were also given CoQ10 therapy. Over the study period the group receiving CoQ10 experienced a drop in hypertension, and no change was observed in the group that received only vitamin E alone or in the control group. And there was a significant rise in CoQ10 levels in the blood. 55% of the patients in the CoQ10 group responded by achieving a reduction in systolic blood pressure of 25 mm Hg. The absence of response in the remaining 45% suggests the possibility of a threshold effect in CoQ10 ‘s mechanism of action. It is possible that a higher dose of CoQ10 may have increased the number of responders in the study.
These and other studies have confirmed what Dr. Sinatra has been practicing with his patients, CoQ10 is a great addition to a high blood pressure health protocol. He was even able to reduce at least half of their cardiac medications.
Dr. Sinatra considers CoQ10 the best way to lower hypertension. It all the studies CoQ10 has consistently been proven to lower high blood pressure in both systolic and diastolic pressure in patients with uncontrolled or poorly controlled blood pressure. What is in CoQ10 that makes this possible? CoQ10 may indirectly influence vascular function by preventing the oxidative damage to LDL, as well as by improving blood sugar control. Since oxidative damage to LDL, insulin resistance and elevation in plasma glucose concentrations can increase oxidative stress, the damage within the arterial wall is a critical event in the development of vascular dysfunction and even atherosclerosis. In a study with type 2 diabetics treated with 200 mg of CoQ10 a day, there was a significant reduction in glycated hemoglobin which is suggestive of improved sugar control and insulin resistance. More researchers have found impressive reductions in fasting glucose and insulin concentrations in patients treated with CoQ10, especially hypertensive patients who also suffered diabetes. This evidence suggests that coQ10 can reduce oxidative stress within the arterial wall via its antioxidant mechanism.
CoQ10 is also protective of the lining of small vessels and serves as an endothelial cell protector.
This condition, known for a ‘squeezing’, pressure or burning-like chest pain , or ‘heart cramp’, is caused by an insufficient supply of oxygen to the heart tissues, which drains them of energy and makes them vulnerable. This deprivation of oxygen is almost always caused by atherosclerotic plaque formation in the blood vessels feeding the heart, called coronary artery disease. Intense cold, physical exertion, or emotional stress may cause an increased need for oxygen and result in symptoms of angina too. Dr. Sinatra also treats patients with angina with CoQ10. It has been found to be effective in several small studies of patients with angina. Just 150 ml of Coq10 a day decreased the frequency of anginal episodes, a 54% reduction in the number of times nitroglycerin was needed and an increase of exercise time during treadmill test.
One study stands out in proving how CoQ10 increases exercise tolerance and decreases the frequency of anginal attacks. In this study, 15 patients with chronic stable angina were enrolled in a double blind placebo controlled crossover trial. Participants took 600 mg of CoQ10, a placebo or a combination of anti-anginal drugs. Results of the three interventions were compared. CoQ10 was shown to provide a significant reduction of exercise induced electrocardiographic abnormalities during stress testing when compared to placebo. A reduction in exercise systolic blood pressure without any changes in diastolic blood pressure or heart rate.
The mechanisms by which CoQ10 improves exercise capacity are not fully understood. But some possible explanations are that CoQ10 has beneficial effects on increasing energy metabolism delaying the onset of anginal symptoms. Also it is possible that its free radical reduction, or a combination of both had to do with the results. CoQ10 is an excellent adjunct strategy to angina pectoris sufferers. A dose of 180-360 mg/day is a good start or higher if there are no results.
Arrhythmia frequently occurs in the setting of a heart attack because the oxygen deprived heart is electrically unstable and heart cells then fire randomly.
By stabilizing the membranes of the electrical conduction system, CoQ10 can make it harder for arrhythmia to start in the first place. All the studies done have been on animal models. But the results have proven promising: reduced free radical stress, for blood clotting dissolving therapy during an acute heart attack, angioplasty, and coronary artery bypass surgery.
In one study of 27 patients with abnormal heart beat, reduction in premature ventricular contraction activity was significantly greater after four to five weeks of CoQ10 administration, 60 mg/day. This reduction of palpitations was also seen in diabetics, and hypertensives.
CoQ10 can have an effect on shortening the interval between heartbeats on the electrocardiogram, that may be of benefit for the period immediatly after a heart attack.
The good effects of CoQ10 on reducing oxidative damage, while at the same time controlling arrhythmia potential, suggests coQ10 is a logical treatment of choice in acute heart attack.
CoQ10 appears to be of great value in any case of acute coronary insufficiency, whether from angina, heart attack, congestive heart failure or any coronary heart procedures.
Myocardial protection in cardiac surgery
Pretreating surgical candidates with CoQ10 during cardiac operations has been proven to provide a great deal of protection because the heart is placed under a great deal of metabolic stress that significantly affects the function of the heart following surgery. This has resulted in proven improvement in right and left ventricular myocardial structure.
CoQ10 is effective in preserving heart function following CABG (coronary artery bypass graft surgery) and valve repair surgery and protects the heart against injury. In CABG patients, CoQ10 was proven to have higher myocardial performance and lower requirements for cardiac drugs that help support the heart while coming off heart lung-bypass.
Coronary artery disease and fat oxidation
Coronary artery disease is a condition in which the arteries that supply blood to the heart muscle become clogged by atherosclerotic plaque that is deposited on the walls of the artery by oxidized low density lipoprotein (LDL). If plaque buildup is allowed to proceed, coronary artery disease can eventually lead to heart attacks that will kill portions of the heart. Heart attacks are the direct result of energy starvation, caused by the inability of the heart to supply enough oxygen-rich blood to keep the energy furnaces burning. This reduction of blood supply is called ischemia.
Several studies have proven that CoQ10, because it is a fat soluble nutrient, can act as a potent antioxidant of fats, including cholesterol and its components.
In a study by the ‘Heart Research Institute’ in Sidney, Australia researchers found that CoQ10, 100mg 3 times a day, for 11 days increased resistance of LDL to the oxidation process. This has enormous implications since the oxidation of LDL appears to be the key step in atherosclerosis.
These results were taken even further in a 2003 report in the scientific journal Molecular and Cellular Biochemistry, this study studied 144 patients with classic symptoms of acute myocardial infarction (AMI), or heart attack. Patients were followed for one year. This study showed for the first time that treatment with CoQ10 was associated with significant decline in total cardiac events, including nonfatal heart attacks and cardiac deaths, probably because of its rapid protective effects on blood clot formation (thrombosis), endothelial function, and prevention of oxidative damage (free radicals).
No other study has researched this, and it is highly significant because studies like these indicate that treatment with CoQ10 within 72 hours of infarction may be associated with a significant decline in total cardiac events, decreased risk of atherosclerosis, increased blood levels of vitamin E helping inhibit LDL oxidation and reduced oxidative damage to the heart by fighting free radicals and reducing injury.
Concluding, Co-enzyme Q10 has proven to be of great importance in the energy production of the heart. It is so important that the body will make its own under healthy circumstances. However, since there are many factors that can influence its availability, it is important to consider supplementing with CoQ10, as part of a health regiment that includes the other vital nutrients: D-Ribose, L-Carnitine, and magnesium, together with the ‘Heart and Body Extract’, a sensible diet and moderate exercise.
Thank you for reading.
(1) Sinatra, Stephen T. The Sinatra Solution: Metabolic Cardiology. Laguna Beach, CA: Basic Health, 2011. 59-100. Print.