Treatment of Heart Disease with CoenzymeQ10:
CoenzymeQ10 is known to be highly concentrated in heart
muscle cells due to the high energy requirements of this cell type. For
the past 14 years, the great bulk of clinical work with CoQ10 has focused
on heart disease. Specifically, congestive heart failure (from a wide
variety of causes) has been strongly correlated with significantly low
blood and tissue levels of CoenzymeQ1015.
The severity of heart
failure correlates with the severity of CoenzymeQ10 deficiency16.
This CoenzymeQ10 deficiency may well be a primary etiologic factor in
some types of heart muscle dysfunction while in others it may be a secondary
phenomenon. Whether primary, secondary or both, this deficiency of CoQ10
appears to be a major treatable factor in the otherwise inexorable progression
of heart failure.
Pioneering trials
of CoenzymeQ10 in heart failure involved primarily patients with dilated
weak heart muscle of unknown cause (idiopathic dilated cardiomyopathy).
CoQ10 was added to standard treatments for heart failure such as fluid
pills (diuretics), digitalis preparations (Lanoxin), and ACE inhibitors.
Several trials involved the comparison between supplemental CoQ10 and
placebo on heart function as measured by echocardiography. CoenzymeQ10
was given orally in divided doses as a dry tablet chewed with a fat containing
food or an oil based CoenzymeQ10 gel cap swallowed at mealtime. Heart
function, as indicated by the fraction of blood pumped out of the heart
with each beat (the ejection fraction), showed a gradual and sustained
improvement in tempo with a gradual and sustained improvement in patients'
symptoms of fatigue, dyspnea, chest pain, and palpitations. The degree
of improvement was occasionally dramatic with some patients developing
a normal heart size and function on CoenzymeQ10 alone. Most of these dramatic
cases were patients who began CoQ10 shortly after the onset of congestive
heart failure. Patients with more established disease frequently showed
clear improvement but not a return to normal heart size and function.
Internationally, there
have been at least nine placebo controlled studies on the treatment of
heart disease with CoenzymeQ10: two in Japan, two in the United States,
two in Italy, two in Germany, and one in Sweden17,18,19,20,21,22,23,24,25.
All nine of these CoenzymeQ10 studies have confirmed the effectiveness
of CoenzymeQ10 as well as CoQ10 remarkable safety. There have now been
eight international symposia on the biomedical and clinical aspects of
CoenzymeQ10 (from 1976 through 199326,27,28,29,30,31,32,33).
These eight CoenzymeQ10 symposia comprised over 300 papers presented by
approximately 200 different physicians and scientists from 18 different
countries. The majority of these CoenzymeQ10 scientific papers were Japanese
(34%), with American (26%), Italian (20%) and the remaining 20% from Sweden,
Denmark, Germany, United Kingdom, Belgium, Australia, Austria, France,
India, Korea, Netherlands, Poland, Switzerland, USSR, and Finland. The
majority of the CoenzymeQ10 clinical studies concerned the treatment of
heart disease and were remarkably consistent in their conclusions: that
treatment with CoQ10 significantly improved heart muscle function while
producing no adverse effects or drug interactions.
It should be mentioned
that a slight decrease in the effectiveness of the blood thinner, coumadin,
was noted in a case by a Norwegian clinician34.
This possible drug - CoenzymeQ10 interaction has not been observed by
other investigators even when using much higher doses of CoQ10 for up
to seven years and involving 25 patients treated with coumadin concomitantly
with CoQ10 (this is still, as of this date, unpublished data).
The efficacy and safety
of CoenzymeQ10 in the treatment of congestive heart failure, whether related
to primary cardiomyopathies or secondary forms of heart failure, appears
to be well established35,36,37,38,39,40,41,42.
The largest CoenzymeQ10 study to date is the Italian multicenter trial,
by Baggio et al., involving 2,664 patients with heart failure43.
The most recent work in heart failure examined the effect of CoQ10 on
diastolic dysfunction, one of the earliest identifiable signs of myocardial
failure that is often found in mitral valve prolapse, hypertensive heart
disease and certain fatigue syndromes44,45.
Diastolic dysfunction might be considered the common denominator and a
basic cause of symptoms in these three diagnostic groups of disease. Diastole
is the filling phase of the cardiac cycle. Diastolic function has a larger
cellular energy requirement than the systolic contraction and, therefore,
the process of diastolic relaxation is more highly energy dependent and
thus more highly dependent on CoQ10. In simpler terms, it takes more energy
to fill the heart than to empty it. Diastolic dysfunction is a stiffening
of the heart muscle which interferes with the heart's ability to function
as an effective pump. It is seen early in the course of many common cardiac
disorders and is demonstrable by echocardiography. This stiffening returns
towards normal with supplemental CoQ10 in tempo with clinical improvement.
It is important to note that in all of the above clinical trials, CoenzymeQ10
was used in addition to traditional medical treatments, not to their exclusion.
In one study by Langsjoen
et al46, of 109 patients with
essential hypertension, 51% were able to stop between one and three antihypertensive
drugs at an average of 4.4 months after starting CoenzymeQ10 treatment
while the overall New York Heart Association (NYHA) functional class improved
significantly from a mean of 2.40 to 1.36. Hypertension is reduced when
diastolic function improves. In another CoenzymeQ10 study39,
there was a gradual and sustained decrease in dosage or discontinuation
of concomitant cardiovascular drug therapy: Of 424 patients with cardiovascular
disease, 43% were able to stop between one and three cardiovascular drugs
with CoQ10 therapy. The authors conclude that the vitamin-like substance,
CoenzymeQ10, "may be ushering in the new era of cellular/biochemical treatment
of disease, complementing and extending the systems-oriented, macro and
microscopic approach that has served us well to this point".
See References
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