Sense and Nonsense of Dietary Supplements

Scientific evaluation of Cardiovascular health benefits of dietary supplements

coq10

Coenzyme Q10

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Coenzyme Q10 is found in high concentrations in the mitochondria (power house) of every cell, it is involved in the energy metabolism (electron transport) of cells. As an energy (electron) carrier, the CoQ10 molecule is continually going through an oxidation-reduction cycle. As it accepts electrons, it becomes reduced (Ubiquinol) and becomes oxidized again (Ubiquinone) as it gives up electrons. As such it is a powerful antioxidant that prevents oxidative stress caused by our body’s energy metabolism. Because nearly all cellular functions depend on an adequate energy supply, CoQ10 deficiency is felt by all cells and particularly by those with high energy consumption, such as cardiac muscle cells, nerve cells and cells of the immune system.

CoQ10 can be synthesised by the body and therefore there is no need for CoQ10 in diets of healthy individuals. There are, however, a number of reported health benefits that can be achieved in populations with either hypertension, heart failure, dementia or people that take statins. Below the specific cardiovascular disease related health benefits of CoQ10 will be summarized.


Hypertension

Two meta-analyses one consisting of 3 clinical trials containing a total of 96 participants and one of 12 trials and 362 patients showed that treatment with CoQ10 in subjects with high blood pressure resulted in mean decreases in 11-17 mmHg in systolic and 7-10 mmHg in diastolic blood pressure without significant side effects ( 1, 2 ). A third meta-analysis concluded that favourable effects of CoQ10 on heart function (ejection fraction, exercise tolerance, cardiac output, and stroke volume) have been demonstrated in the literature, but that further research is needed to recommend CoQ10 as medical therapy ( 3 ).


Endothelial dysfunction

Endothelial dysfunction is one of the main causes of hypertension and has a role in atherosclerotic plaque development. In a recent meta-analysis of 5 clinical trials with 194 patients concluded that CoQ10 supplementation is associated with significant improvement in endothelial function ( 4 ).


Reduce side effects of statin treatment

Statin therapy effectively reduces the bodies cholesterol production by inhibiting Hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase. However this enzyme is also responsible for the production of CoQ10. Studies have shown that CoQ10 levels are significantly reduced upon statin treatment ( 5-10 ). More and more studies demonstrate that CoQ10 supplementation can help to reduce side effects of statin treatment, most importantly myalgia and myopathy (muscle aches, rhabdomyalysis). Several studies have demonstrated reduced side effects of statin treatment after CoQ10 supplementation ( 11-14 ). However, some studies report no reduction of myalgia upon CoQ10 supplementation alongside statin treatment ( 15, 16 ). It must be noted that in these studies either the levels of myalgia were very low or the bioavailability of the supplement was not tested by measuring coenzyme Q10 blood levels. Thus far, no large clinical trials have confirmed this theory.

Noteworthy, the pharmaceutical company Merck that markets simvastatin under the trade name Zocor, also believed in the benefits of CoQ10 supplementation alongside statin treatment. They even filed a patent to protect the pharmaceutical use of CoQ10 to reduce statin induced myopathy.

Patent: Coenzyme Q10 with HMG-CoA reductase inhibitors, EP0383432B1.


Cholesterol lowering

There is no scientific evidence of a cholesterol lowering effect of coenzyme Q10.

Conclusion

Traffic light Red Based on the available scientific evidence CoQ10 supplements cannot be recommended to healthy individuals.

 

Traffic Light Green

However, it can be recommended to lower blood pressure in people with high blood pressure and is an important measure to reduce the most common side effect of statin use, myopathy (Muscle aches).

 

   Accepted EFSA Claims

  • None
Names: Coenzyme Q10, Co-Q10, Q10, Ubiquinol, Ubiquinone  
Diseases: Cardiovascular disease, muscle ache, statin side effects 

Reference List

  1. Ho MJ et al. , Blood pressure lowering efficacy of coenzyme Q10 for primary hypertension. Cochrane database of systematic reviews , CD007435 (2009).
  2. Rosenfeldt FL et al. , Coenzyme Q10 in the treatment of hypertension: a meta-analysis of the clinical trials. Journal of human hypertension 21 , 297-306 (Apr, 2007).
  3. Tran MT et al. , Role of coenzyme Q10 in chronic heart failure, angina, and hypertension. Pharmacotherapy 21 , 797-806 (Jul, 2001).
  4. Gao L et al. , Effects of coenzyme Q10 on vascular endothelial function in humans: a meta-analysis of randomized controlled trials. Atherosclerosis 221 , 311-6 (Apr, 2012).
  5. Mortensen SA et al. , Dose-related decrease of serum coenzyme Q10 during treatment with HMG-CoA reductase inhibitors. Molecular aspects of medicine 18 Suppl , S137-44 (1997).
  6. Ghirlanda G et al. , Evidence of plasma CoQ10-lowering effect by HMG-CoA reductase inhibitors: a double-blind, placebo-controlled study. Journal of clinical pharmacology 33 , 226-9 (Mar, 1993).
  7. Colquhoun DM et al. , Effects of simvastatin on blood lipids, vitamin E, coenzyme Q10 levels and left ventricular function in humans. European journal of clinical investigation 35 , 251-8 (Apr, 2005).
  8. Watts GF et al. , Plasma coenzyme Q (ubiquinone) concentrations in patients treated with simvastatin. Journal of clinical pathology 46 , 1055-7 (Nov, 1993).
  9. Lamperti C et al. , Muscle coenzyme Q10 level in statin-related myopathy. Archives of neurology 62 , 1709-12 (Nov, 2005).
  10. Paiva H et al. , High-dose statins and skeletal muscle metabolism in humans: a randomized, controlled trial. Clinical pharmacology and therapeutics 78 , 60-8 (Jul, 2005).
  11. Thibault A et al. , Phase I study of lovastatin, an inhibitor of the mevalonate pathway, in patients with cancer. Clinical cancer research : an official journal of the American Association for Cancer Research 2 , 483-91 (Mar, 1996).
  12. Kim WS et al. , Phase II study of high-dose lovastatin in patients with advanced gastric adenocarcinoma. Investigational new drugs 19 , 81-3 (2001).
  13. Caso G et al. , Effect of coenzyme q10 on myopathic symptoms in patients treated with statins. The American journal of cardiology 99 , 1409-12 (May 15, 2007).
  14. Zlatohlavek L et al. , The effect of coenzyme Q10 in statin myopathy. Neuro endocrinology letters 33 , 98-101 (Nov 28, 2012).
  15. Young JM et al. , Effect of coenzyme Q(10) supplementation on simvastatin-induced myalgia. The American journal of cardiology 100 , 1400-3 (Nov 1, 2007).
  16. Bookstaver DA et al. , Effect of coenzyme Q10 supplementation on statin-induced myalgias. The American journal of cardiology 110 , 526-9 (Aug 15, 2012).

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