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The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure. Results from the Q-SYMBIO study

A paper presented at congress of the Heart Failure Association of the European Society of Cardiology by Svend Aage Mortensen et al., from the Heart Centre, Copenhagen University, found that Vitamin-like nutrient CoQ10 can reduce mortality rates by half in patients with moderate to severe heart failure.

Dysfunction of bioenergetics and energy starvation of the myocardium may be a dominant feature of heart failure (HF) and attention is directed towards a support of the myocardial metabolism. The myocardial tissue level of the essential redox component of the respiratory chain Coenzyme Q10 (CoQ10) has been found inversely related to the severity of HF. We investigated the effects of CoQ10 on patients symptoms, functional capacity and biomarker status (NT-proBNP) and the long-term outcome with morbidity and mortality.

Methods: HF patients in New York Heart Association (NYHA) Class III or IV who were receiving current pharmacologic therapy were randomly assigned in parallel groups to CoQ10 100 mg three times daily versus placebo. The primary long-term endpoint was the time to first MACE (major adverse cardiovascular event) including unplanned hospitalization due to worsening of HF, cardiovascular death, urgent cardiac transplantation and mechanical support, using a time to first event analysis.

Results: A total of 420 patients – CoQ10 (N=202), placebo (N=218) – were enrolled with a follow-up time of 2 years. After 3 months there was a trend with a reduced level of NT-proBNP in the CoQ10 group. After 2 years there was a significant improvement of the NYHA Class in the CoQ10 group (p=0.047). The primary endpoint was reached by 29 patients in the CoQ10 group, as compared with 55 patients in the placebo group (14 percent vs. 25 percent; hazard ratio CoQ10 vs. placebo: 2.0 (95% CI: 1.3-3.2); P=0.003) by intention to treat analysis. CoQ10 treated patients had significantly lower cardiovascular mortality (p=0.02) and lower occurrence of hospitalizations for HF (p=0.05). All cause mortality was also lower in the CoQ10 group, 18 patients vs. 36 patients in the placebo-group (9 percent vs. 17 percent; hazard ratio CoQ10 vs. placebo: 2.1 (95% CI: 1.2-3.8); p=0.01). There were fewer adverse events in the CoQ10 group compared to the placebo group (p=0.073). 

Conclusions: Q-SYMBIO is the first double-blind trial in chronic HF addressing whether CoQ10 supplementation might improve survival. The CoQ10 treated patients had reduced hospital admission rates for worsening HF and lower cardiovascular death both of which may reflect a significant improvement in cardiac function. CoQ10 treatment was safe with a reduced all cause mortality rate. CoQ10 should be considered as a part of the maintenance therapy of patients with chronic HF.

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