Dr Sarah Brewer August 05, 2019

Heart failure becomes increasingly common with age, with the average age of first diagnosis being 76(1). Recently, research has led healthcare professionals to consider the benefits of coenzyme Q10 to complement medical treatment. We’ve put together this guide, breaking down everything from what coQ10 is to how it may work to support your heart.

What is heart failure?

Heart failure is a condition in which the heart becomes unable to pump blood around the body as efficiently as it should. This leads to blood pooling in the lower limbs and, in some cases, within the lungs, and can cause symptoms such as swollen ankles, fatigue, breathlessness and palpitations. If you are diagnosed with heart failure your doctor will prescribe medication to support the heart and provide advice about limiting salt and fluid intake, avoiding smoking and keeping alcohol intake within recommended limits.2

What is coenzyme Q10?

Coenzyme Q10 is a vitamin like substance needed during by cells to burn glucose and fatty acids to create energy. There are two main forms of coenzyme Q10: ubiquinone and ubiquinol. These form a vital part of the electron transport chain that generates energy within mitochondria - the cells’ equivalent of batteries. During energy production, the active ‘body ready’ form of coenzyme Q10, ubiquinol, donates an electron and is converted into the oxidised or ‘spent’ form of coenzyme Q10, known as ubiquinone. Ubiquinone must then be converted back into ubiquinol before it can function again. This cycle repeats itself over and over within the mitochondria. While your cells can make ubiquinol, the amount they produce reduces with age, and the efficiency with which coenzyme Q10 is absorbed from the diet also decreases.

How does coenzyme Q10 impact heart health?

Cells with the highest energy requirement have the greatest need for coenzyme Q10, so it is taken up and concentrated in organ and muscle cells – especially those of the heart which are constantly contracting.3 Coenzyme Q10 is also a powerful antioxidant and acts to neutralise free radicals, unstable molecules which damage cells and are linked to the development of a number of age-related diseases, including cardiovascular disease.4 Falling levels of co-enzyme Q10 reduces a cell’s ability to generate energy and function properly, which is a major contributor to cell ageing. Blood levels of ubiquinol are consistently lower in people with common age-related problems including diabetes, heart disease and neurological disorders. In patients with heart failure, for example, patients with more severe disease have the lowest levels of CoQ10.5 Taking ubiquinol can help to improve blood levels and heart function and is increasingly recommended by cardiologists to support medical treatment.6

CoQ10 and heart failure

As far back as 1985, low levels of coenzyme Q10 in heart muscle was linked to an increased risk of developing heart failure.7 Since then, clinical trials involving people with heart failure show that taking coenzyme Q10 supplements can improve the ability of the heart to act as a pump and reduce major adverse cardiovascular events without causing any significant side effects.4, 8,9 Taking coenzyme Q10 may also reduce the development of atrial fibrillation, a heart rhythm abnormality that can occur in people with heart failure.10

CoQ10 and cholesterol

If your cholesterol level is raised, or if your risk of cardiovascular disease is increased, your doctor may recommend that you take a type of drug known as a statin. Statins work by inhibiting an enzyme which is needed to synthesise cholesterol in the liver. This enzyme, HMG-CoA reductase, is also needed to make coenzyme Q10.11,12,13,14,15 As a result, taking a statin can halve your circulating blood levels of co-enzyme Q10 within 4 weeks.16 Statins are generally considered safe but, like all medicines they can have side effects. A significant number of people taking a statin drug develop muscle aches and pains, inflammation and weakness.17 Lack of co-enzyme Q10 may contribute to the muscle aches and pains that can occur in people taking statins.18,13,14 Trials in which people with statin-associated muscle side effects have taken coenzyme Q10 supplements have not all shown benefit, but an updated analysis of all available data, published in the Journal of the American Heart Association in 2018 found that, compared with placebo, taking coenzyme Q10 supplements significantly relieved statin-associated muscle pains, weakness, cramps and muscle tiredness.19 Importantly, taking a co-enzyme Q10 supplement does not affect the cholesterol-lowering action of statin drugs.20 As always, however, if you are taking any prescribed medicines it is important to check with your doctor before taking any supplement. For more on information on lowering cholesterol, see our guide to using natural alternatives to statins.

CoQ10 and blood pressure

Heart failure can result from having a persistently high blood pressure. Ubiquinol reduces oxidative stress and improves the elasticity of artery walls, allowing better dilation of arteries to improve blood pressure control. The results from 12 clinical trials concluded that coenzyme Q10 has the potential to lower blood pressure by as much as 17/10 mmHg in people with hypertension without significant side effects. In three studies, coenzyme Q10 was given in addition to existing anti-hypertensive medication, and in one of these over 50% of those taking supplements were able to cease taking at least one of their anti-hypertensive medications during the trial.21

How to increase coQ10 levels

While coenzyme Q10 is found naturally in a wide range of foods, average intakes are low and estimated at 3–5 mg daily among meat eaters and 1 mg daily among vegetarians.22 While there is currently no set recommended intake of CoQ10, some research shows that at least 30-60 milligrams per day (mg/day) is recommended.23 The most commonly used dose of the body-ready form of ubiquinol is 100mg per day, which is equivalent to around 280mg ubiquinone coenzyme Q10.

For more information on heart failure and a range of other common heart conditions, visit our heart health hub, which includes information on the link between vitamin D deficiency and cardiovascular conditions such as stroke.


References
1Heart Failure Definition, NICE
2Heart Failure Management, NICE
3Pepe, S. et al. (2007). Coenzyme Q10 in cardiovascular disease. Mitochondrion 7S
4DiNicolantonio, J.J., Bhutani, J., McCarty, M.F. et al. (2015). Coenzyme Q10 for the treatment of heart failure: a review of the literature. Open Heart 2
5Onur, S. et al. (2015). Association between serum level of ubiquinol and NT-proBNP, a marker for chronic heart failure, in healthy elderly subjects. Biofactors 41(1)
6Langsjoen, P. H., Langsjoen, A. M. (2008). Supplemental ubiquinol in patients with advanced congestive heart failure. Biofactors 32(1-4)
7Folkers, K. et al. (1985). Biochemical rationale and myocardial tissue data on the effective therapy of cardiomyopathy with coenzyme Q10. Proceedings of the National Academy of Sciences 82(3)
8Jankowski, K. et al. (2016). Coenzyme Q10 – A new player in the treatment of heart failure? Pharmacological Reports 68(5)
9Fuke, C. et al. (2000). Coenzyme Q10: a review of essential functions and clinical trials. US Pharmacist 25(10)
10Zhao Q. et al. (2015). Effect of coenzyme Q10 on the incidence of atrial fibrillation in patients with heart failure. Journal of Investigative Medicine 63(5)
11Langsjoen P., Langsjoen A. et al. (2003). The clinical use of HMG-CoA-reductase inhibitors and the associated depletion of coenzyme Q10. A review of animal and human publications. BioFactors 18
12Littarru G. P., Langsjoen, P. et al. (2007). Coenzyme Q10 and statins: Biochemical and clinical implications. Mitochondrion 7S
13Bliznakov E. G., Wilkins D. J. et al. (1998). Biochemical and clinical consequences of CoQ10 biosynthesis by lipid-lowering HMG-CoA reductase inhibitors (statins): A critical review. Advances in Therapy 15
14Passi S. et al. (2003). Statins lower plasma and lymphocyte ubiquinol/ubiquinone without affecting other antioxidants and PUFA. BioFactors 18
15Ghirlanda G. et al. (1993). Evidence of plasma CoQ10-lowering effect by HMG-CoA reductase inhibitors: a double-blind, placebo-controlled study. Journal of Clinical Pharmacology 33
16Rundek T. et al. (2004). Atorvastatin decreases the coenzyme Q10 level in the blood of patients at risk for cardiovascular disease and stroke. Arch Neurol 61(6)
17Thompson P. D., Clarkson, P., Karas, R. H. (2003). Statin associated myopathy. JAMA 289(13)
18Lamperti, C. et al. (2005). Muscle Coenzyme Q10 level in statin-related myopathy. Archives of Neurology 62
19Hua Q. et al. (2018). Effects of Coenzyme Q10 on Statin-Induced Myopathy: An Updated Meta-Analysis of Randomized Controlled Trials. Journal of American Heart Association 7
20Bargossi A. M. et al. (1994). Exogenous CoQ10 supplementation prevents plasma ubiquinone reduction induced by HMG-CoA reductase inhibitors. Molecular Aspects of Medicine 15
21Rosenfeldt F. L. et al. (2007). Coenzyme Q10 in the treatment of hypertension: a meta-analysis of the clinical trials. J Hum Hypertens 21(4)
22Weber C. et al. (1997). The coenzyme Q10 content of the average Danish diet. Int J Vitam Nutr Res. 67(2)
23Oleck, S., Ventura, H. O. (2016). Coenzyme Q10 and Utility in Heart Failure: Just Another Supplement? Curr Heart Fail Rep 13

Nothing beats a healthy, balanced diet to provide all the nutrients we need. But when this isn't possible, supplements can help. This article isn't intended to replace medical advice. Please consult your healthcare professional before trying supplements or herbal medicines.

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