Cochrane Review Finds Ubiquinol Associated with Reduced Heart Failure

Written by Dr Peter McCullough MD, MPH on September 17, 2024. Posted in Current News

Heart failure is on the rise with the aging of the population and the superimposed effect of COVID-19 vaccination causing subclinical myopericarditis and contributing to the long-term risk of cardiomyopathy and heart failure

Most of the body’s daily requirement for coenzyme Q10 (CoQ₁₀) is produced within the body.

Only a small amount of CoQ₁₀ is ingested from food (typically 5 mg/day [5]).

It is estimated that the daily requirement for CoQ₁₀, from both endogenous bio-synthesis and food sources, is about 500 mg.

This estimate serves as the justification for the size of the dosage (typically 300 mg/day) that is used in many clinical trial studies.

As we grow older, the ability of the body to synthesise its own CoQ₁₀ decreases; optimal human bio-synthesis occurs in the mid-twenties, with a continual gradual decline in tissue levels thereafter [6].

In addition to the normal aging process, CoQ₁₀ levels have also been shown to be depleted in a number of disorders, particularly heart disease [7].

CoQ₁₀ in the oxidised form (ubiquinone) and the reduced form (ubiquinol); is continually inter-converted within cells as part of the normal function of CoQ₁₀.

In the blood, CoQ₁₀ is transported in ubiquinol form (bound to low-density lipoprotein- and very low-density lipoprotein- cholesterol), irrespective of the initial dietary form (ubiquinone or ubiquinol) [11].

Recent technical improvements in encapsulation methods have made the production of CoQ₁₀ supplements in the ubiquinol form possible that may be more bioavailable.

A 2021 Cochrane review found that with oral supplementation of 200 to 400 mg of CoQ₁₀ per day yielded favorable results when added to heart failure drug therapy.

“We included eleven studies, with 1573 participants, comparing coenzyme Q10 to placebo or conventional therapy (control). In the majority of the studies, sample size was relatively small.

There were important differences among studies in daily coenzyme Q10 dose, follow-up period, and the measures of treatment. All studies had unclear, or high risk of bias, or both, in one or more bias domains.

We were only able to conduct meta-analysis for some of the outcomes. None of the included trials considered quality of life, measured on a validated scale, exercise variables (exercise haemodynamics), or cost-effectiveness.

Coenzyme Q10 probably reduces the risk of all-cause mortality more than control (RR 0.58, 95 percent CI 0.35 to 0.95; 1 study, 420 participants; number needed to treat for an additional beneficial outcome (NNTB) 13.3; moderate-quality evidence).

There was low-quality evidence of inconclusive results between the coenzyme Q10 and control groups for the risk of myocardial infarction (RR 1.62, 95 percent CI 0.27 to 9.59; 1 study, 420 participants), and stroke (RR 0.18, 95 percent CI 0.02 to 1.48; 1 study, 420 participants).

Coenzyme Q10 probably reduces hospitalisation related to heart failure (RR 0.62, 95 percent CI 0.49 to 0.78; 2 studies, 1061 participants; NNTB 9.7; moderate-quality evidence).

Very low-quality evidence suggests that coenzyme Q10 may improve the left ventricular ejection fraction (MD 1.77, 95 percent CI 0.09 to 3.44; 7 studies, 650 participants), but the results are inconclusive for exercise capacity (MD 48.23, 95 percent CI -24.75 to 121.20; 3 studies, 91 participants); and the risk of developing adverse events (RR 0.70, 95 percent CI 0.45 to 1.10; 2 studies, 568 participants).”

Qazi et al have reported from 16 studies that oral supplementation of CoQ₁₀ is associated with a 40% improvement in exercise capacity.

Because CoQ₁₀ is very well tolerated and the unknowns of vaccine heart damage and heart failure risk, I have upgraded my recommendation of CoQ₁₀ to 800 mg a day.

This is conservative and may hit a dose target which future studies would find an improvement in left ventricular ejection fraction to go along with reductions in heart failure hospitalization and death.

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