Coenzyme Q10: What Role in Heart Failure?

I appreciated the article “Chronic Heart Failure: When to Consider Device Therapy” by Muhammad Dogar, MD, Meriam F. Caboral, MSN, NP-C, and Judith E. Mitchell, MD (CONSULTANT, May 2009, page 305). However, the authors did not address the role of coenzyme Q10 in the management of heart failure. I would be interested in hearing their thoughts.
-- PA-C

The role of coenzyme Q10 in the development of heart failure and as a potential treatment is still being studied. The latest American College of Cardiology Foundation/American Heart Association heart failure guidelines state:

Patients with heart failure, particularly those treated with diuretics, may become deficient in vitamins and micronutrients. Several nutritional supplements (eg, coenzyme Q10, carnitine, taurine, and antioxidants) and hormonal therapies (eg, growth hormone or thyroid hormone) have been proposed for the treatment of heart failure. Aside from replenishment of documented deficiencies, randomized trials have failed to demonstrate benefit for routine vitamin, nutritional, or hormonal supplementation.¹

In most of the literature on nutraceuticals, including outcomes analyses, there are issues that remain unresolved, such as adverse effects and drugnutraceutical interactions. Also, no clinical trials have demonstrated improved survival in users of nutritional or hormonal therapy. Some studies have suggested a possible effect for coenzyme Q10 in reducing hospitalization rates, dyspnea, and edema in patients with heart failure, but these benefits have not been seen uniformly.

Until more data are available, nutritional supplements or hormonal therapies are not recommended for the treatment of heart failure. However, because nutritional supplements are so widely used and because of their possible adverse effects and drug interactions, physicians who care for patients with heart failure should routinely inquire about their use.

-- Judith E. Mitchell, MD
Associate Professor of Medicine
Director of the Heart Failure Clinic
SUNY Downstate Medical Center
Brooklyn, NY

References:

REFERENCE:

1.

Jessup M, Abraham WT, Casey DE, et al. 2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in collaboration with the International Society for Heart and Lung Transplantation.

J Am Coll Cardiol. 2009;53:1343-1382.

http://content.onlinejacc.org/cgi/content/f/ullj.jacc.2008.11.009.

Accessed August 18, 2009