Coenzyme Q10 (CoQ10) ranks among the bestselling supplements, with global sales predicted to reach $849 million by 2020, according to a recent study. Researchers report that CoQ10 may have significant benefits for people with cardiovascular disease (CVD), from reducing risk for repeat heart attacks and improving outcomes in patients with heart failure to lowering blood pressure and helping combat side effects of cholesterol-lowering statins.
There is also evidence that CoQ10 may have “significant cardiovascular protective effects” that could help prevent CVD, the world’s leading cause of death, reports a recent study published in Cardiovascular Pharmacology: Open Access.
While these are exciting findings, messaging to patients about CoQ10, particularly in the popular media, is often confusing, leading to less than optimal results and poor supplement choice. Here’s a guide to the latest discoveries about the heart health benefits of CoQ10 and how to make smart choices in selecting supplements.
What is Coenzyme Q10?
Found in almost every cell of the body, CoQ10 is a fat-soluble, vitamin-like substance that helps convert food into energy. A powerful antioxidant that protects against damage from toxic free radicals, CoQ10 is produced by the body and is also found in many foods, with higher levels in organ meats, such as liver or kidneys; as well as sardines, mackerel, chicken, cauliflower, broccoli and asparagus.
What are the different forms of CoQ10?
There are two forms of CoQ10: ubiquinone and ubiquinol. Ubiquinol, the active antioxidant form of CoQ10, is made in the body from ubiquinone. As we age, the levels of both forms drop. As early as age 20, the amount of ubiquinone our bodies produce begins to drop. Compounding the problem, the body also loses its ability to make ubiquinol from ubiquinone. Most dietary supplements contain ubiquinone and are relatively cost effective, while ubiquinol supplements, which may be of most benefit as we age, can be harder to find and more expensive.
A simple blood test is available to measure CoQ10 levels. A shortage of this antioxidant may lead to oxidative stress, which increases the risk for a range of disorders, including CVD. Recent research links low blood levels of CoQ10 with low levels of heart-protective “good” cholesterol which in turn may further increase risk for heart disease. Cholesterol-lowering statins may also reduce blood levels of CoQ10.
How does CoQ10 affect heart health?
Recent studies suggest that CoQ10, either alone or combined with other therapies, may be beneficial for the following conditions. However, as with all supplements, patients should consult their medical provider before taking CoQ10 to check if it’s appropriate for them.
- Cardiovascular disease (CVD). Recent studies show that CoQ10 supplements can significantly increase HDL-C and ApoA1 levels, even in people taking statins, and may help reduce risk for CVD. CoQ10 supplementation also lowers levels of inflammatory biomarkers shown to be risk factors for CVD, such as high-sensitivity C-reactive protein. Finally, low CoQ10 levels have been associated with greater tissue damage to the heart during a heart attack and the brain during stroke.
- Statin-related muscle symptoms. Although statin therapy can significantly reduce heart attack and stroke risk, up to 25 percent of patients quit treatment within six months due to side effects, such as muscle aches and weakness. In a 2014 randomized clinical study published in Medical Science Monitor, 75 percent of statin users with muscle symptoms reported reduced pain after taking CoQ10 twice a day for 30 days, versus zero improvement in the placebo group. The researchers concluded that combining statin therapy with CoQ10 supplements could lead to higher compliance with treatment.
- Heart failure (HF). CoQ10 was hailed as “the first new drug to improve heart failure mortality in over and decade” after a multi-center randomized study of 420 patients found that taking it reduced deaths in patients with severe HF by half, compared to a control group. The researchers tracked the patients for two years. The study was presented at the Heart Failure 2013 congress in Lisbon and later published in Journal of the American College of Cardiology Heart Failure.
- After a heart attack. In a randomized clinical trial, patients who received CoQ10 soon after a heart attack had a much lower rate of subsequent cardiac events over the next year than a control group (24.6 percent versus 45 percent). About half the patients in both groups were also taking a statin medication, prompting the researchers to report that, “treatment with CoQ10 in patients with recent [heart attack] may be beneficial in patients with high risk of atherothrombosis, despite optimal lipid lowering therapy.”
- High blood pressure. In an analysis of 12 clinical studies, researchers reported that CoQ10 has the potential to lower systolic blood pressure (the top number in a blood pressure reading) by up to 17 mm Hg and diastolic pressure by 10 mm Hg without significant side effects.
Five key things to remember about CoQ10
- Take CoQ10 with a meal. CoQ10 is fat-soluble and is best absorbed when taken with food.
- All CoQ10 supplements are not created equal. Younger people may benefit more from ubiquinone while older people may benefit more from ubiquinol (the active form).
- Test CoQ10 levels. Measuring CoQ10 in the blood is the only way to determine if you need CoQ10 supplementation.
- Check “good cholesterol” levels. If CoQ10 levels are low, ApoA1 and/or HDL-C levels may be low as well. Likewise, if ApoA1 and/or HDL-C levels are low, CoQ10 levels may be low.
- Compliance is key. CoQ10 supplementation may improve compliance if you’re on statin therapy and experience muscle pain and weakness.