open access

Vol 26, No 2 (2019)
Original articles — Clinical cardiology
Published online: 2019-02-20
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Effect of coenzyme Q10 in Europeans with chronic heart failure: A sub-group analysis of the Q-SYMBIO randomized double-blind trial

Anne Louise Mortensen, Franklin Rosenfeldt, Krzysztof J. Filipiak,
DOI: 10.5603/CJ.a2019.0022
·
Pubmed: 30835327
·
Cardiol J 2019;26(2):147-156.

open access

Vol 26, No 2 (2019)
Original articles — Clinical cardiology
Published online: 2019-02-20

Abstract

Background: Geographical differences in patient characteristics, management and outcomes in heart failure (HF) trials are well recognized. The aim of this study was to assess the consistency of the treat- ment effect of coenzyme Q10 (CoQ10) in the European sub-population of Q-SYMBIO, a randomized double-blind multinational trial of treatment with CoQ10, in addition to standard therapy in chronic HF. 

Methods: Patients with moderate to severe HF were randomized to CoQ10 300 mg daily or placebo in addition to standard therapy. At 3 months the primary short-term endpoints were changes in New York Heart Association (NYHA) functional classification, 6-min walk test, and levels of N-terminal pro–B type natriuretic peptide. At 2 years the primary long-term endpoint was major adverse cardiovascular events (MACE).

Results: There were no significant changes in short-term endpoints. The primary long-term endpoint of MACE was reached by significantly fewer patients in the CoQ10 group (n = 10, 9%) compared to the placebo group (n = 33, 27%, p = 0.001). The following secondary endpoints were significantly improved in the CoQ10 group compared with the placebo group: all-cause and cardiovascular mortality, NYHA classification and left ventricular ejection fraction (LVEF). In the European sub-population, when compared to the whole group, there was greater adherence to guideline directed therapy and similar results for short- and long-term endpoints. A new finding revealed a significant improvement in LVEF.

Conclusions: The therapeutic efficacy of CoQ10 demonstrated in the Q-SYMBIO study was confirmed in the European sub-population in terms of safely reducing MACE, all-cause mortality, cardiovascular mortality, hospitalization and improvement of symptoms.

Abstract

Background: Geographical differences in patient characteristics, management and outcomes in heart failure (HF) trials are well recognized. The aim of this study was to assess the consistency of the treat- ment effect of coenzyme Q10 (CoQ10) in the European sub-population of Q-SYMBIO, a randomized double-blind multinational trial of treatment with CoQ10, in addition to standard therapy in chronic HF. 

Methods: Patients with moderate to severe HF were randomized to CoQ10 300 mg daily or placebo in addition to standard therapy. At 3 months the primary short-term endpoints were changes in New York Heart Association (NYHA) functional classification, 6-min walk test, and levels of N-terminal pro–B type natriuretic peptide. At 2 years the primary long-term endpoint was major adverse cardiovascular events (MACE).

Results: There were no significant changes in short-term endpoints. The primary long-term endpoint of MACE was reached by significantly fewer patients in the CoQ10 group (n = 10, 9%) compared to the placebo group (n = 33, 27%, p = 0.001). The following secondary endpoints were significantly improved in the CoQ10 group compared with the placebo group: all-cause and cardiovascular mortality, NYHA classification and left ventricular ejection fraction (LVEF). In the European sub-population, when compared to the whole group, there was greater adherence to guideline directed therapy and similar results for short- and long-term endpoints. A new finding revealed a significant improvement in LVEF.

Conclusions: The therapeutic efficacy of CoQ10 demonstrated in the Q-SYMBIO study was confirmed in the European sub-population in terms of safely reducing MACE, all-cause mortality, cardiovascular mortality, hospitalization and improvement of symptoms.

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Keywords

chronic heart failure; coenzyme CoQ10; ubiquinone; randomized controlled trial; major adverse cardiovascular events; mortality; hospitalization

About this article
Title

Effect of coenzyme Q10 in Europeans with chronic heart failure: A sub-group analysis of the Q-SYMBIO randomized double-blind trial

Journal

Cardiology Journal

Issue

Vol 26, No 2 (2019)

Pages

147-156

Published online

2019-02-20

DOI

10.5603/CJ.a2019.0022

Pubmed

30835327

Bibliographic record

Cardiol J 2019;26(2):147-156.

Keywords

chronic heart failure
coenzyme CoQ10
ubiquinone
randomized controlled trial
major adverse cardiovascular events
mortality
hospitalization

Authors

Anne Louise Mortensen
Franklin Rosenfeldt
Krzysztof J. Filipiak

References (32)
  1. Levy D, Kenchaiah S, Larson MG, et al. Long-term trends in the incidence of and survival with heart failure. N Engl J Med. 2002; 347(18): 1397–1402.
  2. Turunen M, Olsson J, Dallner G. Metabolism and function of coenzyme Q. Biochim Biophys Acta. 2004; 1660(1-2): 171–199.
  3. Littarru GP, Tiano L. Bioenergetic and antioxidant properties of coenzyme Q10: recent developments. Mol Biotechnol. 2007; 37(1): 31–37.
  4. Bhagavan HN, Chopra RK. Coenzyme Q10: absorption, tissue uptake, metabolism and pharmacokinetics. Free Radic Res. 2006; 40(5): 445–453.
  5. Kalén A, Appelkvist EL, Dallner G. Age-related changes in the lipid compositions of rat and human tissues. Lipids. 1989; 24(7): 579–584.
  6. Bentinger M, Tekle M, Dallner G. Coenzyme Q--biosynthesis and functions. Biochem Biophys Res Commun. 2010; 396(1): 74–79.
  7. Littarru GP, Tiano L. Clinical aspects of coenzyme Q10: an update. Nutrition. 2010; 26(3): 250–254.
  8. Folkers K, Littarru GP, Ho L, et al. Evidence for a deficiency of coenzyme Q10 in human heart disease. Int Z Vitaminforsch. 1970; 40(3): 380–390.
  9. Folkers K, Vadhanavikit S, Mortensen SA. Biochemical rationale and myocardial tissue data on the effective therapy of cardiomyopathy with coenzyme Q10. Proc Natl Acad Sci U S A. 1985; 82(3): 901–904.
  10. Vadhanavikit S, Morishita M, Duff GA, et al. Micro-analysis for coenzyme Q10 in endomyocardial biopsies of cardiac patients and data on bovine and canine hearts. Biochem Biophys Res Commun. 1984; 123(3): 1165–1169.
  11. Sharov VG, Todor AV, Silverman N, et al. Abnormal mitochondrial respiration in failed human myocardium. J Mol Cell Cardiol. 2000; 32(12): 2361–2367.
  12. Mortensen SA, Rosenfeldt F, Kumar A, et al. The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: results from Q-SYMBIO: a randomized double-blind trial. JACC Heart Fail. 2014; 2(6): 641–649.
  13. Poole-Wilson PA. Global differences in the outcome of heart failure: implications for clinical practice. J Am Coll Cardiol. 2008; 52(20): 1649–1651.
  14. Egwim C, Dixon B, Ambrosy AP, et al. Global variations in patient populations and outcomes in heart failure clinical trials. Curr Heart Fail Rep. 2017; 14(1): 30–39.
  15. Ferreira JP, Girerd N, Rossignol P, et al. Geographic differences in heart failure trials. Eur J Heart Fail. 2015; 17(9): 893–905.
  16. Kristensen SL, Martinez F, Jhund PS, et al. Geographic variations in the PARADIGM-HF heart failure trial. Eur Heart J. 2016; 37(41): 3167–3174.
  17. Littarru GP, Mosca F, Fattorini D, et al. Assay of coenzyme Q10 in plasma by a single dilution step. Methods Enzymol. 2004; 378: 170–176.
  18. Sokoll LJ, Baum H, Collinson PO, et al. Multicenter analytical performance evaluation of the Elecsys proBNP assay. Clin Chem Lab Med. 2004; 42(8): 965–972.
  19. O'Connor CM, Fiuzat M, Swedberg K, et al. Influence of global region on outcomes in heart failure β-blocker trials. J Am Coll Cardiol. 2011; 58(9): 915–922.
  20. Greene SJ, Fonarow GC, Solomon SD, et al. Global variation in clinical profile, management, and post-discharge outcomes among patients hospitalized for worsening chronic heart failure: findings from the ASTRONAUT trial. Eur J Heart Fail. 2015; 17(6): 591–600.
  21. Mentz RJ, Roessig L, Greenberg BH, et al. Heart failure clinical trials in east and southeast asia: understanding the importance and defining the next steps. JACC Heart Fail. 2016; 4(6): 419–427.
  22. Sharma KK, Gupta R, Agrawal A, et al. Low use of statins and other coronary secondary prevention therapies in primary and secondary care in India. Vasc Health Risk Manag. 2009; 5: 1007–1014.
  23. Ingwall JS. Energy metabolism in heart failure and remodelling. Cardiovascular Research. 2009; 81(3): 412–419.
  24. Mortensen SA. Perspectives on therapy of cardiovascular diseases with oenzyme Q10 (Ubiquinone). Clinical Investigator. 1993; 71(S8): S116–S123.
  25. Ferrari R, Guardigli G, Mele D, et al. Oxidative stress during myocardial ischaemia and heart failure. Curr Pharm Des. 2004; 10(14): 1699–1711.
  26. Opie LH. The metabolic vicious cycle in heart failure. Lancet. 2004; 364(9447): 1733–1734.
  27. Papucci L, Schiavone N, Witort E, et al. Coenzyme q10 prevents apoptosis by inhibiting mitochondrial depolarization independently of its free radical scavenging property. J Biol Chem. 2003; 278(30): 28220–28228.
  28. Belardinelli R, Muçaj A, Lacalaprice F, et al. Coenzyme Q10 and exercise training in chronic heart failure. Eur Heart J. 2006; 27(22): 2675–2681.
  29. Littarru GP, Tiano L, Belardinelli R, et al. Coenzyme Q(10) , endothelial function, and cardiovascular disease. Biofactors. 2011; 37(5): 366–373.
  30. Rosenfeldt F, Marasco S, Lyon W, et al. Coenzyme Q10 therapy before cardiac surgery improves mitochondrial function and in vitro contractility of myocardial tissue. J Thorac Cardiovasc Surg. 2005; 129(1): 25–32.
  31. Belardinelli R, Muçaj A, Lacalaprice F, et al. Coenzyme Q10 improves contractility of dysfunctional myocardium in chronic heart failure. Biofactors. 2005; 25(1-4): 137–145.
  32. Wilcox JE, Fonarow GC, Ardehali H, et al. "Targeting the Heart" in Heart Failure: Myocardial Recovery in Heart Failure With Reduced Ejection Fraction. JACC Heart Fail. 2015; 3(9): 661–669.

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