Heart Failure—Do We Need New Drugs or Have Them Already? A Case of Coenzyme Q10

Abstract

Heart failure (HF) is a global epidemic that contributes to the deterioration of quality of life and its shortening in 1–3% of adult people in the world. Pharmacotherapy of HF should rely on highly effective drugs that improve prognosis and prolong life. Currently, the ESC guidelines from 2021 indicate that ACEI, ARNI, BB, and SGLT2 inhibitors are the first-line drugs in HF. It is also worth remembering that the use of coenzyme Q10 brought many benefits in patients with HF. Coenzyme Q10 is a very important compound that performs many functions in the human body. The most important function of coenzyme Q10 is participation in the production of energy in the mitochondria, which determines the proper functioning of all cells, tissues, and organs. The highest concentration of coenzyme Q10 is found in the tissue of the heart muscle. As the body ages, the concentration of coenzyme Q10 in the tissue of the heart muscle decreases, which makes it more susceptible to damage by free radicals. It has been shown that in patients with HF, the aggravation of disease symptoms is inversely related to the concentration of coenzyme Q10. Importantly, the concentration of coenzyme Q10 in patients with HF was an important predictor of the risk of death. Long-term coenzyme Q10 supplementation at a dose of 300 mg/day (Q-SYMBIO study) has been shown to significantly improve heart function and prognosis in patients with HF. This article summarizes the latest and most important data on CoQ10 in pathogenesis.

Effect of coenzyme Q10 on cardiac function and survival in heart failure: an overview of systematic reviews and meta-analyses

“…Since there is altered synthesis of ATP, reactive oxygen species and the electron transport chain in HF, as mentioned above, CoQ10 may benefit by reversing these alterations. 46 In addition, CoQ10 supplementation may also improve lipid and glycaemic parameters, endothelial function, lower systolic blood pressure, and reduce the proinflammatory state by reducing C-reactive protein and tumour necrosis factor alpha. [47][48][49][50][51][52][53] Finally, the results for NYHA classification and exercise capacity were conflicting.…”

Pharmacotherapy of heart failure A.D. 2023. Expert opinion of Working Group on Cardiovascular Pharmacotherapy, Polish Cardiac Society

“…However, the Q-SYMBIO study identifies an easily available, relatively inexpensive drug for adjuvant chronic HF therapy [50]. Further studies are awaited to precisely define its clinical benefits in HF patients.…”

Coq10 for preventing cardiotoxicity in breast cancer patients treated with trastuzumab

“…Watts et al [11] discovered this effect in individuals with type 2 diabetes [11], while Belardinelli et al investigated it in patients with ischemic heart disease [12]. CoQ10 levels are low in patients with chronic heart failure in blood and myocardial tissue samples [13,14]. Oral CoQ 10 supplementation improves cardiac contractility and endothelial dysfunction in individuals with stable mild congestive heart failure [15].…”