The resurrection of coenzyme Q10: It’s all about the money

A recent meta-analysis published in the American Journal of Clinical Nutrition suggests that coenzyme Q10 is of benefit in congestive heart failure. For those who like the idea that food and nutrients can be excellent medicine, this paper is interesting at the very least. But there is a case to be made that it is far more than that. There is a case to be made that it is, in a word, miraculous.

For resurrection, after all, is a miracle. And according to a paper published in the Annals of Internal Medicine in April of 2000, coenzyme Q10 for heart failure was a dead concept. The authors reported 13 years ago that “coenzyme Q10 has been studied in randomized, blinded, and controlled studies and … these studies have found no detectable benefit” and that “coenzyme Q10 should not be recommended for treatment of heart failure.”

The final nail had been driven into the CoQ10-for-heart-failure hypothesis 13 years ago — and yet now, it’s back. If that’s not a miracle — then what is going on?

First, a bit of relevant orientation. The condition in question here, congestive heart failure, occurs in particular in the aftermath of one or more heart attacks (myocardial infarctions) which cause portions of the heart muscle to die for want of oxygen. Those areas stop pumping, of course, and the whole heart does its job less well.

The pumping efficiency of the heart is routinely measured using ultrasound as the “left ventricular ejection fraction” (LVEF), which, as the name suggests, is the proportion of blood the left ventricle is able to pump out of itself when it contracts. Roughly 55 to 70 percent is considered normal. High values can occur when the heart is stiff and muscle-bound, and tend to mean the heart empties well, but fills poorly. Congestive heart failure is associated with low values.

And that, in principle is where coenzyme Q10 (also known as ubiquinone, because it is all but “ubiquitous” in plants, albeit at very low concentrations) comes in. A coenzyme supports the work of one or more enzymes, and CoQ10 supports enzymes in the mitochondria, the energy generators of our cells, that transfer electrons. Perhaps you recall ATP, the body’s principal form of stored energy, from high school biology. Well, CoQ10 helps us make it.

Since ATP represents stored energy muscle cells can use to contract, and inadequate contraction is the problem in congestive heart failure, it is plausible that coenzyme Q10 might help.

So why didn’t it in the April, 2000 study in the Annals? Well, of course it’s possible that it really doesn’t work. Not every good and plausible idea is right — that’s why we need good science and unbiased methods. We fall all too readily in love with our own hypotheses, and only robust, objective methods can save us from that tendency.

But there’s another good explanation. The study in question enrolled a total of 55 adults — of whom nine failed to finish. The study lasted a total of six months. So, in 46 adults already on what was optimal medication for congestive heart failure at the time, CoQ10 for six months did not produce a discernible improvement in the LVEF.

The problem with that was revealed almost exactly a year later. In May of 2001, results of the CAPRICORN trial were published in the Lancet. CAPRICORN demonstrated that the proprietary drug carvedilol, patented and marketed as Coreg by GlaxoSmithKline, was effective in reducing mortality from congestive heart failure. It did so by enrolling nearly 2,000 patients and following them for a span of years.

Had carvedilol been studied in 46 patients for six months, it’s quite clear that nothing of consequence would have been seen. Presumably, on that basis, the final nail might have been driven into the carvedilol-for-heart-failure hypothesis. But a huge trial, costing many millions of dollars, and funded by the company that stood to profit from its results — precluded that unhappy outcome.

What would the result have been if coenzyme Q10 had been studied in 2,000 people followed for years? Nobody knows. Since no one company can patent CoQ10, no entity is motivated to fund such a trial. Certainly the new meta-analysis, which pools data from multiple smaller studies, suggests the results of a larger trial of CoQ10 might be very different. I have been aware of this possibility all along, have recommended CoQ10 to some of my patients with heart failure, and been impressed with the apparent effects on more than one occasion.

My clinical practice since 2000 is an Integrative Medicine Center I direct. I have taken some heat over the years for my support of integrative medicine from self-appointed arbiters of science. But, in fact, I have no special interest in CAM or integrative medicine. I just have a special interest in helping my patients get better — and conventional medicine hasn’t always gotten the job done.

Neither, of course, does CAM — so the open-minded skeptic looks at both with the same cautious eye.

It is well established that much, even most, of what constitutes conventional medicine is just tradition and not truly evidence-based by today’s standards. My own work in evidence mapping, a technique colleagues and I invented that was subsequently adopted by the World Health Organization, reveals that the evidence base underlying practices in CAM is quite diverse. The simple summary of it all is that there is both baby and bathwater in CAM and conventional medicine alike, and it requires open-mindedness and unbiased methods to distinguish between them.

It also requires money, which brings us full circle.

Reports of nails in CAM’s coffin tend to be premature — because the many unpatentable modalities in the realm of CAM do not inspire huge and costly trials. We need such trials to know for sure what does and doesn’t work. In the absence of them, we have absence of evidence, not evidence of absence — and need to avoid a rush to judgment. Io believe at this point that CoQ10 is beneficial in heart failure — but don’t know for sure.

The story of CoQ10′s resurrection for heart failure across a span of more than a decade is in fact, not a tale of miracles. It’s all about money.

David L. Katz is the founding director of Yale University’s Prevention Research Center

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  • NormRx

    And now even the Mayo clinic is recommending CoQ10 for those patients on a statin. And let’s not forget that it seems everyone is low on D3 and needs a supplement.

  • http://Meddebate.com/ Jamal Ross

    Interesting article. It’s a shame that money is behind all of this, would love to read more on related topics.

  • http://www.facebook.com/people/RIchard-Feinman/100002248386290 RIchard Feinman

    I don’t know the details of this question but I thought that it was not about CoQ and heart disease, per se, but rather compensating for the effects of statins. Statins block the synthesis of cholesterol by blocking HMG-CoA to mevalonic acid step which leads to other products of which CoQ is one. Isn’t this the story? The effects should be studied in people taking statins (“already on what was optimal medication”), no? And six months may be short.

  • Molly_Rn

    Money makes the world go round. Just was at a large medical symposium and in the exhibitor’s hall were unbelievably huge pharmaceutical booths, all from big bucks from drug sales. There were no booths for execise or nutrition which could make a real difference in both preventing and treatment of heart disease or diabetes. Why? Money. So we have booths about testing, treatment and maintenance but not really prevention in the form of nutrition, lifestyle including exercise. Diabetes and heart disease make big bucks. Made me wonder what would happen to all those companies if we actually had a cure?

  • StephenModesto

    Thank you for the posting. I saved the article for future reference.

  • http://twitter.com/Wolftrail34 Michael Groesch

    I take between 1200, and 800mg of CoQ10 per day..and have for the past 2 years after having a low E.F after an enlarged heart, irregular heartbeat, and severe mitral valve regurgitation required surgery. I had my valve repaired, and an awesome thing called a M.A.Z.E procedure done (Google It) to correct my irregular heartbeat. 6 months after my surgery I went back for my echo and my E.F was a disappointing 45% —not horrible, but it was actually LOWER than it was before my surgery, after questioning my doctors, they explained that my initial E.F of around 55% was artificially inflated because of the regurge and my actual E.F was probably much lower, and the 45% reflected reality–at this time I was on Metropolol…
    Scared to death I was entering into the beginning stages of CF (at age 37) I began to take Carvedilol with Lisinopril (Had to get off the Lisinopril because of the cough–google that too) and The large amounts of CoQ10 that I mentioned above…1 year later my E.F was back to normal in the 55-60% range!
    Now was it the Carvedilol that saved me, or the CoQ10? I really don’t know, but I DO know that, I was taking a small amount of CoQ10 (400mg or so) initially when I was on the Metropolol–and after the bad E.F news I got I tripled my dosage for 12 months…and Im back in the ballgame and climbing The Grand Teton in July 2013–
    The person who did my echo when it was 45% kept asking me…What did was it before, what was it before?? She was stunned at the fast improvement.

    I get my CoQ10 from Sams wholsale club, 200mg caps 120 in a bottle and I take 6 a day..it costs me around 23 bucks a month or so. I realize this isn’t cheap, and not everyone can do it, but budget your money and give it a chance if you really want to give it a good shot. Take at least 1000mg for a while..the low dose will not do anything for you…
    For those of you with CHF, its time to up the ante–you have NOTHING to lose.
    Good Luck everyone–Live long and prosper!