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CoQ10 Proven Benefits in Heart Failure Patients

The European Journal of Heart Failure has published data from one of the most robust studies to date on coenzyme Q10.

This ten year study conclusively showed that CoQ10 supplementation significantly improves survival for even the most severe heart failure patients while radically reducing incidences of hospitalization.

This new study shows that CoQ10 supplementation can restore deficient CoQ10 levels in patients with moderate-to-severe heart failure, extend lifespan, and improve quality of life.

The compelling results from this 10-year-long study found that patients who took 100 mg of CoQ10 three times daily were…

Significantly less likely to die from heart failure, Less than half as likely to die from any cause at all, and Half as likely to have a major adverse cardiac event during the study period, compared with control subjects. After only three months of supplementation, the researchers detected a trend towards reduced levels of a blood marker of heart failure severity that is released from over-worked heart muscle cells.1,2 At two years, significantly more treated patients had improved measurements of heart function than did placebo recipients.

This impressive study demonstrates how CoQ10 offers important heart health benefits and how essential it is to cardiac patients. Ideally, the practice of cardiology will soon include CoQ10 as part of their protocol to improve the lives of those living with heart failure.

Class Functional Capacity: How a patient with cardiac disease feels during physical activity
I Patients with cardiac disease but resulting in no limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, difficulty breathing, or anginal pain.
II Patients with cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, difficulty breathing, or anginal pain.
III Patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes fatigue, palpitation, difficulty breathing, or anginal pain.
IV Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of heart failure or the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort increases.


Most people have heard of heart failure, but few understand what it really is.

Contrary to what most people might think, heart failure does not mean that the heart stops beating. Rather, heart failure occurs whenever the heart is unable to pump enough blood to sustain normal function in other organs.

Your heart is one of the hardest-working organs in your body; it literally never takes a rest. Beat after beat, hour after hour, day after day, for your entire life, your heart contracts and relaxes a little more than once per second, providing the blood flow that every other organ in your body relies on.

That much effort requires a steady supply of energy. And to perform at optimal function—literally without missing a beat—your heart needs to be able to derive that energy from its fuel (primarily fatty acids and glucose) efficiently and with little waste.

In order to support this task, your mitochondria pump out a steady supply of energy derived from food. This is called bioenergetics. But your mitochondria don’t work alone. Just as a clean-burning automobile engine is more fuel-efficient and lasts longer than an out-of-tune one, the mitochondria need help maintaining top-level efficiency and performance.

CoQ10 is essential for the heart to maintain sufficient energy management. But when CoQ10 levels decline, tissues burn fuel inefficiently, eventually producing oxidative damage and ultimately losing their function. When the heart muscle loses its fuel efficiency, heart failure may occur.

Research has shown that CoQ10 levels are lower in patients with heart failure and the lower the levels, the more severe the failure. In fact, heart failure patients with lower CoQ10 levels have up to a two-fold risk of dying compared to those with higher levels.



  • Loss of efficient energy management, or bioenergetics, is a root cause of heart failure and many other conditions associated with aging.
  • Many patients with heart failure are deficient in CoQ10, a nutrient that optimizes bioenergetics in the heart muscle’s mitochondria.
  • A dramatic new study shows that CoQ10 supplementation can restore deficient CoQ10 levels, extending life span and improving quality of life, even in patients with the most severe classes of heart failure.
  • CoQ10 supplementation is finding a role in the management of other cardiovascular disease processes, including endothelial dysfunction, hypertension, heart attack, and the ischemia-reperfusion injury that accompanies heart attacks and strokes.
  • Aging changes your basic biochemistry; you can restore optimal bioenergetics with CoQ10 supplementation.


Over the past 30 years, mounting evidence has been establishing CoQ10 as one of the most vital nutrients necessary for heart health.

CoQ10 has been known to benefit cardiac bioenergetics since the 1970s. In 1985, a small study found that patients with the most severe levels of heart failure experienced significant improvements in cardiac function and clinical state during CoQ10 treatment.

Since then, other small studies showed similar improvement in clinical status and heart function testing, typically using doses of 100 to 200 mg/day. Roughly 75% of patients taking CoQ10 experienced improvements in cyanosis (bluish skin), liver enlargement, lung examinations, difficulty breathing, palpitations, sweating, heart arrhythmias, insomnia, vertigo, and nighttime urination.

Several of the studies demonstrated an improvement in cardiac functional status, as determined by the New York Heart Association, reducing patients’ class levels of heart failure by an average of 0.5 compared with placebo. This means that heart failure patients could move from a strict Class II with limitations on physical activity to a class I-II with fewer or even no limitations resulting in substantial improvements in quality of life.

Other studies over the past 15 years or so showed small but significant improvements in objective measures of heart function, such as ejection fraction (the proportion of blood pumped out of the heart with each beat), stroke volume (volume of blood pumped with each beat), and cardiac output (total amount of blood pumped per minute).

But it wasn’t until mid-2013 that results were published from the first comprehensive, double-blind, multi-center study demonstrating the dramatic, life-saving impact of CoQ10 supplementation in patients with chronic heart failure.


Most biochemical compounds exist in more than one form. CoQ10 is no exception. A common form of the substance is called ubiquinone, and, while it has demonstrated biological activity, it is much less bioavailable than ubiquinol. Ubiquinol is the so-called “reduced” form of CoQ10. In chemical terms, that means it carries an extra electron. This is important because that electron is what allows CoQ10 to help neutralize, or “reduce,” dangerous reactive oxygen and nitrogen species. Therefore, your CoQ10 supplement should ideally contain the ubiquinol form of CoQ10.


This new study showed that even in patients with the most severe classes of heart failure, CoQ10 supplementation can restore deficient CoQ10 levels, extending life span and improving quality of life.

The study, begun in 2003, included only the most severely affected patients (those in the New York Heart Association class III or IV).1 In addition to their regular medication, study subjects were randomly assigned to receive either 100 mg of CoQ10 or placebo 3 times daily. Each patient was followed up with a wide variety of outcomes measures for two years.

After only three months of supplementation, the researchers detected a trend towards reduced levels of proBNP, a marker of heart failure severity that is released from over-worked heart muscle cells. At two years,significantly more treated patients had improved their heart failure class than did placebo recipients.

But the study’s main endpoint measurement was the most dramatic indicator of success. Only 14% of patients in the supplemented group had a major adverse cardiac event (defined as unplanned hospitalization for worsening heart failure, death from a cardiovascular cause, urgent heart transplantation, or artificial mechanical heart support), while 25% of those in the placebo group had a major cardiac event. In statistical terms, that produced a “hazard ratio” of 2.0—meaning the untreated patients had twice the risk of a major cardiac event!

Compared with control patients, those taking CoQ10 experienced significantly fewer cardiovascular deaths and hospitalizations for worsening heart failure. The difference in death rate from all causes between the CoQ10 and placebo groups was striking. Subjects on placebo had twice the rate of death compared to those taking CoQ10. And, unlike most drug studies, there were significantly fewer adverse events in the supplemented group than in the placebo group.

This study was the first ever to show that CoQ10 supplementation in advanced heart failure improves survival, while slashing hospitalization rates.

It highlights the importance of regular supplementation with this cardiac “fuel additive” for anyone with heart failure or its risk factors, such as endothelial dysfunction, hypertension, and a history of a heart attack. Studies have shown that CoQ10 improves each of these risk factors for heart failure. Let’s look at each in turn.


Heart failure affects around 5.7 million Americans, and causes or contributes to more than 335,000 deaths each year. Half of those with heart failure die within 5 years of their diagnosis.

There are many primary causes of heart failure.9,43 The most common include coronary artery disease and high blood pressure but can also include heart attacks, obesity, and diabetes, all of which place excessive demands on the heart muscle, making it work harder and harder just to produce enough blood flow to sustain life at rest. That extra demand for energy uses up CoQ10, resulting in a loss of fuel efficiency precisely when the heart needs every bit of energy it can generate.

Eventually, the heart muscle simply tires out, becoming enlarged and flabby, squeezing more weakly with each contraction, and pumping smaller and smaller amounts of blood out to the body.

Symptoms of heart failure reflect the diminished blood flow to all of the organs in the body, especially the lungs, kidneys, and liver. Such symptoms commonly include shortness of breath even with normal daily activities, difficulty breathing when lying down, and swelling in the lower extremities or lower back. These symptoms are usually accompanied by substantial weight gain (“water weight”), and generalized fatigue and weakness.

Eventually, symptoms worsen, requiring frequent hospitalization with increased risk of life-threatening heart arrhythmias and pulmonary edema.44 Even with the best conventional treatment, some people with heart failure, particularly those who in spite of conventional treatment fail to show evidence of clinical improvement, may die within two years.


Chronic oxidative stress is one of the main factors reducing the functioning of the endothelium, the thin layer of cells lining arteries that controls blood flow and pressure. Endothelial dysfunction is a major precursor to hypertension, coronary heart disease, and strokes. Since CoQ10 is a unique antioxidant, it makes sense that it would have beneficial effects on endothelial function.

That has proven to be the case. In patients with known coronary artery disease, who are at high risk for heart attack, and who need every bit of functioning endothelium, supplementation with 300 mg of CoQ10 a day significantly improved their natural endothelial antioxidant levels, improved their arterial relaxation, and improved their oxygen utilization.

Similar improvements were seen in patients with New York Heart Association grade II to III heart failure, who experienced a 9% improvement in oxygen utilization and a 38% improvement in endothelial function when they used the same dose of CoQ10, with no side effects.

CoQ10 has subsequently shown value in improving endothelial dysfunction caused by diabetes and by high LDL-cholesterol, two major contributors to cardiovascular disease. In addition, it reduces blood vessel stiffness, a consequence of endothelial dysfunction.


Low levels of CoQ10 have been correlated with increased cancer risk in some populations.45 This is due in part to the fact that cancer cells are enormous users of energy, perturbing the bioenergetics of surrounding tissue and bathing host cells in free radicals and other destructive byproducts.

Though research is still in its early stages, CoQ10 supplementation is showing real promise in counteracting these effects to slow—and in some cases reverse—cancer’s progression. Here is a synopsis of scientific progress:

  • CoQ10 along with vitamin B6 boosted the function of cancer-fighting immune cells.
  • CoQ10 alone or in combination with B vitamins enhanced the efficacy of the anti-breast cancer drug tamoxifen in animal studies, and decreased plasma markers of metastasis and new blood vessel growth in human breast cancer patients.
  • CoQ10 suppressed development of pre-cancerous lesions in animal models of colon cancer.
  • CoQ10 increased median actual survival by more than 40% in patients with a variety of end-stage cancers.

It seems all but inevitable that further studies will highlight greater benefits in humans, especially at the level of prevention rather than treatment, an area in which mainstream medicine is sadly lacking.


Oxidative stress and endothelial dysfunction are major causes of elevated blood pressure, which affects about 67 million US adults. CoQ10 supplementation is showing promise in reducing blood pressure in hypertensive patients, without producing dangerous abrupt drops in pressure.

A multitude of studies have shown that doses of CoQ10 as low as 60 mg twice daily can lower blood pressure by up to 17.8 points systolic (top number) and 7 points diastolic (bottom number).30-32 None of these studies reported significant side effects, and CoQ10 is now recommended by some researchers for use in addition to standard drug treatment for hypertension, especially in elderly patients.


Your brain receives the largest proportion of total blood flow from your heart; as a result, it has some of the most volatile fluctuations in bioenergetic demands. Because of this, CoQ10 is of tremendous importance in maintaining brain health and preventing neuronal damage.

Unfortunately, studies have clearly shown a loss of CoQ10 functioning in the aging brain—with severe deficiencies in those with neurodegenerative disorders such as Parkinson’s and Alzheimer’s diseases, and following strokes.

Fortunately, laboratory studies have shown that supplementing with CoQ10 has multiple brain-protective effects, especially in aging animals. Take a look:

  • CoQ10 has been shown to decelerate the aging process in a strain of mice with abnormally accelerated aging.
  • When aging, stroke-prone mice were supplemented long-term with CoQ10, they had smaller volumes of damaged brain, and larger volumes of healthy, functioning brain.
  • In culture dishes, CoQ10 kept brain stem cells alive following periods of oxygen deprivation (as seen in strokes), setting the stage for possible recovery through new cell development.
  • In a mouse model of Alzheimer’s disease, CoQ10 decreased the amount of destructive amyloid beta plaque in brain tissue, while improving the animals’ behaviors.
  • In aging mice at risk for Parkinson’s disease, supplementation reduced the loss of dopamine-producing neurons and raised brain dopamine levels (dopamine is the neurotransmitter that is diminished in human Parkinson’s).

Preliminary human studies show good results as well—especially in patients with early and mild Parkinson’s disease. CoQ10 at 360 mg/day produced moderate reduction in symptom scores, while 1,200 mg/day appeared to slow functional decline in those with early disease. Studies have shown that up to 3,000 mg/day is well tolerated, with 2,400 mg/day being the highest dose used in studies involving Parkinson’s patients.

The superior absorption of the ubiquinol form of CoQ10 would allow lower doses to be used. Those with congestive heart failure or neurological conditions should ideally strive for a coenzyme Q10 blood level of over 3.5 micrograms per milliliter (mcg/mL).


CoQ10 is especially valuable in reducing the damage caused by a heart attack. Never is your heart in greater need of efficient bioenergetics than during and immediately after a heart attack. CoQ10 is sharply diminished in heart attack victims. In fact, low CoQ10 levels are associated with an increased risk of dying in post-cardiac arrest patients.34 The main damage in survivors of a heart attack doesn’t come from the loss of blood flow itself (ischemia), but rather from the restoration of oxygen-rich blood to tissues that have lacked oxygen for the critical minutes before circulation is restored (reperfusion).35 CoQ10 reduces the impact of ischemia-reperfusion injury by optimizing the heart muscle’s bioenergetics and providing antioxidant support during this crucial period. Supplementation reduces markers of extreme oxidative stress and poor mitochondrial function, while reducing the rates of post-reperfusion arrhythmias and improving heart musclefunctioning.

Studies show that CoQ10 at doses of 100 to 120 mg/day reduced total arrhythmias and other cardiac events, increased left ventricular (main pumping chamber) function, and reduced the death rate from repeat heart attacks.

CoQ10 is powerful enough that it has been given intravenously during bypass grafting procedures, where it improved left ventricular functioning 6 to 10 hours after the operation, compared with control patients, and reduced blood markers of heart muscle damage.37 Similar beneficial effects have now been shown in patients who take 150 to 180 mg of CoQ10 per day for 7 to 10 days prior to elective bypass surgery.


Your mitochondria pump out a steady supply of energy derived from the food you supply them with. Like any finely-tuned machine, however, they need help maintaining top-level efficiency and performance.

CoQ10 is the main molecule your body requires to keep mitochondrial energy production, or bioenergetics, running smoothly. Declining CoQ10 levels cause tissues to burn fuel inefficiently, eventually producing oxidative damage and ultimately losing their function.

CoQ10 deficiency and the resulting bioenergetic collapse is the underlying cause of heart failure, one of the largest causes of death and disability in Americans today. Studies show that CoQ10 supplementation at 300 mg/day not only restores normal CoQ10 levels, but prevents progression of heart failure and in fact can reverse that progression and extend survival and improve quality of life.

Similar beneficial effects have now been shown in patients with endothelial dysfunction, hypertension, and coronary artery disease, the precursors of heart attacks and ultimately heart failure.

Since we all require efficient and uninterrupted energy supplies, we all need to be thinking about optimizing our bioenergetic status with CoQ10 supplementation.