Tuesday, May 29

Cellular Energy to the Most Hardworking Cells in Your Body



Overview of Coenzyme Q10.
Coenzyme Q10, also referred to as CoQ10 or ubiquinone, is a vitamin-like compound which is present in all cells.  It occurs naturally in the body and is found in highest amounts in the mitochondria, where cellular energy is created.  CoQ10 levels are highest in the hardest-working tissues of the body, especially the heart.
Coenzyme Q10 is an antioxidant, that is, it helps to protect cells from damage caused by the body's own free radicals.  The body produces free radicals in the normal course of energy production.  However as we get older our bodies generate an excess of free radicals.  This can be deleterious for individuals whose bodies are not producing enough Coenzyme Q10 and other antioxidants to control these free radicals.
Coenzyme Q10 has several different actions in the body.  Its most notable effects/help are:
                    it scavenges free radicals as an Antioxidant
                    Improves the efficacy of cellular energy production in the mitochondria (energy factories) of the cell
                    Regulates genes concerned with energy production
                    Stabilizes membranes

As we age there is a decline in the amount of CoQ10 our body produces.  It is not possible to get large amounts of CoQ10 from diet alone.  Therefore taking a daily supplement, especially as we age, can increase cell energy levels and strengthen the body's antioxidant defence network. 

Basic Cardiovascular Function
In a variety of laboratory and animal experiments, coenzyme Q10 has been shown to be effective in reducing the adverse effects of ischaemia-reperfusion injury.  It can enhance energy production in mitochondria and cells and improve clinical outcomes.

Coenzyme Q10 in Hypertension
There have been twelve clinical trials of coenzyme Q10 in the treatment of hypertension.  Four were prospective randomized trials and eights were before and after studies.  Overall, the twelve studies showed a fall in blood pressure of 17 mmHg systolic and 10 mmHg diastolic.  coenzyme Q10 has shown to be particularly effective with hypertension in diabetics were it not only lowers blood pressure but also improves diabetic control.  The mechanism of action of coenzyme Q10 in hypertension is almost certainly as an antioxidant, were it scavenges free oxygen radicals, protects the endothelium from oxygen free radical attack and thus improves vascular dilatation by nitric oxide.

Coenzyme Q10 in Heart Failure
A review of all the published trials of coenzyme Q10 in heart failure was first published in 1997.  This showed a beneficial effect of coenzyme Q10.  We updated the findings for this analysis by analyzing nine randomized trials of coenzyme Q10 in heart failure published up to 2003 (2).  Only prospective randomized, double-blind and placebo-controlled trials were included in that analysis.  The three parameters with adequate numbers of patients for meaningful analysis were coenzyme Q10 levels (5 trials), ejection fraction at rest (7 trials) and mortality (5 trials).  Other parameters were measured in only two trials each.  For CoQ10 levels (279 patients), the weighted mean differences was 1.4 µg/µl representing an increase of 161%.  For ejection fraction at rest (384 patients) the weighted mean difference showed a trend in favor of CoQ10 of 1.9% (95% confidence limits - 0.13% to 3.9%).
An updated meta-analysis has been published recently (12).  This meta-analysis included eleven randomized trials of coenzyme Q10 in heart failure including cross-over and parallel trial designs.  The main end-point of resting ejection fraction showed an absolute 3.7% net improvement (P < 0.0006).  Stroke index also increased by 5.8 ml (P = 0.02).  Sub-group analyses showed that the ejection fraction improvement was more pronounced when only idiopathic cardiomyopathy was evaluated and among patients not receiving angiotensin converting enzyme (ACE) inhibitors.  When the results were re-analyzed using a less conservative statistical test (fixed effects modeling) than was used in the initial analysis (random effects modeling), increases in cardiac output, cardiac index and stroke volume all became significant.
In light of the encouraging findings of the abovementioned meta-analyses it is not unreasonable to recommend to patients with symptomatic heart failure despite conventional therapy or those who are experiencing side effects from conventional therapy (especially ACE inhibitors) to take 150-300 mg of coenzyme Q10 daily and to monitor CoQ10 blood levels and clinical response.

Coenzyme Q10 in Cardiac Surgery
Coenzyme Q10 has been used in the cardiothoracic surgical setting in order to offset reperfusion-related increases in free radical formation and oxidative stress.  From 1982 to 2004 at least eight controlled trials of coenzyme Q10 in cardiac surgery have been published.14-22 All but one of these have shown a beneficial effect of some kind.  The one trial showing an absence of effect20 used oral CoQ10 for only 12 hours before surgery, an inadequate time frame for sufficient dosing to increase myocardial levels.  A prospective randomized, placebo-controlled trial from our unit of 300 mg per day of oral CoQ10 for two weeks preoperatively in 121 coronary bypass or valve replacement procedures showed increased mitochondrial CoQ10 content, increased effiency of mitochondrial energy production and improved contractile function in myocardial trabeculae.

Cardiac Arrhythmias
There is some anecdotal experimental and clinical evidence of a beneficial effect of coenzyme Q10 in cardiac arrhythmias.  This would make sense in light of the effect of coenzyme Q10 in improving cellular membrane function and energy production, thus reducing the myocardial ischaemia that can generate arrhythmias.


Side Effects and Drug Interactions
Coenzyme Q10 is essentially devoid of side effects.  There are occasional reports of gastrointestinal upset but no other major side effects.

Does coenzyme Q10 Interfere with Warfarin?
The literature contains a case report describing a reduction in the efficacy of warfarin caused by coenzyme Q10.  However, a subsequent prospective randomised trial of coenzyme Q10 showed no effect of coenzyme Q10 on coagulation status in patients receiving Warfarin therapy.  In summary, anticoagulation should be closely monitored during the initiation or withdrawal of coenzyme Q10therapy.

Dosage
Doses between 150 and 300 mg per day are used for heart failure or hypertension.  Ideally, dosage is adjusted according to serum coenzyme Q10 levels. Therapeutic effects are most likely when serum levels are increased to twice normal. CoQuinone 30 dietary supplement was developed to deliver high-quality, highly bioavailable CoQ10 to the cells to support the production of adenosine-5-triphosphate (ATP).

Conclusions
There is accumulating laboratory and clinical evidence of the efficacy of coenzyme Q10 in a variety of cardiovascular disorders.  Not all of these have been conclusively proven, but in the absence of side effects, it is reasonable to administer coenzyme Q10 to selected patients with various types of cardiovascular disease and gauge the response.

Major Reference: Coenzyme Q10 Research

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