Congestive Heart Failure (CHF) and Coenzyme Q10

CHF
Congestive heart failure is a serious, chronic condition that results when the heart is unable to pump well enough to meet the body's need for oxygen. The heart fails to pump efficiently which often leads to a build-up of fluid in the lungs. As a result, more stress is placed upon the heart to overcompensate for the congestion and the problem worsens. Caution: Congestive heart failure is a serious medical condition that requires medical attention.

Conditions that cause CHF include coronary artery disease, hypertension, heart attacks, cardiomyopathy, heart valve disease/infections, congenital heart disease and pulmonary hypertension. Initial symptoms of CHF, such as lower-body edema (i.e. swelling of the ankles), can be minor enough that treatment is not sought by patients until the CHF has progressed significantly. Once diagnosed, a number of treatment plans may be prescribed. These include medications, nutritional supplements and/or invasive procedures such as a balloon angioplasty with coronary stenting. Severe cases may require major surgery.

According to the American Heart Association, 550,000 new cases of CHF are diagnosed in the United States every year, including 1% of people over the age of 65. Fifty percent of all newly diagnosed CHF patients do not survive past 5 years after initial diagnosis. Men and women appear to be affected equally, although more women pass away annually from the condition.

As mentioned, CHF is usually a chronic disease. This simply means that it is a long-term condition that tends to gradually worsen over time. More often than not, the heart has lost some pumping capacity by the time CHF is diagnosed. The hearts compensates for this loss by enlarging or pumping faster-both of these states are very undesirable.

In addition, the body compensates by narrowing blood vessels to keep blood pressure up and diverting blood from less important tissues and organs to maintain flow to the most vital organs. These factors can mask CHF for years. Eventually, the heart and body can no longer compensate and the fatigue, edema and breathing disorders commence. This usually prompts a visit to a physician.

What is CoQ10?
CoQ10 is an antioxidant (vitamin), manufactured in the human body, and also present in small amounts in some foods -- unsaturated oils, fish, meats and nuts. As we age, we produce less CoQ10; and it would be difficult to get a significant amount from foods.

Some disease states tend to use up the body's store of CoQ10, and research is ongoing as to whether supplements of CoQ10 could be beneficial. It has been used to treat certain heart conditions, such as congestive heart disease; and also for patients with chronic renal failure.

Medications and CoQ10 - Interactions
Some medications may interfere with the action of CoQ10 or perhaps decrease its production in the body. Such medications include "statins", some diabetes drugs, chemotherapy drugs and other medications. Many doctors now routinely prescribe supplements of CoQ10 for their patients who are taking cholesterol-lowering statins including lovastatin (Mevacor), simvastatin (Zocor), and pravastatin (Pravachol), and the dietary supplement Cholestin.

Persons using some oral diabetes drugs (glyburide [Diabeta, Glynase, Micronase], phenformin, and tolazamide) should speak with their doctors regarding CoQ10, which may lower blood sugar. It's possible that beta-blockers (propranolol [Inderal], metoprolol [Lopressor, Toprol], and alprenolol), phenothiazines, tricyclic antidepressants, methyldopa, hydrochlorothiazide, clonidine, and hydralazine may create a need for CoQ10, but this is not firmly established.

And there is a single report that CoQ10 interfered with the medication warfarin (Coumadin), an anticoagulant. People using warfarin should not take CoQ10 without first consulting their physician.

How much CoQ10 is safe to take?
The typical recommended dosage of CoQ10 based on various past studies is 30 to 300 mg daily; however, recent studies have used amounts of up to 1200 mg per day. Do not take such a large amount without consulting your doctor. If you do take supplements, it's best to take these in divided doses, two or three times a day, rather than all at once.

What's the best form to use?
CoQ10 comes in hard capsule or soft-gel form. Which ever form you take it is important to remember that CoQ10 is fat soluble--that means it should be taken with a small amount of fat to help it get absorbed into the body and be most effective. Vitamin E may also enhance the absorption of CoQ10 (30 IU vitamin E is a good amount to take). It appears that CoQ10 and vitamin E work synergistically (better together than separately).

Side effects
*CHF patients who are taking CoQ10 should not discontinue taking CoQ10 supplements unless under the supervision of a doctor.

There appears to be none to few adverse effects associated with the usual amounts used in studies -- 30 to 300 mg per day. A very small percentage have some rare reported side effects including minor stomach upset, minimal loss of appetite, nausea, diarrhea. People taking CoQ10 late at night have reported insomnia.

Studies on the safety of CoQ10 have not been conducted on women who are pregnant or breastfeeding, or on children, and these individuals should not use CoQ10 prior to consulting with their physician.

CHF & Coenzyme Q10
The highest concentration of CoQ10 in the human body is found in the heart. Therefore, it is not surprising that early clinical trials on the therapeutic potential of CoQ10 focused on heart disease. CHF was one of the first conditions to be clinically evaluated using CoQ10. The efficacy of CoQ10 was first discovered in Japan in 1967 where researchers found a link between heart disease and CoQ10 deficiency. Since then studies have found a link between CHF and tissue levels of CoQ10. Here is a quick summary of a few important studies:

Clinical Studies:
Jpn Heart J 1976; 17:32-42.
-17 patients with CHF received CoQ10 at 30 mg QD for 7 - 182 days. Evaluation after 4 months found that nine patients became symptom-free and the rest significantly improved.

Biomedical and Clinical Aspects of Coenzyme Q10, Vol. 4, Elsevier Science Publishers, Amsterdam, 1984, pp. 353-67.
-34 patients with CHF (NYHA class IV) with Co Q10 at 100 mg QD while continuing previously prescribed digitalis and diuretics. 82% of the patients showed improvement in stroke volume, cardiac index, and ejection fraction-improvement continued for at least one year. Mean ejection fraction increased from 25% to 40% during treatment with CoQ10. Survival rates (71% after 1 year and 62% after 2 years) were considered very high for class IV patients previously hospitalized 2+ times for CHF.

Proc Nat Acad Sci 1985; 82:4240-44.
-Double-blind crossover study involving 19 patients with NYHA class III or IV heart disease given 100 mg QD CoQ10 or placebo for 12 weeks. Findings: significant increases in blood CoQ10 levels and cardiac function during the CoQ10 treatment period, but not during placebo period. 18 of 19 patients reported increased tolerance to physical activity during the CoQ10 treatment period compared to the placebo period.

Clinical Investigation 1993; 71:s129-s133.
-1,715 outpatients with NYHA class II and III CHF were treated with 50 mg QD CoQ10 for 4 weeks while standard treatment was continued. CoQ10 improved dyspnea (at rest and with exertion), lower extremity edema, palpitations, pulmonary rales, cyanosis, and hepatomegaly. The rate of improvement was the same in 192 patients receiving CoQ10 alone as it was in patients receiving other treatments.

Clin Investig 1993; 71:s134-136. -Double-blind study: 641 patients with NYHA class III and IV CHF were randomly selected to be given placebo or CoQ10 at a dose of 2 mg/kg QD for one year with continuation of previously-prescribed therapies. The number of patients requiring inpatient care for CHF was 38% less in CoQ10 group (p<0.001) compared to the control group. A reduction in cardiac asthma and pulmonary edema was 60% in the treated group versus 50% in the control group (p<0.001).

Clinical Investigation 1993; 71:s145-149.
-1,113 patients with CHF who were diagnosed for at least 6 months and had conventional treatment unchanged for at least 3 months. CoQ10 was given for 3 months in dosage 50-150 mg QD with 78% receiving 100 mg QD. A positive correlation was found with the CoQ10 group and improvement in CHF status.

**Although CoQ10 is definitely not a cure, studies such as these suggest how it may be beneficial to individuals with CHF and other heart ailments. However, as always, please consult your physician prior to starting any treatment plan.

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