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Overview on coenzyme Q10 as adjunctive therapy in chronic heart failure. Rationale, design and end-points of "Q-symbio"--a multinational trial.

Abstract

Energy starvation of the myocardium is probably a dominant feature of heart failure and attention has been directed towards agents which may stabilize myocardial metabolism and maintain adequate energy stores. A reduced myocardial tissue content of the essential redox-component and natural antioxidant Coenzyme Q10 (CoQ10) has been detected in patients with heart failure and the observed level of CoQ10 deficiency was correlated to the severity of heart failure. CoQ10 fulfills various criteria of an obvious adjunct in patients with symptomatic heart failure: it is devoid of significant side effects and it improves symptoms and quality of life. Till this date, several double-blind placebo-controlled trials with CoQ10 supplementation in more than 1000 patients have been positive and statistically significant with respect to various clinical parameters, e.g. improvement in NYHA Class, exercise capacity and reduced hospitalisation frequency. Also treatment with CoQ10 led to a significant improvement of relevant hemodynamic parameters. In only 3 out of 13 double-blind studies comprising 10% of the total number of patients treated the results were neutral. Thus, based on the available controlled data CoQ10 is a promising, effective and safe approach in chronic heart failure. This is why a double-blind multicenter trial with focus on morbidity and mortality has been planned to start in 2003: Q-SYMBIO. Patients in NYHA classes III to IV (N=550) receiving standard therapy are being randomized to treatment with CoQ10 100 mg t.i.d. or placebo in parallel groups. End-points in a short-term evaluation phase of 3 months include symptoms, functional capacity and biomarker status (BNP). The aim of a subsequent 2-year follow-up study is to test the hypothesis that CoQ10 may reduce cardiovascular morbidity (unplanned cardiovascular hospitalisation due to worsening heart failure) and mortality as a composite endpoint. This trial should help to establish the future role of CoQ10 as part of a maintenance therapy in patients with chronic heart failure.

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  • Publisher Full Text
  • Publisher Full Text
  • Authors+Show Affiliations

    The Heart Centre, Medical Department B, Copenhagen University Hospital, Denmark. samortensen@dadlnet.dk

    Source

    BioFactors (Oxford, England) 18:1-4 2003 pg 79-89

    MeSH

    Cardiac Output, Low
    Coenzymes
    Controlled Clinical Trials as Topic
    Double-Blind Method
    Humans
    Placebos
    Randomized Controlled Trials as Topic
    Treatment Outcome
    Ubiquinone

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    14695923

    Citation

    Mortensen, Svend Aage. "Overview On Coenzyme Q10 as Adjunctive Therapy in Chronic Heart Failure. Rationale, Design and End-points of "Q-symbio"--a Multinational Trial." BioFactors (Oxford, England), vol. 18, no. 1-4, 2003, pp. 79-89.
    Mortensen SA. Overview on coenzyme Q10 as adjunctive therapy in chronic heart failure. Rationale, design and end-points of "Q-symbio"--a multinational trial. Biofactors. 2003;18(1-4):79-89.
    Mortensen, S. A. (2003). Overview on coenzyme Q10 as adjunctive therapy in chronic heart failure. Rationale, design and end-points of "Q-symbio"--a multinational trial. BioFactors (Oxford, England), 18(1-4), pp. 79-89.
    Mortensen SA. Overview On Coenzyme Q10 as Adjunctive Therapy in Chronic Heart Failure. Rationale, Design and End-points of "Q-symbio"--a Multinational Trial. Biofactors. 2003;18(1-4):79-89. PubMed PMID: 14695923.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Overview on coenzyme Q10 as adjunctive therapy in chronic heart failure. Rationale, design and end-points of "Q-symbio"--a multinational trial. A1 - Mortensen,Svend Aage, PY - 2003/12/30/pubmed PY - 2004/4/16/medline PY - 2003/12/30/entrez SP - 79 EP - 89 JF - BioFactors (Oxford, England) JO - Biofactors VL - 18 IS - 1-4 N2 - Energy starvation of the myocardium is probably a dominant feature of heart failure and attention has been directed towards agents which may stabilize myocardial metabolism and maintain adequate energy stores. A reduced myocardial tissue content of the essential redox-component and natural antioxidant Coenzyme Q10 (CoQ10) has been detected in patients with heart failure and the observed level of CoQ10 deficiency was correlated to the severity of heart failure. CoQ10 fulfills various criteria of an obvious adjunct in patients with symptomatic heart failure: it is devoid of significant side effects and it improves symptoms and quality of life. Till this date, several double-blind placebo-controlled trials with CoQ10 supplementation in more than 1000 patients have been positive and statistically significant with respect to various clinical parameters, e.g. improvement in NYHA Class, exercise capacity and reduced hospitalisation frequency. Also treatment with CoQ10 led to a significant improvement of relevant hemodynamic parameters. In only 3 out of 13 double-blind studies comprising 10% of the total number of patients treated the results were neutral. Thus, based on the available controlled data CoQ10 is a promising, effective and safe approach in chronic heart failure. This is why a double-blind multicenter trial with focus on morbidity and mortality has been planned to start in 2003: Q-SYMBIO. Patients in NYHA classes III to IV (N=550) receiving standard therapy are being randomized to treatment with CoQ10 100 mg t.i.d. or placebo in parallel groups. End-points in a short-term evaluation phase of 3 months include symptoms, functional capacity and biomarker status (BNP). The aim of a subsequent 2-year follow-up study is to test the hypothesis that CoQ10 may reduce cardiovascular morbidity (unplanned cardiovascular hospitalisation due to worsening heart failure) and mortality as a composite endpoint. This trial should help to establish the future role of CoQ10 as part of a maintenance therapy in patients with chronic heart failure. SN - 0951-6433 UR - https://www.unboundmedicine.com/medline/citation/14695923/Overview_on_coenzyme_Q10_as_adjunctive_therapy_in_chronic_heart_failure__Rationale_design_and_end_points_of_ L2 - https://content.iospress.com/openurl?genre=article&issn=0951-6433&volume=18&issue=1-4&spage=79 DB - PRIME DP - Unbound Medicine ER -