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Coenzyme Q10 for heart failure

Tareq Al Saadi, Yazan Assaf, Medhat Farwati, Khaled Turkmani, Ahmed Al-Mouakeh, Baraa Shebli, Mohammed Khoja, Adib Essali, Mohammed E Madmani
Cochrane Database of Systematic Reviews 2021 2021(2):CD008684

Bibliography

PubMed
PMID 35608922
PubMed Central
PMC8092430
DOI
10.1002/14651858.CD008684.pub3
Funding
Cochrane review. The accessible review record documents standard review support and funding disclosures for included studies; no commercial sponsor of the review itself was identified in the sources checked.
Competing interests
The review applied Cochrane conflict-of-interest and risk-of-bias procedures. No review-level commercial conflict was identified in the accessible sources checked.

Study snapshot

DesignCochrane systematic review and meta-analysis of randomized controlled trials
ModelCochrane review of parallel and crossover randomized trials comparing CoQ10 with placebo or conventional therapy in people with heart failure, with evidence current to October 2020.
Sample11 randomized controlled trials; 1,573 participants.
InterventionCoQ10 supplementation versus placebo or conventional therapy; doses and follow-up periods varied substantially.
DurationVariable across included trials.
EndpointsAll-cause mortality; Heart-failure hospitalization; Myocardial infarction; Stroke; Left ventricular ejection fraction; Exercise capacity; Adverse events

What the study showed, in plain terms

This 2021 Cochrane review included 11 randomized trials with 1,573 participants and graded the certainty of evidence rather than treating all heart-failure outcomes as equally reliable.

CoQ10 probably reduced all-cause mortality (RR 0.58, 95% CI 0.35 to 0.95) and heart-failure hospitalization (RR 0.62, 95% CI 0.49 to 0.78), both rated moderate-quality evidence. However, the mortality estimate came from one 420-person trial and hospitalization from two trials.

Evidence for LVEF and exercise capacity was much less certain. The authors concluded that there was still no convincing evidence to definitively support or refute CoQ10 for heart failure and called for further trials.

Key findings

All-cause mortality: RR 0.58, 95% CI 0.35 to 0.95; 1 study, 420 participants; moderate-quality evidence.

Heart-failure hospitalization: RR 0.62, 95% CI 0.49 to 0.78; 2 studies, 1,061 participants; moderate-quality evidence.

LVEF: MD +1.77, 95% CI 0.09 to 3.44; 7 studies, 650 participants; very low-quality evidence.

Exercise capacity: MD 48.23, 95% CI -24.75 to 121.20; 3 studies, 91 participants; inconclusive.

Adverse events: RR 0.70, 95% CI 0.45 to 1.10; 2 studies, 568 participants; low-quality and inconclusive.

What this study can and cannot tell us

Most included trials were small and many had unclear or high risk of bias in at least one domain.

Mortality was driven by a single 420-participant trial, so the pooled evidence is less independently replicated than the headline RR can imply.

Dose, duration, background therapy and outcome definitions varied substantially.

The evidence search ended in 2020, so later trials and the 2024 meta-analysis are not included.

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Dr. Khaled Mahmoud, MBBChCritical Care Medicine, Longevity Science & Editorial Direction Dr. Amr Yasser, PhDCardiometabolic, Musculoskeletal, Gut & Bioavailability Dr. Abdulla Mostafa, PhDCellular Senescence, Neurological, Mitochondrial & Brain-Ageing Biology