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Effect of coenzyme Q10 on cardiac function and survival in heart failure: an overview of systematic reviews and meta-analyses

Eva Alarcón-Vieco, Irene Martínez-García, Irene Sequí-Domínguez, Eva Rodríguez-Gutiérrez, Nerea Moreno-Herráiz, Carlos Pascual-Morena
Food & Function 2023 14(14):6302-6311

Bibliography

PubMed
PMID 37350565
DOI
10.1039/d3fo01255g
Funding
Supported by the University of Castilla-La Mancha, of which the authors are members.
Competing interests
The authors declared no conflict of interest.

Study snapshot

DesignOverview of systematic reviews and meta-analyses
ModelUmbrella-style evidence synthesis of published meta-analyses evaluating CoQ10 in heart failure through March 2023.
Sample10 meta-analyses met inclusion criteria.
InterventionCoQ10 supplementation versus control across the randomized and controlled heart-failure trials represented in included meta-analyses.
DurationVariable across the underlying trials and meta-analyses.
EndpointsLeft ventricular ejection fraction; Cardiac output; Cardiac index; Stroke volume; Mortality; Hospitalization; Exercise capacity; NYHA functional class; Circulating CoQ10

What the study showed, in plain terms

This 2023 overview compared the conclusions of 10 published meta-analyses rather than simply adding another pooled estimate.

Six of nine meta-analyses assessing ejection fraction reported improvement, with pooled increases ranging from about 1.77 to 3.81 percentage points. Mortality estimates across reviews generally favored CoQ10, with relative risks ranging approximately from 0.69 to 0.58; hospitalization was reported at RR 0.62 in one synthesis.

The evidence was less consistent for exercise capacity and NYHA class. The overview therefore supports a possible benefit while emphasizing that different reviews, populations, doses and overlapping trials do not produce a uniformly positive picture.

Key findings

Ejection fraction: 6 of 9 included meta-analyses reported benefit, with pooled increases ranging from 1.77% (0.10 to 3.44) to 3.81% (1.22 to 6.40).

Mortality: favorable pooled relative risks across included analyses ranged from approximately 0.69 (0.50 to 0.95) to 0.58 (0.35 to 0.95).

Hospitalization: one included synthesis reported RR 0.62 (0.49 to 0.78), favoring CoQ10.

Exercise capacity was not consistently improved; only one review showed an effect on NYHA classification.

Circulating CoQ10 increased consistently, confirming biochemical exposure without proving that every clinical endpoint improves.

What this study can and cannot tell us

An overview of meta-analyses inherits the limitations and risk of bias of the underlying trials and reviews.

The same influential trials can appear repeatedly across multiple meta-analyses, so review counts are not equivalent to independent replication.

CoQ10 dose, duration, participant characteristics and heart-failure severity varied substantially across the evidence base.

Heterogeneity was high for some outcomes and the authors concluded that more research is needed to determine conditions that may optimize therapy.

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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