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Effect of coenzyme Q10 supplementation on heart failure: a meta-analysis

A Domnica Fotino, Angela M Thompson-Paul, Lydia A Bazzano
American Journal of Clinical Nutrition 2013 97(2):268-275

Bibliography

PubMed
PMID 23221577
PubMed Central
PMC3742297
DOI
10.3945/ajcn.112.040741
Funding
Supported by the Research Enhancement Fund of Tulane University and National Heart, Lung, and Blood Institute grant K08 HL091108.
Competing interests
A specific author conflict-of-interest statement was not identified in the accessible article record checked during this audit.

Study snapshot

DesignSystematic review and meta-analysis of randomized controlled trials
ModelMeta-analysis of randomized CoQ10 trials in congestive heart failure reporting left ventricular ejection fraction or NYHA functional class.
Sample13 randomized controlled trials met inclusion criteria.
InterventionOral CoQ10 supplementation versus placebo/control across randomized trials; dose and duration varied.
DurationVariable across included trials.
EndpointsLeft ventricular ejection fraction; NYHA functional class; Blood CoQ10 concentration; Subgroup analyses by dose, duration, design and disease severity

What the study showed, in plain terms

This meta-analysis pooled 13 randomized heart-failure trials to assess ejection fraction and NYHA functional class.

CoQ10 increased left ventricular ejection fraction by a pooled net 3.67 percentage points (95% CI 1.60 to 5.74). NYHA class changed by -0.30 (95% CI -0.66 to 0.06), which did not reach statistical significance.

The apparent ejection-fraction benefit was stronger in several subgroups, but the authors cautioned that those analyses involved small numbers. This is evidence for a surrogate cardiac-function signal, not proof of lower mortality or hospitalization.

Key findings

LVEF: pooled mean net change +3.67 percentage points, 95% CI 1.60 to 5.74.

NYHA class: pooled mean net change -0.30, 95% CI -0.66 to 0.06; not statistically significant.

Blood CoQ10 increased by a pooled 1.4 micrograms/mL, 95% CI 1.1 to 1.7, in studies reporting exposure.

Subgroup signals favored crossover trials, shorter trials, older publications, doses at or below 100 mg/day and less severe CHF; these analyses were explicitly cautioned due to small study counts.

What this study can and cannot tell us

The underlying RCTs were small and heterogeneous in design, dose, duration and heart-failure severity.

Many included trials were old and predated contemporary guideline-directed heart-failure therapy.

The primary evidence concerned LVEF and NYHA class rather than mortality or hospitalization.

Subgroup analyses were based on small numbers and should not be used to define an optimal CoQ10 dose.

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