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Efficacy of coenzyme Q10 in patients with cardiac failure: a meta-analysis of clinical trials

Li Lei, Yan Liu
BMC Cardiovascular Disorders 2017 17(1):196

Bibliography

PubMed
PMID 28738783
PubMed Central
PMC5525208
DOI
10.1186/s12872-017-0628-9
Funding
None reported by the authors.
Competing interests
All authors declared no competing interests.

Study snapshot

DesignSystematic review and meta-analysis of randomized controlled trials
ModelSystematic review and random-effects meta-analysis of 14 randomized controlled trials in patients with heart failure comparing CoQ10 with placebo/other control therapy.
Sample14 RCTs; 2,149 randomized participants: 1,064 to CoQ10 and 1,085 to control.
InterventionCoQ10 regimens varied across trials (approximately 30–300 mg/day, with one pediatric trial using 2 mg/kg/day), generally versus placebo; patient populations and background therapy varied.
DurationTreatment duration varied across included trials; dose and duration were explicitly heterogeneous.
EndpointsMortality; Left ventricular ejection fraction; Exercise capacity; NYHA functional class; Publication bias and sensitivity analyses

What the study showed, in plain terms

This 2017 meta-analysis combined 14 randomized trials involving 2,149 patients with heart failure. It found a statistically significant reduction in mortality and a small-to-moderate pooled improvement in exercise capacity with CoQ10, but did not find clear pooled improvement in LVEF or NYHA class.

Mortality was 55/904 in CoQ10-treated participants versus 83/923 controls in the trials contributing mortality data, corresponding to RR 0.69 (95% CI 0.50–0.95; p=0.02; I²=0%). Exercise capacity favored CoQ10 (SMD 0.62, 95% CI 0.02–1.12; p=0.04) but heterogeneity was substantial (I²=75%).

LVEF did not significantly differ (SMD 0.14, 95% CI -0.08 to 0.37; p=0.22), and NYHA class was also non-significant (SMD -0.70, 95% CI -1.92 to 0.51; p=0.26). The review therefore supports a possible mortality signal while showing that not every functional or cardiac measure improved consistently.

Key findings

Mortality: 55/904 CoQ10 vs 83/923 control; RR 0.69, 95% CI 0.50–0.95, p=0.02, I²=0%.

LVEF: 9 trials; SMD 0.14, 95% CI -0.08 to 0.37, p=0.22, I²=54%—not statistically significant.

Exercise capacity: 4 trials/264 participants; SMD 0.62, 95% CI 0.02–1.12, p=0.04, I²=75%—statistically significant but heterogeneous.

NYHA class: 3 trials/126 participants; SMD -0.70, 95% CI -1.92 to 0.51, p=0.26, I²=89%—not statistically significant and highly heterogeneous.

Publication-bias testing did not detect significant asymmetry for the analyzed outcomes, and leave-one-out sensitivity analyses did not materially reverse the main findings.

What this study can and cannot tell us

CoQ10 doses and treatment durations differed substantially across trials, weakening direct comparability.

Several trials did not clearly describe allocation concealment and blinding, leaving risk-of-bias uncertainty.

Exercise capacity and NYHA class were informed by few trials and showed high heterogeneity (I²=75% and 89%, respectively).

The included studies differed in design, population, background therapy and era, so the pooled mortality estimate should not be read as a uniform effect across all heart-failure patients or formulations.

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