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Dose-Response Effect of Coenzyme Q10 Supplementation on Blood Pressure among Patients with Cardiometabolic Disorders: A GRADE-Assessed Systematic Review and Meta-Analysis of Randomized Controlled Trials

Dan Zhao, Ying Liang, Suming Dai, Shanshan Hou, Zhihao Liu, Meitong Liu, Xiaoxi Dong, Yiqiang Zhan, Zezhong Tian, Yan Yang
Advances in Nutrition 2022 13(6):2180-2194

Bibliography

PubMed
PMID 36130103
PubMed Central
PMC9776655
DOI
10.1093/advances/nmac100
Funding
Key Program of the National Natural Science Foundation of China (82030098); National Natural Science Foundation of China (81872617); Chinese Nutrition Society Research Fund for Dietary Reference Intake; National innovation and entrepreneurship undergraduate training programs 202210558159 and 202210558161. Authors state funders had no role in design, collection, analysis, interpretation, manuscript preparation or submission.
Competing interests
Author disclosures: no conflicts of interest reported.

Study snapshot

DesignSystematic review and dose-response meta-analysis of randomized controlled trials
ModelGRADE-assessed systematic review and dose-response meta-analysis of randomized controlled trials of CoQ10 supplementation in patients with cardiometabolic disorders.
Sample26 studies; 1,831 participants; 29 treatment arms contributed systolic-blood-pressure data.
InterventionCoQ10 supplementation across randomized trials with varying doses and formulations versus placebo/control; intervention duration had to be at least 2 weeks.
DurationAt least 2 weeks; subgroup analyses included >12-week interventions.
EndpointsSystolic blood pressure; Diastolic blood pressure; Circulating CoQ10 concentration; Nonlinear dose-response relationship; GRADE certainty; Subgroup analyses by disease, duration, dose and funding

What the study showed, in plain terms

This 2022 meta-analysis asked not only whether CoQ10 lowers blood pressure in cardiometabolic disease, but whether the effect changes with dose. Across 26 studies and 1,831 participants, CoQ10 lowered systolic blood pressure by an average 4.77 mmHg versus control while clearly raising circulating CoQ10 levels.

The dose-response analysis was nonlinear (p for nonlinearity=0.004), with the largest modeled systolic reduction around 100–200 mg/day. Longer trials (>12 weeks), diabetes and dyslipidemia subgroups showed larger reductions. The evidence certainty was rated moderate for systolic BP, low for diastolic BP and very low for circulating CoQ10.

The result supports a modest systolic BP effect in cardiometabolic populations, not a guarantee that 100–200 mg/day is universally optimal. The dose-response curve is derived from between-trial data and therefore remains vulnerable to confounding by trial characteristics.

Key findings

Systolic BP: WMD -4.77 mmHg, 95% CI -6.57 to -2.97 versus control.

Circulating CoQ10: +1.62 μg/mL, 95% CI 1.26–1.97 versus control, confirming biochemical exposure.

Dose-response: statistically significant U-shaped/nonlinear relationship (χ²=10.84; p-nonlinearity=0.004), with the model showing the largest SBP reduction around 100–200 mg/day.

Subgroups: greater SBP reductions were reported in diabetes, dyslipidemia and interventions lasting >12 weeks; analyses excluding medication/supplement contamination and industry-funded studies also tended to show larger effects.

GRADE: moderate certainty for systolic BP; low certainty for diastolic BP; very low certainty for circulating CoQ10.

Protocol: PROSPERO CRD42021252933. Search date: through 21 March 2022.

What this study can and cannot tell us

The pooled trials varied in cardiometabolic diagnosis, baseline blood pressure, dose, formulation, treatment duration and concomitant medication/supplement use.

The apparent 100–200 mg/day optimum is a meta-regression/dose-response inference across trials rather than a direct randomized head-to-head dose comparison in one population.

Evidence certainty was not uniformly high: diastolic BP was rated low and circulating CoQ10 very low by GRADE.

The findings apply specifically to cardiometabolic populations represented in the included RCTs and should not be generalized automatically to normotensive healthy adults.

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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