The effects of coenzyme Q10 supplementation on biomarkers of inflammation and oxidative stress in among coronary artery disease: a systematic review and meta-analysis of randomized controlled trials

  • Mohammad Vahid Jorat
  • Reza Tabrizi
  • Fariba Kolahdooz
  • Maryam Akbari
  • Maryamalsadat Salami
  • Seyed Taghi Heydari
  • Zatollah AsemiEmail author
Review Article



Systemic inflammation and oxidative stress significantly contribute in developing coronary artery disease (CAD). This systematic review and meta-analysis was aimed to determine the effects of coenzyme Q10 (CoQ10) supplementation on biomarkers of inflammation and oxidative stress among patients with CAD.


The electronic databases including MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Library databases were systematically searched until Oct 2018. The quality assessment and heterogeneity of the selected randomized clinical Trials (RCTs) were examined using the Cochrane Collaboration risk of bias tool, and Q and I2 tests, respectively. Given the presence of heterogeneity, random-effects model or fixed-effect model were used to pool standardized mean differences (SMDs) as summary effect sizes.


A total of 13 clinical RCTs of 912 potential citations were found to be eligible for the current meta-analysis. The pooled findings for biomarkers of inflammation and oxidative stress demonstrated that CoQ10 supplementation significantly increased superoxide dismutase (SOD) (SMD 2.63; 95% CI, 1.17, 4.09, P < 0.001; I2 = 94.5%) and catalase (CAT) levels (SMD 1.00; 95% CI, 0.57, 1.43, P < 0.001; I2 = 24.5%), and significantly reduced malondialdehyde (MDA) (SMD − 4.29; 95% CI − 6.72, − 1.86, P = 0.001; I2 = 97.6%) and diene levels (SMD − 2.40; 95% CI − 3.11, − 1.68, P < 0.001; I2 = 72.6%). We did not observe any significant effect of CoQ10 supplementation on C-reactive protein (CRP) (SMD − 0.62; 95% CI − 1.31, 0.08, P = 0.08; I2 = 87.9%), tumor necrosis factor alpha (TNF-α) (SMD 0.22; 95% CI − 1.07, 1.51, P = 0.73; I2 = 89.7%), interleukin-6 (IL-6) (SMD − 1.63; 95% CI − 3.43, 0.17, P = 0.07; I2 = 95.2%), and glutathione peroxidase (GPx) levels (SMD 0.14; 95% CI − 0.77, 1.04, P = 0.76; I2 = 78.7%).


Overall, this meta-analysis demonstrated CoQ10 supplementation increased SOD and CAT, and decreased MDA and diene levels, but did not affect CRP, TNF-α, IL-6, and GPx levels among patients with CAD.


CoQ10 Inflammation Oxidative stress Coronary artery disease Meta-analysis 


Author contributions

ZA, MA and RT contributed in conception, design, statistical analysis and drafting of the manuscript. M-VJ, FK, MS and S-TH contributed in conception, data collection and manuscript drafting.


The research grant provided by Research Deputy of Shiraz University of Medical Sciences (SUMS).

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.


  1. Arroyo A, Kagan VE, Tyurin VA, Burgess JR, de Cabo R, Navas P, Villalba JM (2000) NADH and NADPH-dependent reduction of coenzyme Q at the plasma membrane. Antioxid Redox Signal 2:251–262CrossRefGoogle Scholar
  2. Aslanabadi N, Safaie N, Asgharzadeh Y, Houshmand F, Ghaffari S, Garjani A, Dousti S, Hamishehkar H, Entezari-Maleki T (2016) The randomized clinical trial of coenzyme Q10 for the prevention of periprocedural myocardial injury following elective percutaneous coronary intervention. Cardiovasc Ther 34:254–260CrossRefGoogle Scholar
  3. Berman M, Erman A, Ben-Gal T, Dvir D, Georghiou GP, Stamler A, Vered Y, Vidne BA, Aravot D (2004) Coenzyme Q10 in patients with end-stage heart failure awaiting cardiac transplantation: a randomized, placebo-controlled study. Clin Cardiol 27:295–299CrossRefGoogle Scholar
  4. Bocci V, Valacchi G (2013) Free radicals and antioxidants: how to reestablish redox homeostasis in chronic diseases? Curr Med Chem 20:3397–3415CrossRefGoogle Scholar
  5. Braunwald E (1997) Shattuck lecture—cardiovascular medicine at the turn of the millennium: triumphs, concerns, and opportunities. N Engl J Med 337:1360–1369CrossRefGoogle Scholar
  6. Dai YL, Luk TH, Yiu KH, Wang M, Yip PM, Lee SW, Li SW, Tam S, Fong B, Lau CP, Siu CW, Tse HF (2011) Reversal of mitochondrial dysfunction by coenzyme Q10 supplement improves endothelial function in patients with ischaemic left ventricular systolic dysfunction: a randomized controlled trial. Atherosclerosis 216:395–401CrossRefGoogle Scholar
  7. Davies MJ (2000) The pathophysiology of acute coronary syndromes. Heart 83:361–366CrossRefGoogle Scholar
  8. Fan L, Feng Y, Chen GC, Qin LQ, Fu CL, Chen LH (2017) Effects of coenzyme Q10 supplementation on inflammatory markers: a systematic review and meta-analysis of randomized controlled trials. Pharmacol Res 119:128–136CrossRefGoogle Scholar
  9. Jang S, Lee L, Ryu SM, Lee H, Park J-R, Kim H, Kim D, Jang A, Yang S-R (2017) Effect of coenzyme Q10 via nitric oxide production and growth arrest of human colon cancer HCT116 cells. J Prev Vet Med 41:59–65CrossRefGoogle Scholar
  10. Lass A, Sohal RS (1998) Electron transport-linked ubiquinone-dependent recycling of alpha-tocopherol inhibits autooxidation of mitochondrial membranes. Arch Biochem Biophys 352:229–236CrossRefGoogle Scholar
  11. Lee BJ, Huang YC, Chen SJ, Lin PT (2012a) Coenzyme Q10 supplementation reduces oxidative stress and increases antioxidant enzyme activity in patients with coronary artery disease. Nutrition 28:250–255CrossRefGoogle Scholar
  12. Lee BJ, Huang YC, Chen SJ, Lin PT (2012b) Effects of coenzyme Q10 supplementation on inflammatory markers (high-sensitivity C-reactive protein, interleukin-6, and homocysteine) in patients with coronary artery disease. Nutrition 28:767–772CrossRefGoogle Scholar
  13. Lee BJ, Lin YC, Huang YC, Ko YW, Hsia S, Lin PT (2012c) The relationship between coenzyme Q10, oxidative stress, and antioxidant enzymes activities and coronary artery disease. Sci World J 2012:792756Google Scholar
  14. Lee BJ, Tseng YF, Yen CH, Lin PT (2013) Effects of coenzyme Q10 supplementation (300 mg/day) on antioxidation and anti-inflammation in coronary artery disease patients during statins therapy: a randomized, placebo-controlled trial. Nutr J 12:142CrossRefGoogle Scholar
  15. Mirhashemi SM, Najafi V, Raygan F, Asemi Z (2016) The effects of coenzyme Q10 supplementation on cardiometabolic markers in overweight type 2 diabetic patients with stable myocardial infarction: A randomized, double-blind, placebo-controlled trial. ARYA Atheroscler 12:158–165Google Scholar
  16. Mortensen SA (2003) Overview on coenzyme Q10 as adjunctive therapy in chronic heart failure. Rationale, design and end-points of "Q-symbio"—a multinational trial. BioFactors 18:79–89CrossRefGoogle Scholar
  17. Pourmoghaddas M, Rabbani M, Shahabi J, Garakyaraghi M, Khanjani R, Hedayat P (2014) Combination of atorvastatin/coenzyme Q10 as adjunctive treatment in congestive heart failure: A double-blind randomized placebo-controlled clinical trial. ARYA Atheroscler 10:1–5Google Scholar
  18. Ridker PM, Rifai N, Pfeffer M, Sacks F, Lepage S, Braunwald E (2000a) Elevation of tumor necrosis factor-alpha and increased risk of recurrent coronary events after myocardial infarction. Circulation 101:2149–2153CrossRefGoogle Scholar
  19. Ridker PM, Rifai N, Stampfer MJ, Hennekens CH (2000b) Plasma concentration of interleukin-6 and the risk of future myocardial infarction among apparently healthy men. Circulation 101:1767–1772CrossRefGoogle Scholar
  20. Schmelzer C, Lindner I, Rimbach G, Niklowitz P, Menke T, Doring F (2008) Functions of coenzyme Q10 in inflammation and gene expression. BioFactors 32:179–183CrossRefGoogle Scholar
  21. Shepherd J, Cobbe SM, Ford I, Isles CG, Lorimer AR, MacFarlane PW, McKillop JH, Packard CJ (2004) Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. 1995. Atheroscler Suppl 5:91–97CrossRefGoogle Scholar
  22. Singh RB, Niaz MA (1999) Serum concentration of lipoprotein(a) decreases on treatment with hydrosoluble coenzyme Q10 in patients with coronary artery disease: discovery of a new role. Int J Cardiol 68:23–29CrossRefGoogle Scholar
  23. Singh RB, Wander GS, Rastogi A, Shukla PK, Mittal A, Sharma JP, Mehrotra SK, Kapoor R, Chopra RK (1998) Randomized, double-blind placebo-controlled trial of coenzyme Q10 in patients with acute myocardial infarction. Cardiovasc Drugs Ther 12:347–353CrossRefGoogle Scholar
  24. Singh RB, Kartikey K, Charu AS, Niaz MA, Schaffer S (2003a) Effect of taurine and coenzyme Q10 in patients with acute myocardial infarction. Adv Exp Med Biol 526:41–48CrossRefGoogle Scholar
  25. Singh RB, Neki NS, Kartikey K, Pella D, Kumar A, Niaz MA, Thakur AS (2003b) Effect of coenzyme Q10 on risk of atherosclerosis in patients with recent myocardial infarction. Mol Cell Biochem 246:75–82CrossRefGoogle Scholar
  26. Singh U, Devaraj S, Jialal I (2007) Coenzyme Q10 supplementation and heart failure. Nutr Rev 65:286–293CrossRefGoogle Scholar
  27. Stoyanovsky DA, Osipov AN, Quinn PJ, Kagan VE (1995) Ubiquinone-dependent recycling of vitamin E radicals by superoxide. Arch Biochem Biophys 323:343–351CrossRefGoogle Scholar
  28. Tiano L, Belardinelli R, Carnevali P, Principi F, Seddaiu G, Littarru GP (2007) Effect of coenzyme Q10 administration on endothelial function and extracellular superoxide dismutase in patients with ischaemic heart disease: a double-blind, randomized controlled study. Eur Heart J 28:2249–2255CrossRefGoogle Scholar
  29. Weissberg PL (2000) Atherogenesis: current understanding of the causes of atheroma. Indian Heart J 52:467–472Google Scholar
  30. Wilson PW (2008) Evidence of systemic inflammation and estimation of coronary artery disease risk: a population perspective. Am J Med 121:S15–20CrossRefGoogle Scholar
  31. Witte KK, Nikitin NP, Parker AC, von Haehling S, Volk HD, Anker SD, Clark AL, Cleland JG (2005) The effect of micronutrient supplementation on quality-of-life and left ventricular function in elderly patients with chronic heart failure. Eur Heart J 26:2238–2244CrossRefGoogle Scholar
  32. Zhai J, Bo Y, Lu Y, Liu C, Zhang L (2017) Effects of coenzyme Q10 on markers of inflammation: a systematic review and meta-analysis. PLoS ONE 12:e0170172. CrossRefGoogle Scholar
  33. Zhang YP, Eber A, Yuan Y, Yang Z, Rodriguez Y, Levitt RC, Takacs P, Candiotti KA (2013) Prophylactic and antinociceptive effects of coenzyme Q10 on diabetic neuropathic pain in a mouse model of type 1 diabetes. Anesthesiology 118:945–954CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Mohammad Vahid Jorat
    • 1
  • Reza Tabrizi
    • 2
  • Fariba Kolahdooz
    • 3
  • Maryam Akbari
    • 2
  • Maryamalsadat Salami
    • 4
  • Seyed Taghi Heydari
    • 5
  • Zatollah Asemi
    • 6
    Email author
  1. 1.Department of CardiologyShiraz University of Medical SciencesShirazIran
  2. 2.Health Policy Research Center, Institute of Health, Student Research CommitteeShiraz University of Medical SciencesShirazIran
  3. 3.Indigenous and Global Health Research Group, Department of MedicineUniversity of AlbertaEdmontonCanada
  4. 4.Shiraz University of Medical SciencesShirazIran
  5. 5.Health Policy Research CenterInstitute of Health, Shiraz University of Medical SciencesShirazIran
  6. 6.Research Center for Biochemistry and Nutrition in Metabolic DiseasesKashan University of Medical SciencesKashanIran

Personalised recommendations