Recent Developments in the Role of Coenzyme Q10 for Coronary Heart Disease: a Systematic Review

  • Jessica Ayers
  • Jamie Cook
  • Rachel A. Koenig
  • Evan M. Sisson
  • Dave L. Dixon
Coronary Heart Disease (S. Virani and S. Naderi, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Coronary Heart Disease


Purpose of Review

This review examines recent randomized clinical trials evaluating the role of coenzyme Q10 (CoQ10) in the management of coronary heart disease.

Recent Findings

CoQ10 is one of the most commonly used dietary supplements in the USA. Due to its antioxidant and anti-inflammatory effects, CoQ10 has been studied extensively for possible use in managing coronary heart disease. One of the most common applications of CoQ10 is to mitigate statin-associated muscle symptoms (SAMS) based on the theory that SAMS are caused by statin depletion of CoQ10 in the muscle. Although previous studies of CoQ10 for SAMS have produced mixed results, CoQ10 appears to be safe. Because CoQ10 is a cofactor in the generation of adenosine triphosphate, supplementation has also recently been studied in patients with heart failure, which is inherently an energy deprived state. The Q-SYMBIO trial found that CoQ10 supplementation in patients with heart failure not only improved functional capacity, but also significantly reduced cardiovascular events and mortality. Despite these positive findings, a larger prospective trial is warranted to support routine use of CoQ10. Less impressive are the effects of CoQ10 on specific cardiovascular risk factors such as blood pressure, dyslipidemia, and glycemic control.


Current evidence does not support routine use of CoQ10 in patients with coronary heart disease. Additional studies are warranted to fully determine the benefit of CoQ10 in patients with heart failure before including it in guideline-directed medical therapy.


Coenzyme Q10 Cardiovascular disease Heart failure Statins Myalgia 


Compliance with Ethical Standards

Conflict of Interest

Jessica Ayers, Jamie Cook, Rachel A. Koenig, Evan M. Sisson, and Dave L. Dixon declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    • Clarke TC, Black LI, Stussman BJ, Barnes PM, Nahin RL. Trends in the use of complementary health approaches among adults: United States, 2002–2012. National health statistics reports; no 79. Hyattsville, MD: National Center for Health Statistics. 2015. Discusses increase in use of co-enzyme Q10 over time. Google Scholar
  2. 2.
    Benjamin EJ, Virani SS, Callaway CW, Chang AR, Cheng C, Chiuve SE, et al. Heart Disease and Stroke Statistics—2018 update: a report from the American Heart Association. Circulation 2018;137;
  3. 3.
    Littarru GP, Bruge F, Tiano L. Biochemistry of coenzyme Q10. In: Balercia G, et al., editors. Antioxidants in andrology, trends in andrology and sexual medicine. Switzlerland: Springer International Publishing; 2017. Scholar
  4. 4.
    Saini R. Coenzyme Q10: the essential nutrient. J Pharm Bioallied Sci. 2011;3(3):466–7. Scholar
  5. 5.
    Haynes RB, McKibbon KA, Wilczynski NL, Walter SD, Werre SR. Optimal search strategies for retrieving scientifically strong studies of treatment from Medline: analytical survey. BMJ. 2005;330(7501):1179. Scholar
  6. 6.
    Abdollahzad H, Alipourb B, Aghdashic MA, Jafarabadid MA. Coenzyme Q10 supplementation in patients with rheumatoid arthritis: are there any effects on cardiovascular risk factors? Eur J Integr Med. 2015;7(5):534–9.CrossRefGoogle Scholar
  7. 7.
    Aljawad FH, Hashim HM, Jasim GA, Kadhim HM, Gorgi AQ, Jawad RF. Effects of atorvastatin and coenzyme Q10 on glycemic control and lipid profile in type 2 diabetic patients. Int J Pharm Sci Rev Res. 2015;34(2):183–6.Google Scholar
  8. 8.
    Mohseni M, Vafa MR, Hajimiresmail SJ, Zarrati M, Rahimi Forushani A, Bitarafan V, et al. Effects of coenzyme q10 supplementation on serum lipoproteins, plasma fibrinogen, and blood pressure in patients with hyperlipidemia and myocardial infarction. Iran Red Crescent Med J. 2014;16(10):e16433. Scholar
  9. 9.
    Young JM, Florkowski CM, Molyneux SL, McEwan RG, Frampton CM, Nicholls MG, et al. A randomized, double-blind, placebo-controlled crossover study of coenzyme Q10 therapy in hypertensive patients with the metabolic syndrome. Am J Hypertens. 2012;25(2):261–70. Scholar
  10. 10.
    Zahedi H, Eghtesadi S, Seifirad S, Rezaee N, Shidfar F, Heydari I, et al. Effects of CoQ10 supplementation on lipid profiles and glycemic control in patients with type 2 diabetes: a randomized, double blind, placebo-controlled trial. J Diabetes Metab Disord. 2014;13:81. Scholar
  11. 11.
    •• Mortensen SA, Rosenfeldt F, Kumar A, Dolliner P, Filipiak KJ, et al. The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: results from Q-SYMBIO: a randomized double-blind trial. JACC Heart Fail. 2014;2(6):641–9. First randomized double-blind trial demonstrating co-enzyme Q10 may reduce morbidity and mortality in patients with heart failure. CrossRefPubMedGoogle Scholar
  12. 12.
    Skarlovnik A, Janic M, Lunder M, Turk M, Sabovic M. Coenzyme Q10 supplementation decreases statin-replaced mild-to-moderate muscle symptoms: a randomized clinical study. Med Sci Monir. 2014;20:2183–8. Scholar
  13. 13.
    Buettner C, Davis RB, Phillips RS, Mittleman MA. CoQ10 does not improve statin myalgia—a randomized controlled trial [abstract]. Atherosclerosis. 2015;e206:241.Google Scholar
  14. 14.
    Mazirka P, Jones E, Strachan P, McNurlan M, Lawson W, Caso G. Effect of coenzyme Q10 supplementation in patients with statin-related myalgia [abstract]. FASEB J. 2015;29(1_supplement):LB334.Google Scholar
  15. 15.
    Taylor BA, Lorson L, White M, Thompson PD. A randomized trial of coenzyme Q10 in patients with confirmed statin myopathy. Atherosclerosis. 2015;238(2):329–35. Scholar
  16. 16.
    Marcoff L, Thompson PD. The role of coenzyme Q10 in statin associated myopathy. System Rev J Am Coll Cardiol. 2007;49(23):2231–7.CrossRefGoogle Scholar
  17. 17.
    •• Banach Maciej SC, Sahebkar A, Ursoniu S, Rysz J, Muntner P, et al. Effects of coenzyme Q10 on statin-induced myopathy: a meta-analysis of randomized controlled trials. Mayo Clin Proc. 2015;90(1):23–34. Meta-analysis of previously conducted randomized clinical trials evaluating use of co-enzyme Q10 for statin-induced myopathy. CrossRefGoogle Scholar
  18. 18.
    Mortensen SA. Overview of coenzyme Q10 as adjunctive therapy in chronic heart failure. Rationale, design and end-points of “Q-symbio”—a multinational trial. Biofactors. 2003;18(1–4):79–89.CrossRefPubMedGoogle Scholar
  19. 19.
    Beal MF. Therapeutic approaches to mitrochondrial dysfunction in Parkinson’s disease. Parkinsonism Relat Disord. 2009;15(Suppl 3):S189–94. CrossRefPubMedGoogle Scholar
  20. 20.
    Ventura-Clapier R, Garnier A, Veksler V. Energy metabolism in heart failure. J Physiol. 2004;555(Pt 1):1–13. Scholar
  21. 21.
    Folkers K, Vadhanavikit S, Mortensen S. Biochemical rationale and myocardial tissue data on the effective therapy of cardiomyopathy with coenzyme Q10. Proc Natl Acad Sci U S A. 1985;82:901–4. Scholar
  22. 22.
    Belch JJ, Bridges AB, Scott N, Chopra M. Oxygen free radicals and congestive heart failure. Br Hreat J. 1991;65:245–8. Scholar
  23. 23.
    Fotino AD, Thompson-Paul AM, Bazzano LA. Effect of coenzyme Q10 supplementation on heart-failure: a meta-analysis. J Clin Nutr. 2013;97(2):268–75. Scholar
  24. 24.
    Madmani ME, Yusuf Solaiman A, Tamr Agha K, Madmani Y, Shahrour Y, Essali A, et al. Coenzyme Q10 for heart failure. Cochrane Database Syst Rev. 2014;6:CD008684. CrossRefGoogle Scholar
  25. 25.
    Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm. 2000;57:1221–7.PubMedGoogle Scholar
  26. 26.
    Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147–239. Scholar
  27. 27.
    Chew GT, Watts GF. Coenzyme Q 10 and diabetic endotheliopathy: oxidative stress and the ‘recoupling hypothesis. Q J Med. 2004;97:537–48. Scholar
  28. 28.
    Digiesi V, Cantinit F, Oradei A, Bisi G, Guarino GC, Brocchi A, et al. Coenzyme Q10 in essential hypertension. Molec Aspects Med. 1994;15(Suppl):s257–63.CrossRefGoogle Scholar
  29. 29.
    Pepe S, Marasco SF, Haas SJ, Sheeran FL, Krum H, Rosenfeldt FL. Coenzyme Q10 in cardiovascular disease. Mitochondrion. 2007;7(7 Suppl):S154–67.CrossRefPubMedGoogle Scholar
  30. 30.
    Yamagami T, Shibata N, Folkers K. Bioenergetics in clinical medicine. Studies on coenzyme Q10 and essential hypertension. Res Commun Chem Pathol Pharmacol. 1975;11(2):273–88.PubMedGoogle Scholar
  31. 31.
    Gönenç A, Hacışevki A, Tavil Y, Çengel A, Torun M. Oxidative stress in patients with essential hypertension: a comparison of dippers and non-dippers. Eur J Intern Med. 2013;24(2):139–44. Scholar
  32. 32.
    Mohr D, Bowry VW, Stocker R. Dietary supplementation with coenzyme Q10 results in increased levels of ubiquinol-10 within circulating lipoproteins and increased resistance of human low-density lipoprotein to the initiation of lipid peroxidation. Biochim Biophys Acta. 1992;1126(3):247–54.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Jessica Ayers
    • 1
  • Jamie Cook
    • 1
  • Rachel A. Koenig
    • 2
  • Evan M. Sisson
    • 1
  • Dave L. Dixon
    • 1
  1. 1.Department of Pharmacotherapy & Outcomes ScienceVCU School of PharmacyRichmondUSA
  2. 2.Tompkins-McCaw Library for the Health Sciences, VCU LibrariesVirginia Commonwealth UniversityRichmondUSA

Personalised recommendations