Cardiovascular Drugs and Therapy

, Volume 12, Issue 4, pp 347–353 | Cite as

Randomized, Double-Blind Placebo-Controlled Trial of Coenzyme Q10 in Patients with Acute Myocardial Infarction

  • Ram B. Singh
  • Gurpreet S. Wander
  • Amit Rastogi
  • Pradeep K. Shukla
  • Adarsh Mittal
  • Jagdish P. Sharma
  • Shiv K. Mehrotra
  • Raj Kapoor
  • Raj K. Chopra


The effects of oral treatment with coenzyme Q10 (120 mg/d) were compared for 28 days in 73 (intervention group A) and 71 (placebo group B) patients with acute myocardial infarction (AMI). After treatment, angina pectoris (9.5 vs. 28.1), total arrhythmias (9.5% vs. 25.3%), and poor left ventricular function (8.2% vs. 22.5%) were significantly (P < 0.05) reduced in the coenzyme Q group than placebo group. Total cardiac events, including cardiac deaths and nonfatal infarction, were also significantly reduced in the coenzyme Q10 group compared with the placebo group (15.0% vs. 30.9%, P < 0.02). The extent of cardiac disease, elevation in cardiac enzymes, and oxidative stress at entry to the study were comparable between the two groups. Lipid peroxides, diene conjugates, and malondialdehyde, which are indicators of oxidative stress, showed a greater reduction in the treatment group than in the placebo group. The antioxidants vitamin A, E, and C and beta-carotene, which were lower initially after AMI, increased more in the coenzyme Q10 group than in the placebo group. These findings suggest that coenzyme Q10 can provide rapid protective effects in patients with AMI if administered within 3 days of the onset of symptoms. More studies in a larger number of patients and long-term follow-up are needed to confirm our results.

ubiquinone ischemia oxidative stress antioxidant vitamins infarction 


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  1. 1.
    Grech ED, Jackson M, Ramsdale DR. Reperfusion injury after acute myocardial infarction. Br Med J 1995;310:477- 478.Google Scholar
  2. 2.
    Bernier M, Hearse DJ, Manning AS. Reperfusion induced arrhythmias and oxygen derived free radicals. Circ Res 1986;58:331-340.Google Scholar
  3. 3.
    Ceremuzynski L. Hormonal and metabolic reactions evoked by acute myocardial infarction. Circ Res 1981;48:765-776.Google Scholar
  4. 4.
    Singh RB, Niaz MA, Rastogi S, Sharma JP, Kumar R, Bishnoi I, Beegom R. Plasma levels of antioxidant vitamins and oxidative stress in patients with suspected acute myocardial infarction. Acta Cardiol 1994;49:441-452.Google Scholar
  5. 5.
    Wilkinson P, Sayer J, Laji K, Grundy C, Marchant B, Kopelman P, Timmis AD. Comparison of case fatality in South Asian and white patients after acute myocardial infarction: Observational study. Br Med J 1996;312:1330-1333.Google Scholar
  6. 6.
    Beyer RE, The participation of coenzyme Q10 in free radical production and antioxidation. Free Radic Biol Med 1990;8: 545-565.Google Scholar
  7. 7.
    Lenaz G, Battino M. Studies on the role of ubiquinone in the control of the mitochondrial respiratory chain. Free Radic Res Commun, 1990;8:317-327.Google Scholar
  8. 8.
    Atar D, Mortensen SA, Flachs H, Herzog WR. Coenzyme Q10 protects ischemic myocardium in an open-chest swine model. Clin Investig 1993;71:S 103-111.Google Scholar
  9. 9.
    Herzog WR, Schlossberg ML, Mortensen SA, Serebruany VL. Dietary supplementation with coenzyme Q10 reduces platelet aggregability in swine Coenzyme Q. Res Biol Med 1995;3:5-8.Google Scholar
  10. 10.
    Serebruany VL, Ordonez JV, Herzog WR, Morten R, Mortensen SA, Folkers K, Gurbel PA. Dietary coenzyme Q10 supplementation alters platelet size and inhibits human Vitronectin (CDSI/CD61) receptor expression. J Cardiovasc Pharmacol 1997;29:16-22.Google Scholar
  11. 11.
    Battino M, Fato R, Lenaz G. Coenzyme Q10 can control the efficiency of oxidative phosphorylation. Int J Tissue React 1990;12:137-144.Google Scholar
  12. 12.
    Singh RB, Niaz MA, Rastogi V, Rastogi SS. Coenzyme Q in cardiovascular disease. J Assoc Physiol India 1998;46: 299-306.Google Scholar
  13. 13.
    Kamikawa T, Kobayashi A, Yamashita T, Hayashi H, Yamasaki N. Effects of coenzyme Q10 on exercise tolerance in chronic stable angina pectoris. Am J Cardiol 1985;56:247-257.Google Scholar
  14. 14.
    Mazzola C, Guffanti EE, Vaccarella A, Meregalli M, Colmago R, Ferrario N, Cantoni V, Marcherri G. Noninvasive assessment of coenzyme Q10 in patients with chronic stable effort angina and moderate heart failure. Curr Ther Res 1987;41: 923-930.Google Scholar
  15. 15.
    Hofman-Bang C, Rehnqvist N, Swedberg K, Astrom H. Coenzyme Q10 as an adjunctive in treatment of congestive heart failure. J Am Coll Cardiol 1992;19(Suppl.):774-776.Google Scholar
  16. 16.
    Takasawa K, Fuse K, Konishi T, Watanabe Y. Prevention of premature ventricular contractions with coenzyme Q10 after coronary artery bypass grafting. In: Folkers K, Littami GP, Yamagami T, eds. Biomedical and Clinical Aspects of Coenzyme Q. Vol. 6, Amsterdam: Elsevier 1991:357-359.Google Scholar
  17. 17.
    World Health Organization Myocardial Infarction Community Registers Copenhagen. World Health Organization, 1976.Google Scholar
  18. 18.
    Brubacher G, Vuillenmier JP, Incurtis HC, Roth M, eds. Vitamin C: Clinical Biochemistry, Principles and Methods, Vol. 2. Berlin: de Gruyter, 1974:989-997.Google Scholar
  19. 19.
    Vuilleumier JP, Keller HE, Gysel D, Hunziker F. Clinical chemical methods for the routine assessment of the vitamin status in human population. Part 1. The fat soluble vitamins A, E and beta-carotene. Int J Vit Nutr Res 1983;58:265-272.Google Scholar
  20. 20.
    Esterbauer H, Cheeseman KH. Determination of aldehyde peroxidation products malonyldialdehyde and 4 hydroxynonenal. Method Enzymol 1990;186:407-421.Google Scholar
  21. 21.
    Niato C, Kawamura M, Yamamoto Y. Lipid peroxides as the initiating factor of atherosclerosis. Am NY Acad Sci 1993; 676:27-45.Google Scholar
  22. 22.
    Lunec J, Hallovan SP, White AG, Dormandy TL. Free radical oxidation (peroxidation) products in serum and synovial fluids in rheumatoid arthritis. J Rheumatol 1981:8:233-245.Google Scholar
  23. 23.
    Schardr F, Welzel D, Schess W, Toda K. Effect of coenzyme Q10 on ischemia-induced ST-segment depression: A double blind, placebo controlled crossover study. In: Folkers K, Yamamura Y, eds. Biomedical and Clinical Aspects of Coenzyme Q10, Vol. 5. Amsterdam: Elsevier, 1986:385-394.Google Scholar
  24. 24.
    Rosi E, Lombardo A, Testa M, et al. Coenzyme Q10 in ischaemic cardiopathy. In: Folkers K, Littarru GP, Yamagami T, eds. Biomedical and Clinical Aspects of Coenzyme Q, Vol. 6. Amsterdam: Elsevier, 1991:321-326.Google Scholar
  25. 25.
    Wilson MF, Frishman WH, Giles T, Sethi G, Greenberg SM, Brackett DJ. Coenzyme Q10 therapy and exercise duration in stable angina. In: Folkers K, Littami GP, Yamagami T, eds. Biomedical and Clinical Aspects of Coenzyme Q, Vol. 6. Amsterdam: Elsevier, 1991:339-348.Google Scholar
  26. 26.
    Kuklinski B, Weissenbacher E, Fahnrich A. Coenzyme Q10 and antioxidants in acute myocardial infarction. Mol Aspect Med 1994:15(Suppl.):143-147.Google Scholar
  27. 27.
    Barbiroli B, Frassineti C, Martinelli P, Iotti S, Lodi R, Cortelli P, Montagna P. Coenzyme Q10 improves mitochondrial respiration in patients with mitrochondrial cytopathies. An in vivo study on brain and skeletal muscle by phosphorous magnetic resonance spectroscopy. Cell Mol Biol 1997:43:741-749.Google Scholar
  28. 28.
    Yoshida T, Maulik G, Bagchi D, Dash SK, Engelman RM, Das DK. Increased myocardial tolerance to ischemia-reperfusion injury by feeding pigs with coenzyme Q10. In: Das DK, Engelman R, Cherian KM, eds. Myocardial Preservation, Preconditioning and Adaptation. Ann NY Acad Sci 1996:793:414-419.Google Scholar
  29. 29.
    Kontush A, Reich A, Baum K, Spranger T, Finckh B, Kohlschutter A, Beisiegel U. Plasma ubiquinol is decreased in patients with hyperlipidemia. Atherosclerosis 1997:129: 119-126.Google Scholar
  30. 30.
    Yokoyama H, Lingle DM, Crestanello JA, et al. Coenzyme Q10 protects coronary endothelial function from ischaemia reperfusion injury via an antioxidant effect. Surgery 1996; 120:189-196.Google Scholar
  31. 31.
    Kagan V, Packer L. Electron transport regenerates vitamin E in mitochandria and microsomes via ubiquinone: An antioxidant aduct. In: Corogni F, Banni S, Desai MA, Rice-Evans C, eds. Free Radicals and Antioxidants and Nutrition. London: Richelieu Press, 1993:27-36.Google Scholar
  32. 32.
    Baggio G, Gandini R, Plancher AC, Passeri M, Carmosino G. Italian multicenter study on the safety and efficacy of coenzyme Q10 as adjunctive therapy in heart failure. Mol Aspects Med 1994;15(Suppl.):287-294.Google Scholar
  33. 33.
    Karlsson J, Lin L, Gunnes S, Sylven C, Astrom H, Jansson E, Semb B. Muscle characteristics in effort angina before and after CABG. Can J Cardiol 1997;13:577-582.Google Scholar
  34. 34.
    Soja AM, Mortensen SA. Treatment of congestive heart failure with coenzyme Q10 illuminated by meta-analyses of clinical trials. Mol Aspects Med 1997:18(Suppl.):159-168.Google Scholar
  35. 35.
    Chopra RK, Goldman R, Sinatra ST, Bhagvan HN. Relative bioavailability of coenzyme Q10 formulations in human subjects. Int J Vit Nutr Res 1998;68:109-113.Google Scholar

Copyright information

© Kluwer Academic Publishers 1998

Authors and Affiliations

  • Ram B. Singh
    • 1
  • Gurpreet S. Wander
    • 1
  • Amit Rastogi
    • 1
  • Pradeep K. Shukla
    • 1
  • Adarsh Mittal
    • 1
  • Jagdish P. Sharma
    • 1
  • Shiv K. Mehrotra
    • 1
  • Raj Kapoor
    • 1
  • Raj K. Chopra
    • 1
  1. 1.Heart Research LaboratoryCentre of Nutrition Medical Hospital and Research CentreMoradabadIndia

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