Heart failure (HF) is one of the most common causes of death in Western society. Recent
results underscore the utility of coenzyme Q10 (CoQ10) addition to standard medications in order to reduce mortality and to improve quality
of life and functional capacity in chronic heart failure (CHF). The rationale for
CoQ10 supplementation in CHF is two-fold. One is the well-known role of CoQ10 in myocardial bioenergetics, and the second is its antioxidant property. Redox balance
is also improved by oral supplementation of CoQ10, and this effect contributes to enhanced endothelium-dependent relaxation. Previous
reports have shown that CoQ10 concentration is decreased in myocardial tissue in CHF and by statin therapy, and
the greater the CoQ10 deficiency the more severe is the cardiocirculatory impairment. In patients with
CHF and hypercholesterolaemia being treated with statins, the combination of CoQ10 with a statin may be useful for two reasons: decreasing skeletal muscle injury and
improving myocardial function. Ubiquinol, the active reduced form of CoQ10, presents higher bioavailability than the oxidised form ubiquinone, and should be
the preferred form to be added to a statin. The combination ezetimibe/simvastatin
may have advantages over single statins. Since ezetimibe reduces absorption of cholesterol
and does not affect CoQ10 synthesis in the liver, the impact of this combination on CoQ10 tissue levels will be much less than that of high dose statin monotherapy at any
target low density lipoprotein-cholesterol (LDL-C) level to be reached. This consideration
makes the ezetimibe/statin combination the ideal LDL-lowering agent to be combined
with ubiquinol in CHF patients. However, particular caution is advisable with the
use of strategies of extreme lowering of cholesterol that may negatively impact on
myocardial function. All in all there is a strong case for considering co-administration
of ubiquinol with statin therapy in patients with depressed or borderline myocardial
function.
Keywords
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Article Info
Publication History
Published online: September 16, 2019
Accepted:
August 16,
2019
Received in revised form:
July 1,
2019
Received:
October 19,
2017
Identification
Copyright
© 2019 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
