title: The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: results from Q-SYMBIO: a randomized double-blind trial.
abstract: OBJECTIVE
  This randomized controlled multicenter trial evaluated coenzyme Q10 (CoQ10) as adjunctive treatment in chronic heart failure (HF).
  
  
  BACKGROUND
  CoQ10 is an essential cofactor for energy production and is also a powerful antioxidant. A low level of myocardial CoQ10 is related to the severity of HF. Previous randomized controlled trials of CoQ10 in HF were underpowered to address major clinical endpoints.
  
  
  METHODS
  Patients with moderate to severe HF were randomly assigned in a 2-year prospective trial to either CoQ10 100 mg 3 times daily or placebo, in addition to standard therapy. The primary short-term endpoints at 16 weeks were changes in New York Heart Association (NYHA) functional classification, 6-min walk test, and levels of N-terminal pro-B type natriuretic peptide. The primary long-term endpoint at 2 years was composite major adverse cardiovascular events as determined by a time to first event analysis.
  
  
  RESULTS
  A total of 420 patients were enrolled. There were no significant changes in short-term endpoints. The primary long-term endpoint was reached by 15% of the patients in the CoQ10 group versus 26% in the placebo group (hazard ratio: 0.50; 95% confidence interval: 0.32 to 0.80; p = 0.003) by intention-to-treat analysis. The following secondary endpoints were significantly lower in the CoQ10 group compared with the placebo group: cardiovascular mortality (9% vs. 16%, p = 0.026), all-cause mortality (10% vs. 18%, p = 0.018), and incidence of hospital stays for HF (p = 0.033). In addition, a significant improvement of NYHA class was found in the CoQ10 group after 2 years (p = 0.028).
  
  
  CONCLUSIONS
  Long-term CoQ10 treatment of patients with chronic HF is safe, improves symptoms, and reduces major adverse cardiovascular events. (Coenzyme Q10 as adjunctive treatment of chronic heart failure: a randomised, double-blind, multicentre trial with focus on SYMptoms, BIomarker status [Brain-Natriuretic Peptide (BNP)], and long-term Outcome [hospitalisations/mortality]; ISRCTN94506234).
authors.affiliation: Department of Cardiology, Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark. Electronic address: doctormortensen@gmail.com.
authors.forename: Svend A
authors.initials: SA
authors.lastname: Mortensen
authors.affiliation: Cardiac Surgical Research Unit, Alfred Hospital, Monash University, Melbourne, Australia.
authors.forename: Franklin
authors.initials: F
authors.lastname: Rosenfeldt
authors.affiliation: Department of Cardiology, Government Medical College/G.N.D. Hospital, Amritsar, India.
authors.forename: Adarsh
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Dolliner
authors.affiliation: First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Krzysztof J
authors.initials: KJ
authors.lastname: Filipiak
authors.affiliation: Medical Faculty of P.J. Safarik University, Kosice, Slovakia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Pella
authors.affiliation: University Hospital, Linköping, Sweden.
authors.forename: Urban
authors.initials: U
authors.lastname: Alehagen
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Günter
authors.initials: G
authors.lastname: Steurer
authors.affiliation: Clinical and Dental Sciences, Biochemistry Section, Polytechnic University of The Marche, Ancona, Italy.
authors.forename: Gian P
authors.initials: GP
authors.lastname: Littarru
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D002908:Chronic Disease; D016757:Death, Sudden, Cardiac / Q000209:etiology; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D010446:Peptide Fragments / Q000378:metabolism; D011446:Prospective Studies; D014451:Ubiquinone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014815:Vitamins / Q000627:therapeutic use*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D014815:Vitamins; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D014451:Ubiquinone; C024989:coenzyme Q10
keywords: chronic heart failure; coenzyme Q(10); metabolic therapy; randomized controlled trial; ubiquinone