Tag: statins

May 24, 2022

New review article highlights ubiquinone/Q10 as a first choice for heart failure.

Heart failure is a relatively common disorder, and often occurs as a result of a blood clot in the heart, which has left a scar in the heart muscle. This scar tissue is connective tissue that does not have the normal muscle function of the myocardium, and if a large part of the muscles of the left ventricle in particular is out of order, it is clear that the heart can no longer pump as efficiently.

The most common symptom is dyspnoea, which means that you breathe faster with physical exertion, because the oxygen concentration in the blood can not be maintained when the heart has reduced its ability to pump blood to oxygenate the lungs.

This condition is clinically classified in the so-called “NYHA” groups 1-4, which were once defined by the New York Heart Association, hence the name.

Roughly speaking, in class 1 you have no problems with normal activity, in class 2 you can not run, only walk, in class 3 only sit, and in class 4 you are largely bedridden.

All this is precisely limited by dyspnoea.

The heart failure is diagnosed and graded by ultrasound-Doppler examination and especially the “stroke volume” / EF (Ejection Fraction) of the left ventricle is measured, which is usually around 60% and satisfactory at 50%.

(The volume of the heart is a bit like with the lungs. You can not completely empty it of blood, just as you can not completely empty the lungs of air. Therefore, it is satisfying if the heart can pump out half of its contents at each heart rate.)

The heart muscle can be weakened by many things other than a blood clot, and by any of the transient conditions, such as eg. inflammation of the heart muscle (myocarditis), the pump function can also be restored afterwards.

But after a blood clot, it is difficult because the scar tissue that is formed after the blood clot will never actively pump again.
However, there is hope because the part of the heart muscle that is not damaged may well become stronger.

This is the focus of rehabilitation after a blood clot, but there is also something else that can be done. -You can optimize the energy production in the cells of the myocardium.

Treatment of heart failure
The usual treatment for heart failure was once limited to diuretics and digoxin, but has been under constant development and is today complemented with ACE inhibitors, Procoralan, SGLT-2 inhibitors and even beta-blockers, which were once contraindicated in heart failure. .

This is how the treatments develop continuously, and the idea with the treatment is primarily to relieve the heart and prevent arrhythmias or prevent that you get a blood clot again.

There are also patients with heart failure who benefit from a pacemaker, and if the situation it is completely bad, then a heart pump or a transplant.

Stop for a moment
Before we go off at a tangent maybe we should just try to get a little overview. What exactly do we want to achieve?

We want to achieve that a person with heart failure lives as well as possible for as long as possible.

So should we not try the least invasive treatment so that we avoid many of the heavy side effects following all the above treatments?

All the common treatments are intended to relieve the heart. But there are also options to make the heart stronger so that it pumps better with the remaining muscle tissue. As mentioned, exercise is one of the options, but you can also increase energy production in every single heart muscle cell.

Ubiquinon/Q10
Last week, a review article was published in Journal of Cardiovascular Development and Disease , which reviews 22 scientific articles (20 RCTs) on Q10 used against heart failure.

In the 16 articles, they found significant improvement in pump function (EF) or survival or both. In all cases, there was an inverse correlation between the blood concentration of Q10 and the worsening of the symptoms in patients with heart failure, just as the concentration of Q10 was an indicator of longevity.

In other words, those who had the lowest content of Q10 in the blood had a rapid worsening of the symptoms, just as they lived for a shorter time.
In line with this, it was similarly found that supplementation with Q10 improved the pumping function of the heart and increased the life expectancy of these patients.

The article also focuses on the inappropriate effect of statins, which not only lower cholesterol production but also the production of coenzyme Q10, as these form a common synthetic route from AcetylcoA over mevalonate to farnesyl pyrophosphate. This synthesis requires i.a. the enzyme HMG-CoA reductase and this enzyme is inhibited by statins.

Often, statins are actually prescribed to patients with heart failure, although this should be contraindicated according to the above.
It is noted very laconic that Q10 has at least as good a documentary weight as the treatment that is today considered the gold standard for treating heart failure. Exercise is extremely well documented, whereas digoxin and SGLT-2 inhibitors are poorly documented. Here we must say that Q10 is significantly better documented.

Given the solid evidence and the absence of interactions and side effects with ubiquinone/Q10, it is an obvious first-line treatment for heart failure, and should be implemented throughout the public health system.

 

Claus Hancke
Specialist in general medicine

Ref.

2022 Maj 16, Krzysztof J. Filipiak et al: Heart Failure, -Do We Need New Drugs or Have Them Already? A Case of Coenzyme Q10, J. Cardiovasc. Dev. Dis. 2022, 9, 161