The Straight Dope on Heart Disease

What a monster.
The American Heart Association predicts more than 71 million Americans – approximately one in every three – suffer from some form of heart disease. It takes another life every 35 seconds.1

Heart disease includes any number of conditions. Coronary heart disease (CHD) … cardiovascular disease (CVD)… congestive heart failure (CHF)… myocardial infarction (MI)… coronary artery disease (CAD). Each affects blood and oxygen flow to and from the heart in some way.

And it’s not uncommon to find other conditions lurking nearby. High blood pressure, cholesterol, atherosclerosis (clogged arteries), strokes, and peripheral artery disease are frequent companions.

But there is some good news.  Worldwide research supports the notion that a vitamin-like compound called Coenzyme Q10 (CoQ10) may be effective in reducing cardiovascular risk. A few examples:

  • Indian researchers administered CoQ10 to rabbits being fed a high trans fat diet. It reduced markers of oxidative damage and artherosclerosis.2
  • University of Kentucky researchers found limited evidence CoQ10 may lessen oxidative stress.  They also noted depressed CoQ10 levels were common in CHF patients.3  While sufficient levels increased cardiac output and reduced stroke volume in those same type of patients.4
  • A CHF patient in Brazil who was given 150 mg per day experienced gradual improvement in left ventricle function with decreased systolic function only three months after supplementation ended.5
  • Australian researchers found CoQ10 may help reduce both systolic and diastolic blood pressure.6  Another study indicated CoQ10 offers significant benefits for hypertension.7
  • UCLA researchers concluded CoQ10 can be a potent tool in preventing hypertension and hyperlipidemia.8

What is it and how does it work?

Coenzyme Q10 is a vitamin-like compound found in a cell’s mitochondria. It produces adenosine triphosphate (ATP), which in turn produces energy as well as protein needed to protect heart and skeletal muscles.

CoQ10 also works as an antioxidant to destroy cell-damaging free radicals – those oxidized molecules caused by overexposure to the sun, radiation, cigarette smoke, environmental contaminants and air pollution.

It’s found in organ meats, beef, soy oil, sardines, mackerel, and peanuts. So it is possible to get what you need through your diet.  The problem is, your body needs sufficient levels of eight different vitamins, several trace minerals and the amino acid tyrosine for CoQ10 to be effective.  A deficiency in any one of these levels can render CoQ10 useless.

Another challenge with CoQ10 is that it decreases with age. It peaks around age 20 and then starts to decline rapidly. By age 40 you’re only manufacturing about sixty percent of what you used to. That level drops to forty percent by age 70.9

Don’t Believe the Hype

Statins such as atorvastatin, rosuvastatin, pravastatin, simvastatin, lovastatin and fluvastatin are more recognizable by their trade names: Lipitor®, Crestor®, Pravachol®, Zocor®, Mevacor® and Lescol®. These medications lower cholesterol by reducing the body’s production of HMG-CoA reductase, the enzyme needed to produce cholesterol.

But they can also deplete the body of necessary CoQ10.

This creates a deficiency that, at a minimum, lowers immunity and raises the risk of negative side effects. One particular study reported higher incidences of fatigue in patients taking lovastatin.10 And a Columbia University study found patients on a 30-day atorvastatin regimen had significant decreases in CoQ10 levels after just half that time! Lead researchers were quoted in support of CoQ10:

“Widespread inhibition of CoQ10 synthesis could explain the most commonly reported adverse effects of statins, especially exercise intolerance, myalgia, and myoglobinuria.”11

In May 2002, Dr. Julian Whitaker filed petitions with the FDA calling for black box warnings on all statin drugs. He cited similar warnings approved in Canada to plead his case.12 The petitions claim CoQ10 depletion, as a result of statin drug use, can put patients at risk for impaired myocardial function, liver dysfunction and myopathies, including cardiomyopathy and congestive heart failure. The FDA has yet to respond.

There’s more to the Story…

The National Institutes of Health’s expert panel on detection, evaluation, and treatment of high blood cholesterol in adults uses low-density lipoprotein (LDL) cholesterol as a primary predictor of heart disease. Cardiologist Stephen T. Sinatra, MD, FACC, feels this may be inappropriate for a number of reasons:13

  • The panel suggested a threefold increase in the number statin drug prescriptions – a move that would increase annual statin sales by 20%.
  • The oxidation of LDL cholesterol remains a hypothesis for heart disease, yet cholesterol levels continue to drive treatment.
  • Research on omega-3 fatty acids shows improved survival rates for those with cardiovascular disease, independent of cholesterol levels. This lends support to reducing inflammation as a way to improve cardiovascular mortality.
  • The effectiveness of statins in intervention and treatment may be more closely related to their anti-inflammatory properties rather than their cholesterol-lowering properties. One study indicated about half of the MI patients had normal LDL cholesterol levels. It also suggested C-reactive protein may be a better predictor for atherosclerosis.14
  • Subjects with normal C-reactive protein levels did not have an increased risk of recurrent cardiac events while those with elevated C-reactive protein levels had a significant risk regardless of their LDL cholesterol levels when compared to patients taking statins.

According to Dr. Sinatra, the report rejects other, potentially more accurate, predictors of cardiovascular disease, like C-reactive protein and homocysteine levels. Both are measures of internal inflammation.

Dr. Kilmer McCully, a leading expert on heart disease and the first to claim elevated homocysteine levels as a prime risk factor for cardiovascular disease, apparently shares this view:

“This approach to prevention is entirely misguided and based on an outmoded hypothesis of causation,” he says. “Treatment of cholesterol elevation and dyslipidemia is merely addressing a symptom and not the cause of the disease.”15

The Heart of the Matter

Bottom line …we’ve still got a lot to learn about heart disease. It remains the number one cause of death in the world today. And while the perfect remedy is yet to be determined, more and more researchers around the globe are turning to Coenzyme Q10 in an effort to slay this evil beast. If we keep fighting, it might just turn out to be a heartwarming story after all.

Cited Sources

1)“Heart Disease and Stroke Statistics: 2006 Update,” American Heart Association

Accessed Feb. 2006
2) Singh RB, et al. “Effect of coenzyme Q10 on experimental atherosclerosis and chemical composition and quality of atheroma in rabbits.” Atherosclerosis, 146, 2:275-282, 2000.
3) Weant KA & Smith KM. “The role of coenzyme Q10 in heart failure.” Annals of Pharmacotherapy, 39, 9:1522-1526, 2005.
4) Tran MT, et al. “Role of coenzyme Q10 in chronic heart failure, angina and hypertension.” Pharmacotherapy, 21, 7:797-806, 2001.
5) Salles JE, et al. “Myocardial dysfunction in mitochondrial diabetes treated with coenzyme Q10.” Diabetes Research in Clinical Practice, 10/24/2005.
6) Rosenfeldt F, et al. “Systematic review of effect of coenzyme Q10 in physical exercise, hypertension and heart failure.” Biofactors, 18, 1-4:91-100, 2003.
7) Houston MC. “The role of vascular biology, nutrition and Nutraceuticals in the prevention and treatment of hypertension.” JANA, S1:5-71, 2002.
8) Sarter B. “Coenzyme Q10 and cardiovascular disease: a review.” Journal of Cardiovascular Nursing, 16, 4:9-20, 2002.
9) “Benefits of coenzyme Q10,” New Straits Times, 7/31/2005.
10) Singh RB, et al. “Effect of coenzyme Q10 on risk of atherosclerosis in patients with recent myocardial infarction.” Molecular Cellular Biochemistry, 246, 1-2:75-82, 2003.
11) Rundek T, et al. “Atorvastatin decreases the coenzyme Q10 level in the blood of patients at risk for cardiovascular disease and stroke.” Arch Neurology, 61:889-892, 2004.
12) “Dr. Julian M. Whitaker petitions FDA to include coenzyme Q10 use recommendation in all statin drug labeling.” Townsend Letter for Doctors and Patients, 8/1/2002.
13) Sinatra ST, MD. “Is cholesterol lowering with statins the gold standard for treating patients with cardiovascular risk and disease?” (editorial), Southern Medical Journal, 3/1/2003.
14) Ridker PM, Stampfer JM, & Rifai N. “Novel risk factors for systemic atherosclerosis: A comparison of C-reactive protein, fibrinogen, homocysteine, lipoprotein(a), and standard cholesterol screening as predictors of peripheral arterial disease.” JAMA, 285:2481-2485, 2001.
15) Challem J. “A Prescription for Alarm.” Nutrition Science News, 9/1/2001.

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