Influence of ubiquinol on angina severity and dyspnea in patients with acute coronary syndrome
Main Article Content
Keywords
Ubiquinol, Angina severity, Acute coronary syndrome
Abstract
Background: Co-enzyme Q10 (CoQ10) has highest concentration in the heart and a critical role in cellular energy production, but its physiological concentration decreases with aging. Ubiquinol is the active and most bioavailable form of CoQ10; this is extremely important for patients older than 20 years as the metabolic enzyme required for CoQ10 activation starts to decrease. Thus, ubiquinol may have a more potent beneficial impact on improving the health of acute coronary syndrome (ACS) patients. This study aimed to investigate the influence of ubiquinol on angina severity and dyspnea in patients who are receiving optimal medical therapy (OMT) after ACS.
Methods: In a randomized, controlled clinical trial, 50 patients who had undergone percutaneous coronary intervention (PCI) were prospectively assigned to either the control group (n=25) or the ubiquinol group (n=25). The control group received only OMT, while the second group also received a ubiquinol daily dose of 200 mg in addition to the OMT. Measurement of the patients’ angina and dyspnea severity was achieved at baseline and at 2 months post-PCI via utilization of the Seattle Angina Questionnaire (SAQ) and the Rose Dyspnea Scale (RDS), respectively.
Results: After 8 weeks of intervention, a significant difference was revealed in health status improvement between the groups. In the ubiquinol group, 13 (52%) of patients became dyspnea-free, with 12 (48%) experiencing mild grade 1 dyspnea, while in the control group, residual dyspnea was still present in all patients, and 5 (20%) of them were still suffering from grade 4 dyspnea. Regarding the SAQ scores’ improvement, a significant difference between the groups was observed in the mean changes from baseline, with greater mean changes in the ubiquinol group compared to the control group in all three SAQ sub-scales and summary scores (p value < 0.001). The mean change of the SAQ summary score in the ubiquinol group was 55.93 ± 19.71 compared to 11.47 ± 16.47 in the control group, and the ubiquinol group reported significantly larger reductions in angina episodes.
Conclusion: This study demonstrates that ubiquinol addition to OMT after ACS has a highly significant effect on improving clinical outcomes and patients’ quality of life through greater reductions in angina frequency, physical limitations and dyspnea severity. This suggests an effective and safe strategy for optimizing therapeutic outcomes and secondary prevention.
References
2. Rabanal-Ruiz Y, Llanos-González E, Alcain FJ. The Use of Coenzyme Q10 in Cardiovascular Diseases. Antioxidants. 2021 May;10(5):755.
3. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J. 2020 Jan 14;41(3):407–77.
4. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022 Jan 18;145(3):e18–114.
5. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018 Jan 7;39(2):119–77.
6. Chacko L, P. Howard J, Rajkumar C, Nowbar AN, Kane C, Mahdi D, et al. Effects of Percutaneous Coronary Intervention on Death and Myocardial Infarction Stratified by Stable and Unstable Coronary Artery Disease. Circ Cardiovasc Qual Outcomes. 2020 Feb;13(2):e006363.
7. Collet C, Collison D, Mizukami T, McCartney P, Sonck J, Ford T, et al. Differential Improvement in Angina and Health-Related Quality of Life After PCI in Focal and Diffuse Coronary Artery Disease. JACC Cardiovasc Interv. 2022 Dec 26;15(24):2506–18.
8. https://fyra.io. Optimal Medical Therapy After PCI [Internet]. Cardiac Interventions Today.Bryn Mawr Communications; [cited 2023 Mar 18]. Available from: https://citoday.com/articles/2011-mar-apr/optimal-medical-therapy-after-pci
9. Reed SC, Dhir N, Widmer RJ. Optimal cardiovascular medical therapy: current guidelines and new developments. Proc Bayl Univ Med Cent. 35(5):636–42.
10. Optimal Medical Therapy and 10-Year Mortality After Revascularization [Internet]. American College of Cardiology. [cited 2023 Mar 18]. Available from: https://www.acc.org/latest-in-cardiology/journal-scans/2021/07/01/15/40/http%3a%2f%2fwww.acc.org%2flatest-in-cardiology%2fjournal-scans%2f2021%2f07%2f01%2f15%2f40%2fimpact-of-optimal-medical-therapy
11. Joseph P, Leong D, McKee M, Anand SS, Schwalm JD, Teo K, et al. Reducing the Global Burden of Cardiovascular Disease, Part 1: The Epidemiology and Risk Factors. Circ Res. 2017 Sep 1;121(6):677–94.
12. Thomas M, Jones PG, Arnold SV, Spertus JA. State of the Art Review: Interpreting the Seattle Angina Questionnaire as an Outcome in Clinical Trials and in Clinical Care. JAMA Cardiol. 2021 May 1;6(5):593–9.
13. Thomas M, Jones P, Arnold S, Spertus J. Interpretation of the Seattle Angina Questionnaire as an Outcome Measure in Clinical Trials and Clinical Care: A Review. JAMA Cardiol. 2021 Feb 10;6.
14. Arnold SV, Grodzinsky A, Gosch KL, Kosiborod M, Jones PG, Breeding T, et al. Predictors of Physician Under-recognition of Angina in Outpatients with Stable Coronary Artery Disease. Circ Cardiovasc Qual Outcomes. 2016 Sep;9(5):554–9.
15. Qintar M, Grantham JA, Sapontis J, Gosch KL, Lombardi W, Karmpaliotis D, et al. Dyspnea Among Patients with Chronic Total Occlusions Undergoing Percutaneous Coronary Intervention: Prevalence and Predictors of Improvement. Circ Cardiovasc Qual Outcomes. 2017 Dec;10(12):e003665.
16. Gutierrez-Mariscal FM, de la Cruz-Ares S, Torres-Peña JD, Alcalá-Diaz JF, Yubero-Serrano EM, López-Miranda J. Coenzyme Q10 and Cardiovascular Diseases. Antioxidants. 2021 Jun;10(6):906.
17. Taylor BA. Does Coenzyme Q10 Supplementation Mitigate Statin-Associated Muscle Symptoms? Pharmacological and Methodological Considerations. Am J Cardiovasc Drugs. 2018 Apr 1;18(2):75–82.
18. Alf D, Schmidt ME, Siebrecht SC. Ubiquinol supplementation enhances peak power production in trained athletes: a double-blind, placebo controlled study. J Int Soc Sports Nutr. 2013 Apr 29;10:24.
19. Marc Maurice Cohen. Ubiquinol (Reduced Coenzyme Q10): A novel yet ubiquitous nutrient for heart disease. J Adv Nutr Hum Metab. 2015 Feb;e647.
20. Hosoe K, Kitano M, Kishida H, Kubo H, Fujii K, Kitahara M. Study on safety and bioavailability of ubiquinol (Kaneka QHTM) after single and 4-week multiple oral administration to healthy volunteers. Regul Toxicol Pharmacol. 2007 Feb 1;47(1):19–28.
21. Machado ECFA, Ambrosano L, Lage R, Abdalla BMZ, Costa A. Nutraceuticals for Healthy Skin Aging. In: Nutrition and Functional Foods for Healthy Aging [Internet]. Elsevier; 2017 [cited 2023 Mar 22]. p. 273–81. Available from: https://linkinghub.elsevier.com/retrieve/pii/B978012805376800023X
22. Beger B. TOWARDS A BEATING CARDIOVASCULAR DISEASE PLAN FOR EUROPE. 2021;
23. Zozina VI, Covantev S, Goroshko OA, Krasnykh LM, Kukes VG. Coenzyme Q10 in Cardiovascular and Metabolic Diseases: Current State of the Problem. Curr Cardiol Rev. 2018 Aug;14(3):164–74.
24. Arnold SV, Morrow DA, Lei Y, Cohen DJ, Mahoney EM, Braunwald E, et al. Economic Impact of Angina After an Acute Coronary Syndrome. Circ Cardiovasc Qual Outcomes. 2009 Jul;2(4):344–53.
25. Spertus JA, Jones PG, Maron DJ, O’Brien SM, Reynolds HR, Rosenberg Y, et al. Health-Status Outcomes with Invasive or Conservative Care in Coronary Disease. N Engl J Med. 2020 Apr 9;382(15):1408–19.
26. Lappalainen L, Stenvall H, Lavikainen P, Miettinen H, Martikainen J, Sintonen H, et al. Patient-reported outcomes in coronary artery disease: the relationship between the standard, disease-specific set by the International Consortium for Health Outcomes Measurement (ICHOM) and the generic health-related quality of life instrument 15D. Health Qual Life Outcomes. 2021 Aug 28;19(1):206.
27. Abdallah MS, Wang K, Magnuson EA, Spertus JA, Farkouh ME, Fuster V, et al. Quality of Life After PCI vs CABG Among Patients With Diabetes and Multivessel Coronary Artery Disease: A Randomized Clinical Trial. JAMA. 2013 Oct 16;310(15):1581–90.
28. Baron SJ, Chinnakondepalli K, Magnuson EA, Kandzari DE, Puskas JD, Ben-Yehuda O, et al. Quality-of-Life After Everolimus-Eluting Stents or Bypass Surgery for Left-Main Disease: Results From the EXCEL Trial. J Am Coll Cardiol. 2017 Dec 26;70(25):3113–22.
29. Spertus JA, Jones P, McDonell M, Fan V, Fihn SD. Health Status Predicts Long-Term Outcome in Outpatients With Coronary Disease. Circulation. 2002 Jul 2;106(1):43–9.
30. Arnold SV, Spertus JA, Jones PG, Xiao L, Cohen DJ. The impact of dyspnea on health-related quality of life in patients with coronary artery disease: Results from the PREMIER registry. Am Heart J. 2009 Jun 1;157(6):1042-1049.e1.
31. Mazzola C, Guffanti EE, Vaccarella A. Noninvasive assessment of coenzyme Q 10 in patients with chronic stable effort angina and moderate heart failure. Curr Ther Res. 1987;41(6):923–32.
32. Tran MT, Mitchell TM, Kennedy DT, Giles JT. Role of Coenzyme Q 10 in Chronic Heart Failure, Angina, and Hypertension. Pharmacotherapy. 2001 Jul;21(7):797–806.
33. Kamikawa T, Kobayashi A, Yamashita T, Hayashi H, Yamazaki N. Effects of coenzyme Q10 on exercise tolerance in chronic stable angina pectoris. Am J Cardiol. 1985 Aug;56(4):247–51.
34. Singh RB, Fedacko J, Mojto V, Pella D. Coenzyme Q10 Modulates Remodeling Possibly by Decreasing Angiotensin-Converting Enzyme in Patients with Acute Coronary Syndrome. Antioxidants. 2018 Jul 25;7(8):99.
35. Ulla A, Mohamed MK, Sikder B, Rahman AT, Sumi FA, Hossain M, et al. Coenzyme Q10 prevents oxidative stress and fibrosis in isoprenaline induced cardiac remodeling in aged rats. BMC Pharmacol Toxicol. 2017 Apr 20;18:29.
36. Cohn JN, Ferrari R, Sharpe N. Cardiac remodeling—concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. J Am Coll Cardiol. 2000 Mar 1;35(3):569–82.
37. Singh RB, Neki NS, Kartikey K, Pella D, Kumar A, Niaz MA, et al. Effect of coenzyme Q10 on risk of atherosclerosis in patients with recent myocardial infarction. Mol Cell Biochem. 2003 Apr;246(1–2):75–82.
38. Chopra HK. Cardiological Society of India: Cardiology Update 2014. First. JP Medical Ltd; 2015. 211–216 p.
39. Huang CH, Kuo CL, Huang CS, Tseng WM, Lian IB, Chang CC, et al. High plasma coenzyme Q10 concentration is correlated with good left ventricular performance after primary angioplasty in patients with acute myocardial infarction. Medicine (Baltimore). 2016 Aug 7;95(31):e4501.
40. Mantle D, Dybring A. Bioavailability of Coenzyme Q10: An Overview of the Absorption Process and Subsequent Metabolism. Antioxidants. 2020 May 5;9(5):386.
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