Wednesday, January 23, 2008

Co-enzyme Q10 (co-Q10), statin drugs, heart health and the cholesterol conspiracy

From Dr. Ladd MacNamara and with reference to BusinessWeek's story:

In my book, The Cholesterol Conspiracy, I emphasized how important co-enzyme Q10 (Co-Q10) is in promoting heart health: preventing cardiovascular disease, and apparently even reversing the signs of cardiovascular disease. However, the benefits of Co-Q10 are not limited to the heart, but are extended to the entire body, in particular to the brain, the skin, and most importantly to the reduction of cancer development and apparently as an adjunctive therapy in the treatment of cancer itself!

Co-Q10 is a cofactor (or co-enzyme) essential for the functioning of an enzyme system that creates 90% of the molecules needed for cellular energy (ATP molecules). Co-Q10 is the only fat-soluble vitamin produced by our body, however, as we get older we produce less and less. It is found in the mitochondria of cells where energy is created from oxygen and glucose (sugar). Organs that require more energy have more mitochondria, and therefore require more co-Q10, the heart requiring and using more energy, and thus requiring more co-Q10, than any other organ in the body.

The downside of creating ATP energy molecules within the mitochondria is the generation of free radicals, which if unchecked can wreak incredible damage through oxidation. Co-enzyme (Q10) is the first-line antioxidant in the defense against excessive oxidation both within and outside the mitochondria.

Patients with congestive heart failure are found to have a deficiency of co-Q10, and as mentioned above, our bodies make less co-Q10 with they age. (Skin health is affected by the amount of co-Q10 available, and as we age the levels decrease, elasticity is loss, along with an increased risk of skin cancer. A topic for another update.)

The theme of The Cholesterol Conspiracy is that statin drugs reduce co-Q10 levels (and nutritional supplements are an effective means to maintain heart health), and the consequences of co-Q10 deficiency can be devastating; one of which can be the development of congestive heart failure.

When statin drugs first came on the market in 1987 (the first being Mevacor, lovastatin), clinicians who followed co-Q10 levels of their patients saw a dramatic drop, and a worsening of heart functioning, including failure; one requiring a heart transplant. The patients showed an improvement in their co-Q10 levels and heart functioning once the statin drugs were discontinued. All statin drugs block co-Q10 production, and cause depletion in the body, and results in detrimental effects on the heart, as well as the rest of the body (fatigue, depression, foggy thinking, memory loss, and many other effects, including an apparent increase in cancer).

Do statin drugs reduce LDL cholesterol levels? Yes, they do, AND, they may reduce the risk of heart attack by as much as 16 to 24%, but really only among men with heart disease. (They appear not to help those with high cholesterol and no heart disease or women in any category at all.) However, the studies showing any benefits to statin drugs ALSO show that those taking these drugs are having significant side-effects, beyond a decrease in cardiac function (congestive heart failure), ... in some cases actually dying of causes other than repeat heart attacks. For example, the study a few years ago in the New England Journal of Medicine touting the “incredible, undeniable benefits of high-dose Lipitor” which was supposed to be the break-through treatment for those at risk for heart disease if looked at closely actually showed no net saving of lives at all! In this 2005 "TNT" study, 10,001 people received either high-dose Lipitor or low-dose Lipitor. High-dose Lipitor brought down LDL cholesterol levels to an average of 77 mg/dl, and the low dose Lipitor brought LDL down to just about 110 mg/dl.

Source: Intensive Lipid Lowering with Atorvastatin in Patients with Stable Coronary Disease, LaRosa et al, N Engl J Med. 2005 Apr 7; 352(14): 1425-35

Over the next 5 years 8.7% of the high-dose group had a repeat heart attack, and among the low-dose group 10.9% of the people experienced a repeat heart attack. There were 29 fewer deaths from high-dose Lipitor due to heart attack! So, one could conclude that everyone at risk for heart disease should go on high-dose Lipitor, right? Well, that’s exactly the campaign that Pfizer pushed upon physicians. However, this “benefit” was COMPLETELY offset by 31 MORE deaths from people taking high-dose Lipitor who died from OTHER CAUSES (not heart attacks). The conclusion: 80 mg of Lipitor did NOT save ANY lives; in fact maximum dose Lipitor INCREASED one's risk of death due to non-cardiovascular causes (10 of these deaths were from cancer)! Oh, and every one of the eleven authors of this study were either a Pfizer employee or a paid “Pfizer consultant.”

The worst part about this, ... the campaign by Pfizer to spin the information that prescribing statin drugs is not only safe but the BEST TREATMENT for all patients at risk for heart disease has still left a deep impression on physicians today, and is so entrenched in the medical psyche' that it is very difficult for doctors to even think that nutritional supplements have any place at all in the health maintenance or prevention of heart disease.

However to be fair, the medical studies do show that there is a 33% decrease risk of repeat cardiac events (heart attacks) in patients treated with low dose (10 to 20 mg) statin drugs among those at high risk of heart attack (those with coronary artery disease). However, since statin drugs can lead to decrease cardiac function (congestive heart failure) it is prudent for physcians to be aware to recommend that patients also take at least 100 to 200 mg of Co-enzyme Q10 (or an equivalent 60 to 120 mg highly absorbable gel formulation) to prevent the depletion of co-Q10 by statin drugs with the resultant cardiac muscle weakening and possible destruction.

However, one thing has become crystal clear of late, ... the very recent release of the results of the ENHANCE study, a two-year trial of people with high cholesterol taking Zetia or Zocor alone. (Zetia is the brand name for ezemtimbe, which is also found in Vytorin, ...and the results may very well apply to this drug as well.) Although Zetia, which is prescribed to about 1 million Americans at this time, did lower cholesterol, this study revealed it provided absolutely no benefit. Worse, not only did it not provide a benefit, but the rate at which arteries thickened with plaque almost DOUBLED with those taking Zetia (ezemtimbe, also found in Vytorin, which at least another million Americans are taking)!

Source: MedicineNet article on the ENHANCE trial

In other words, this increased the rate of atherosclerosis i.e. coronary artery disease! This study was just two years long, imagine the results over ten years use of this drug. The results were just announced so they are not yet published in a medical journal, but they were reported in several media outlets. Interestingly, it did not make a big splash on TV. If such “bad news” about vitamins would have been released it would have created a tidal wave on the “controversy” of nutritional supplementation, yet this “deadly news” barely made a ripple regarding the issue over cholesterol-lowering drugs’ dark side.

There have been 22 placebo-controlled studies of co-Q10 among people with congestive heart failure. Of those, only 3 studies have failed to shown significant benefit, which means 19 have shown significant heart benefits among those with failing hearts … that is reversal of heart disease! So, why would three studies not have shown a benefit? One study failed to measure co-Q10 levels at all, so there was no way to even know if the patients even obtained therapeutic levels.

Source: Ubiquinone (coenzyme Q10) in the long-term treatment of idiopathic dilated cardiomyopathy, Permanetter, Rossy, Klein, Weingarter, Seidl and Blomer, Eur Heart J. 1992 Nov;13(11):1528-33.

And, although the other two studies measured co-Q10 levels, the co-Q10 levels were sub-therapeutic i.e., the patients did not get enough co-Q10 to be effective in improving heart function! Despite this, these three studies are the most often quoted in discounting the benefits of co-Q10! Why?


Is coenzyme Q10 helpful for patients with idiopathic cardiomyopathy?, Del Mar et al, Med J Aust. 2001 Oct 15;175(8):447; author reply 447-8

The effect of coenzyme Q10 in patients with congestive heart failure, Khatta, Alexander, Krichten, Fisher, Freudenberger, Robinson and Gottlieb, Ann Intern Med. 2000 Apr 18;132(8):636-40

Why not refer to the 19 other studies showing the significant benefits of co-Q10? If these were studies done by pharmaceutical companies, they would more than qualify as good studies: the patients were given the correct therapeutic doses; and 19 powerful studies would be "proof positive" that co-Q10 improved congestive heart failure (among many other benefits) without negative effects. There would be no question for its use in patients with congestive heart failure. Why, it's almost as if there is some group with a financial interest who does not want us to know about the benefits of co-Q10 because they want us to remain uninformed and taking their products ... to our detriment.

It is clear that therapeutic blood levels, i.e., in order to see improvement in heart functioning in those with congestive heart failure, the blood level of co-Q10 should be at least 3.5 micrograms/ml (mcg/ml) or greater.

Of all the studies showing cardiac benefits using co-Q10 there has been absolutely no harmful side-effects or negative drug interactions. Since this has been shown to be true, why aren't more doctors aware of this? The studies are there! All benefit, no harm. With the drugs ... little benefit (or none in some cases), with much harm. Hmmm? Well, at least some people are getting the message, and others are delivering it.

Co-Q10 offers numerous benefits, not only for people with congestive heart failure, but also those with coronary artery disease, atherosclerosis, and those with cancer (again, a topic for another update). In a placebo-controlled study in 2007 of 38 patients using 300 mg /day of Co-Q10, researchers found an increased production of the powerful antioxidant enzyme superoxide dismutase (which has been shown to reverse atherosclerosis, or plaque in the arteries), and vasodilation (blood vessel widening, …which allows blood to flow freely to the heart, brain, muscles, etc. to deliver oxygen to organs, rather than being constricted as with a heart attack).

Source: Effect of coenzyme Q10 administration on endothelial function and extracellular superoxide dismutase in patients with ischaemic heart disease: a double-blind, randomized controlled study, Tiano et al, Eur Heart J. 2007 Jul 19 [Epub ahead of print]

By the way, some highly absorbable gel formulations of co-enzyme Q10 are 1.8 to 2.0 times more absorbable than "regular" co-enzyme Q10. Therefore, if you had a 30 mg gel capsule of this highly absorbable formulation of co-enzyme Q10, you would need about to take about 6 capsules per day to equate to the 300 mg that is referred to in the study above. Remember, they are referring to those with heart disease, not simply taking co-enzyme Q10 for the maintenance of cardiac health in a healthy person. Two of such capsules per day would be sufficient in the maintenance of heart health in a healthy person.

The people supplementing with 300 mg co-Q10 also showed increased peak consumption of oxygen and oxygen pulse, meaning more efficient and effective use of oxygen, which is significant for athletes and those with compromised hearts and lungs.

Regarding the effect of statin drugs on cholesterol, cholesterol on heart health, co-Q10 on heart health and the prevention of heart disease, there are many good books in addition to my own book, The Cholesterol Conspiracy. In my other books, Prostate Cancer and Breast Cancer I write about the role of co-Q10 in cancer. There are so many benefits to co-Q10 for those who are concerned about these health issues, however, for those who are healthy (and for athletic performance enhancement) and just want more energy and vitality in life I would highly suggest considering looking into a high-quality, pharmaceutical-grade, highly absorbable gel formulation of co-Q10.

There is no known toxic dose to co-Q10, and it is clear that for maximum benefit in those with heart disease therapeutic doses must be achieved.

Source: Ladd McNamara, M.D. - expert in nutraceutical and anti-aging medicine, Dr Ladd MacNamara blog,