The term heart failure can be a bit confusing. Most people associate it with a situation where the heart stops beating altogether. Well, heart failure is a condition where the heart is not strong enough to pump blood with required force and as a result blood flows through the body at a slower pace. A weak heart is not able to provide enough oxygen and nutrients to tissues and organs that they need to carry out their functions. Having said that, heart failure is still a serious condition that requires timely and effective management; achieved usually through medication and lifestyle modifications.
What causes heart failure? While ageing, of course, is one important driver, many other conditions also considerably increase the risk quotient, such as coronary artery disease (hardening of arteries due to plaque build-up), high blood pressure, congenital heart disease, long-term stress, smoking, excessive alcohol intake, damaged heart valves, history of heart attack and thyroid issues.
People with heart failure have poor flow of blood in the body and their symptoms include shortness of breath, chronic coughing or wheezing, fluid build-up in legs, ankles or abdomen, fatigue, faster heart rate, confusion and dizziness.
CoQ10 levels and heart failure risk
Depletion of CoQ10 in the heart muscle cells is considered an important mechanism in both the onset and progression of heart failure. Research shows that patients with heart failure have low levels of CoQ10. 
In addition, patients with congestive heart failure are often prescribed statins and β-blockers to prevent additional cardiovascular complications. But these drugs significantly deplete your pool of CoQ10, creating a double whammy of sorts.
How CoQ10 works in heart failure?
CoQ10 helps the cells to make energy. It is actively involved in the process through which the mitochondria produce energy in the cells (by burning ‘fuel’ such as carbohydrates and fatty acids from the food you eat). CoQ10, also known as the ‘spark plug of the cells’, participates in the redox reactions that eventually lead to the formation of ATP and its role here is indispensable. No CoQ10 would mean no clean energy for the cells.
You can imagine what low levels of CoQ10 would mean for your heart, an organ that depends on a continuous supply of energy to fuel an uninterrupted pumping action. No wonder CoQ10 is found in abundance in the heart muscle as compared to other tissues.
Low levels of CoQ10 alter the energy metabolism in the heart and this results in a weak, energy deprived heart muscle that is unable to do it job as efficiently as it should. And then you have a failing heart with abnormal contraction and relaxation function.
With declining CoQ10 levels, the mitochondria in the heart muscle behaves like a worn-out car engine and loses its competency in creating energy in an efficient manner. This leaves behind a trail of excess free radicals, which damage the heart tissue through oxidation.
That’s where CoQ10 supplementation helps. It infuses energy into weak, tired and overworked heart muscle. It also works in an anti-oxidant capacity to protect the heart tissue from oxidative damage. These two mechanisms support CoQ10’s role in alleviating heart failure symptoms.
The Q-SYMBIO trial showed that long-term Co Q10 supplementation improves heart failure symptoms and reduces major adverse cardiovascular events (MACE), a list of events that include death, hospitalization due to deteriorating heart failure, coronary artery bypass surgery, and the need for urgent cardiac transplantation and mechanical support. The randomised double blind study involved 420 patients with severe heart failure and showed that CoQ10 could improve survival rate and improve quality of life. 
According to the lead study author, Professor Mortensen, “other heart failure medications block rather than enhance cellular processes and may have side effects. Supplementation with CoQ10, which is a natural and safe substance, corrects a deficiency in the body and blocks the vicious metabolic cycle in chronic heart failure called the energy starved heart.” 
In addition, a 2014 clinical trial showed that Coq10, when used together with atorvastatin (a cholesterol lowering drug), resulted in improved ejection fraction. This effect was much better achieved than when atorvastatin was used alone.  As explained by the American Heart Association, ejection fraction is the measurement of amount of blood pumped out of the heart during each contraction. EF is an important measurement in diagnosing and monitoring heart failure.
Considering the side effects from conventional therapies to manage heart failure and associated symptoms, CoQ10 represents a safe option without any significant side effects. In addition, CoQ10 is a powerful anti-oxidant and acts as a vasodilator (it helps to dilate the blood vessels).
These properties make CoQ10 supplementation an extremely beneficial therapy in mitigating other cardiovascular risk factors such as high blood pressure, heart attack, endothelial dysfunction and the oxidative damage to heart muscle suffered during heart attacks. We will be covering the role of CoQ10 in managing these risk factors in detail in our up-coming blogs.
- Okonko DO, Shah AM. Heart failure: mitochondrial dysfunction and oxidative stress in CHF. Nat Rev Cardiol. 2015
- European Society of Cardiology (ESC). "First drug to significantly improve heart failure mortality in over a decade." ScienceDaily.
- Pourmoghaddas M, Rabbani M, Shahabi J, Garakyaraghi M, Khanjani R, Hedayat P. Combination of atorvastatin/coenzyme Q10 as adjunctive treatment in congestive heart failure: A double-blind randomized placebo-controlled clinical trial. ARYA Atheroscler. 2014 Jan;10(1):1-5.
- Mortensen SA, Rosenfeldt F, Kumar A, et al. The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: results from Q-SYMBIO: a randomized double-blind trial. JACC Heart Fail 2014
- James J DiNicolantonio, Jaikrit Bhutani, Mark F McCarty and James H O'Keefe. Coenzyme Q10 for the treatment of heart failure: a review of the literature. Open Heart 2015.