Cardioplus

CARDIO PLUS
CoQ10 50mg 60 capsules

CoQ10 is a naturally occurring nutrient found in each cell of the body. CoQ10 was first identified by
University of Wisconsin researchers in 1957. CoQ10 -- also spelled CoQ 10 -- is found in foods, particularly
in fish and meats. In addition to playing a significant role in the energy system of each of our cells, CoQ10 is
also believed to have antioxidant properties. Many who take CoQ10 notice that this nutrient enhances
physical energy.

For which conditions is CoQ10 helpful?
Studies with CoQ10 have mostly focused on its role involving certain types of cardiovascular diseases,
including congestive heart failure and hypertension. However, CoQ10 has also been evaluated for high
cholesterol and in diabetes.
Studies with CoQ10

Diabetes: CoQ10 may be beneficial in diabetics. It helps improve the function of endothelial cells lining
blood vessels and may slightly help with blood sugar control.

Heart Attacks: In a small trial of patients with recent myocardial infarction, CoQ10 -- used in addition to
aspirin and cholesterol-lowering drugs -- decreased the likelihood of further cardiac events for at least one
year after the heart attack. The dosage of CoQ10 used in the study was 60 mg twice daily.

Heart Failure: One study in patients with heart failure showed significant improvement in functional status,
clinical symptoms, and quality of life in end stage heart failure patients who were placed on CoQ10 (see
bottom of page).

Hypertension: CoQ10 may help lower blood pressure by a small amount in some people.

Cholesterol: Individuals on cholesterol medicines of the statin class such as Lipitor and others, may
consider taking CoQ10 supplements since statins decrease blood CoQ10 levels (see study bottom of page).

How does CoQ10 work?

Each cell in the body needs a source of energy to survive, so cells break down sugars, fats, and amino
acids to make energy. Small enclosures within cells that make this energy are called mitochondria. CoQ10
exists naturally in our mitochondria and carries electrons involved in energy metabolism. CoQ10 is essential
in the production of adenosine triphosphate (ATP), the basic energy molecule of each cell.

In the bloodstream, CoQ10 is mainly transported by lipoproteins such as LDL (low-density lipoprotein) and
HDL (high-density lipoprotein). It is thought that CoQ10 is one of the first antioxidants to be depleted when
LDL is subjected to oxidation. Hence, CoQ10 is an important nutrient that prevents the oxidation of
lipoproteins, thus potentially reducing the risk of arteries from forming plaques and getting damaged.
In healthy individuals, CoQ10 is found in high concentrations in the heart, kidneys, and liver.

CoQ10 and Drug interactions

The administration of CoQ10 and warfarin does not significantly affect the anticoagulant effect of warfarin in
rats. A Human trial shows Co Q10 and Ginkgo biloba do not influence the clinical effect of warfarin. Those
who take statin drugs may consider taking additional CoQ10.
Side Effects and Cautions

High dosages of CoQ10 can induce restlessness and insomnia. Long term effects of high dose CoQ10 use
are not clear at this time.

CoQ10 Recommendations

CoQ10 is probably beneficial in cardiovascular conditions and this nutrient will likely be found to play some
positive role in cognitive or neurodegenerative disorders, but more studies are needed.
In the meantime, it would seem appropriate to supplement with this nutrient as part of a long-term health
regimen, particularly for those with cardiovascular conditions. Long-term therapy with 10 to 60 mg a few
days a week seems a reasonable option for many individuals.
CoQ10 Research Update:

Cosupplementation with vitamin E and coenzyme Q10 reduces circulating markers of
inflammation in baboons.
Am J Clin Nutr. 2004 Sep;80(3):649-55.

Inflammation and oxidative stress are processes that mark early metabolic abnormalities in vascular
diseases. We explored the effects of a high-fat, high-cholesterol (HFHC) diet on vascular responses in
baboons and the potential response-attenuating effects of vitamin E and coenzyme Q(10) (CoQ10)
supplementation. We used a longitudinal design by subjecting 21 baboons to sequential dietary challenges.
RESULTS: After being maintained for 3 mo on a baseline diet (low in fat and cholesterol), 21 baboons were
challenged with an HFHC diet for 7 wk. The serum C-reactive protein (CRP) concentrations did not change.
Subsequent supplementation of the HFHC diet with the antioxidant vitamin E (250, 500, or 1000 IU/kg diet)
for 2 wk reduced serum CRP concentrations. Additional supplementation with CoQ10 (2 g/kg diet) further
reduced serum CRP to approximately 30% of baseline. Introduction of the HFHC diet itself significantly
decreased serum P-selectin and von Willebrand factor concentrations. However, neither vitamin E alone nor
vitamin E plus CoQ10 significantly altered the serum concentrations of P-selectin or von Willebrand factor.
CONCLUSIONS: Dietary supplementation with vitamin E alone reduces the baseline inflammatory status that
is indicated by the CRP concentration in healthy adult baboons. Cosupplementation with CoQ10, however,
significantly enhances this antiinflammatory effect of vitamin E.

Pilot trial of high dosages of CoQ10 in patients with Parkinson's disease.
Exp Neurol. 2004 Aug;188(2):491-4.

The safety and tolerability of high dosages of coenzyme Q10 were studied in 17 patients with Parkinson's
disease (PD) in an open label study. The subjects received an escalating dosage of coQ10 -- 1200, 1800,
2400, and 3000 mg/day with a stable dosage of vitamin E (alpha-tocopherol) 1200 IU/day. The plasma level
of coQ10 was measured at each dosage. Thirteen of the subjects achieved the maximal dosage, and
adverse events were typically considered to be unrelated to coQ10. The plasma level reached a plateau at
the 2400 mg/day dosage and did not increase further at the 3000 mg/day dosage. Our data suggest that in
future studies of CoQ10 in PD, a dosage of 2400 mg/day (with vitamin E/alpha-tocopherol 1200 IU/day) is
an appropriate highest dosage to be studied.

Co-supplementation with vitamin E and CoQ10 reduces circulating markers of inflammation in
baboons
American Journal of Clinical Nutrition, Vol. 80, No. 3, 649-655, September 2004

Background: Inflammation and oxidative stress are processes that mark early metabolic abnormalities in
vascular diseases. Objectives: We explored the effects of a high-fat, high-cholesterol (HFHC) diet on
vascular responses in baboons and the potential response-attenuating effects of vitamin E and coenzyme
Q10 (CoQ10) supplementation. Design: We used a longitudinal design by subjecting 21 baboons (Papio
hamadryas) to sequential dietary challenges. Results: After being maintained for 3 mo on a baseline diet
(low in fat and cholesterol), 21 baboons were challenged with an HFHC diet for 7 wk. The serum C-reactive
protein (CRP) concentrations did not change. Subsequent supplementation of the HFHC diet with the
antioxidant vitamin E (250, 500, or 1000 IU/kg diet) for 2 wk reduced serum CRP concentrations from 0.91 ±
0.02 to 0.43 ± 0.06 mg/dL. Additional supplementation with CoQ10 (2 g/kg diet) further reduced serum CRP
to 30% of baseline (0.28 ± 0.03 mg/dL; P = 0.036 compared with the HFHC diet). Introduction of the HFHC
diet itself significantly decreased serum P-selectin and von Willebrand factor (from 187.0 ± 10.1 to 161.9 ±
9.0%, P = 0.02) concentrations. However, neither vitamin E alone nor vitamin E plus CoQ10 significantly
altered the serum concentrations of P-selectin or von Willebrand factor. Conclusions: Dietary
supplementation with vitamin E alone reduces the baseline inflammatory status that is indicated by the CRP
concentration in healthy adult baboons. Cosupplementation with CoQ10, however, significantly enhances
this antiinflammatory effect of vitamin E.

Atorvastatin decreases the CoQ10 level in the blood of patients at risk for cardiovascular
disease and stroke.
Rundek T. olumbia University College of Physicians & Surgeons, New York, NY 10032, USA.
Arch Neurol. 2004 Jun;61(6):889-92.

Statins are widely used for the treatment of hypercholesterolemia and coronary heart disease and for the
prevention of stroke. There have been various adverse effects, most commonly affecting muscle and
ranging from myalgia to rhabdomyolysis. These adverse effects may be due to a coenzyme Q(10) (CoQ10)
deficiency because inhibition of cholesterol biosynthesis also inhibits the synthesis of CoQ10. OBJECTIVE:
To measure CoQ10 levels in blood from hypercholesterolemic subjects before and after exposure to
atorvastatin calcium, 80 mg/d, for 14 and 30 days. DESIGN: Prospective blinded study of the effects of
short-term exposure to atorvastatin on blood levels of CoQ10. SETTING: Stroke center at an academic
tertiary care hospital. We examined a cohort of 34 subjects eligible for statin treatment according to National
Cholesterol Education Program: Adult Treatment Panel III criteria. RESULTS: The mean +/- SD blood
concentration of CoQ10 was 1.26 +/- 0.47 micro g/mL at baseline, and decreased to 0.62 +/- 0.39 micro
g/mL after 30 days of atorvastatin therapy. A significant decrease was already detectable after 14 days of
treatment. CONCLUSIONS: Even brief exposure to atorvastatin causes a marked decrease in blood CoQ10
concentration. Widespread inhibition of CoQ10 synthesis could explain the most commonly reported
adverse effects of statins, especially exercise intolerance, myalgia, and myoglobinuria.

Parkinson's Disease: A small but promising study found that coenzyme CoQ10 may help stop the
nerve cell death that characterizes Parkinson's. disease.
The study involved just 80 people. Half ate maple-nut flavored wafers containing various CoQ10 doses, half
took a placebo for up to 16 months. By the study's end, the 23 patients on the highest daily doses had 44
percent less decline in mental function, movement and ability to perform daily living tasks than the placebo
group. Research has suggested that energy-supplying structures inside cells called mitochondria may be
impaired in Parkinson's disease. Patients studied had early-stage Parkinson's and took a placebo or CoQ10
in doses of 300 milligrams, 600 mgs or 1,200 mgs daily. Their symptoms were evaluated for up to 16
months. By the eighth month, the 23 patients on the highest dose showed significantly less impairment than
the others. Side effects, including back pain, headaches and dizziness, were mostly mild.
Dr. Sahelian comments: I'm surprised these patients could tolerate these very high doses of CoQ10. I have
had feedback from those using high doses of CoQ10 that, in some people, there is excessive stimulant-like
effect and high levels of alertness that may cause insomnia.
CoQ10 in patients with end-stage heart failure awaiting cardiac transplantation: a randomized,
placebo-controlled study.
Clin Cardiol. 2004 May;27(5):295-9.
The number of patients awaiting heart transplantation is increasing in proportion to the waiting period for a
donor. Studies have shown that coenzyme Q10 (CoQ10) has a beneficial effect on patients with heart
failure. HYPOTHESIS: The purpose of the present double-blind, placebo-controlled, randomized study was
to assess the effect of CoQ10 on patients with end-stage heart failure and to determine if CoQ10 can
improve the pharmacological bridge to heart transplantation. METHODS: A prospective double-blind design
was used. Thirty-two patients with end-stage heart failure awaiting heart transplantation were randomly
allocated to receive either 60 mg U/day of Ultrasome--CoQ10 (special preparation to increase intestinal
absorption) or placebo for 3 months. All patients continued their regular medication regimen. Assessments
included anamnesis with an extended questionnaire based partially on the Minnesota Living with Heart
Failure Questionnaire, 6-min walk test, blood tests for atrial natriuretic factor (ANF) and tumor necrosis
factor (TNF), and echocardiography. RESULTS: Twenty-seven patients completed the study. The study
group showed significant improvement in the 6-min walk test and a decrease in dyspnea, New York Heart
Association (NYHA) classification, nocturia, and fatigue. No significant changes were noted after 3 months of
treatment in echocardiography parameters (dimensions and contractility of cardiac chambers) or ANF and
TNF blood levels. CONCLUSIONS: The administration of CoQ10 to heart transplant candidates led to a
significant improvement in functional status, clinical symptoms, and quality of life. However, there were no
objective changes in echo measurements or ANF and TNF blood levels. Coenzyme Q10 may serve as an
optional addition to the pharmacologic armamentarium of patients with end-stage heart failure. The
apparent discrepancy between significant clinical improvement and unchanged cardiac status requires
further investigation.

Serum coenzyme Q10 concentrations in healthy men supplemented with 30 mg or 100 mg coQ10
for two months in a randomized controlled study.
Biofactors. 2003;18(1-4):185-93.

Serum CoQ10 concentrations were evaluated in healthy male volunteers supplemented with 30 mg or 100
mg CoQ10 or placebo as a single daily dose for two months in a randomized, double-blind,
placebo-controlled study. Median baseline serum CoQ10 concentration in 99 men was 1.26 mg/l. Baseline
serum CoQ10 concentration did not depend on age, while borderline significant positive associations were
found for body weight and smoking 1-10 cigarettes/d. Supplementation with 30 mg or 100 mg CoQ10
resulted in median increases in serum CoQ10 concentration of 0.55 mg/l and 1.36 mg/l, respectively,
compared with a median decrease of 0.23 mg/l with placebo. The changes in the CoQ10 groups were
significantly different from that in the placebo group, and the increase in the 100 mg CoQ10 group was
significantly greater than that in the 30 mg CoQ10 group. The change in serum CoQ10 concentration in the
CoQ10 groups did not depend on baseline serum CoQ10 concentration, age, or body weight.

Effect of coenzyme Q10 on risk of atherosclerosis in patients with recent myocardial infarction.
Singh RB. Mol Cell Biochem. 2003 Apr;246(1-2):75-82.

In a randomized, double-blind, controlled trial, the effects of oral treatment with CoQ10, 120 mg/day, a
bioenergetic and antioxidant cytoprotective agent, were compared for 1 year, on the risk factors of
atherosclerosis, in 73 (CoQ10, group A) and 71 (B vitamin group B) patients after acute myocardial
infarction (AMI). After 1 year, total cardiac events (24.6 vs. 45.0%, p < 0.02) including non-fatal infarction
and cardiac deaths were significantly lower in the intervention group compared to control group. The extent
of cardiac disease, elevation in cardiac enzymes, left ventricular enlargement, previous coronary artery
disease and elapsed time from symptom onset to infarction at entry to study showed no significant
differences between the two groups. Plasma level of vitamin E and high density lipoprotein cholesterol (1.26
+/- 0.43 vs. 1.12 +/- 0.32 mmol/L) showed significant (p < 0.05) increase whereas thiobarbituric acid
reactive substances, malondialdehyde and diene conjugates showed significant reduction respectively in
the CoQ10 group compared to control group. Approximately half of the patients in each group (n = 36 vs.
31) were receiving lovastatin (10 mg/day) and both groups had a significant reduction in total and low
density lipoprotein cholesterol compared to baseline levels. It is possible that treatment with CoQ10 in
patients with recent MI may be beneficial in patients with high risk of atherothrombosis, despite optimal lipid
lowering therapy during a follow-up of 1 year. Adverse effect of treatments showed that fatigue (40.8 vs.
6.8%, p < 0.01) was more common in the control group than CoQ10 group.

Open label trial of coenzyme Q10 as a migraine preventive.
Cephalalgia. 2002 Mar;22(2):137-41.

The objective was to assess the efficacy of CoQ10 as a preventive treatment for migraine headaches.
Thirty-two patients (26 women, 6 men) with a history of episodic migraine with or without aura were treated
with coenzyme Q10 at a dose of 150 mg per day. Thirty-one of 32 patients completed the study; 61.3% of
patients had a greater than 50% reduction in number of days with migraine headache. The average number
of days with migraine during the baseline period was 7.34 and this decreased to 2.95 after 3 months of
therapy, which was a statistically significant response. Mean reduction in migraine frequency after 1 month
of treatment was 13.1% and this increased to 55.3% by the end of 3 months. Mean migraine attack
frequency was 4.85 during the baseline period and this decreased to 2.81 attacks by the end of the study
period, which was a statistically significant response (P < 0.001). There were no side-effects noted with
CoQ10. From this open label investigation CoQ10 appears to be a good migraine preventive.
Placebo-controlled trials are now necessary to determine the true efficacy of CoQ10 in migraine prevention.

Randomized, double-blind, placebo-controlled trial of coenzyme Q10 in isolated systolic
hypertension.
South Med J. 2001 Nov;94(11):1112-7.

Increasing numbers of the adult population are using alternative or complementary health resources in the
treatment of chronic medical conditions. Systemic hypertension affects more than 50 million adults and is
one of the most common risk factors for cardiovascular morbidity and mortality. This study evaluates the
antihypertensive effectiveness of oral coenzyme Q10 (CoQ10), an over-the-counter nutritional supplement,
in a cohort of 46 men and 37 women with isolated systolic hypertension. We conducted a 12-week
randomized, double-blind, placebo-controlled trial with twice daily administration of 60 mg of oral CoQ10 and
determination of plasma CoQ10 levels before and after the 12 weeks of treatment. RESULTS: The mean
reduction in systolic blood pressure of the CoQ10-treated group was 17.8 +/- 7.3 mm Hg (mean +/- SEM).
None of the patients exhibited orthostatic blood pressure changes. CONCLUSIONS: Our results suggest
CoQ10 may be safely offered to hypertensive patients as an alternative treatment option.

Burke BE, et al. Randomized, double-blind, placebo-controlled trial of CoQ10 in isolated systolic
hypertension. South Med J 2001 Nov;94(11):1112-7.
Watts GF, et al. CoQ10 improves endothelial dysfunction of the brachial artery in Type II diabetes
mellitus. Diabetologia 2002 Mar;45(3):420-6.

CoQ10 50mg
30 capsules P 988.00

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