The Role of Coenzyme Q10 in Cardiovascular Disease Treatment: An Updated 2024 Systematic Review and Meta-Analysis of Prospective Cohort Studies (2000-2023)

Background and ObjectivesWith the increasing need for clinicians to develop novel treatment strategies for the treatment of CVDs, the future lies in developing personalized nutrient recommendations based on an individuals needs. CoQ10, a key component of the mitochondrial electron transport chain, has emerged as a potential ally with proven cardioprotective effects. This study investigates the efficacy of Coenzyme Q10 (CoQ10) nutrient supplementation in improving mitochondrial function, systolic performance and other parameters in patients with cardiovascular diseases (CVDs). MethodsA systematic review and meta-analysis included data from PubMed, Embase, and the Cochrane Library up to January 2024. Inclusion criteria were randomized controlled trials (RCTs) involving adults with CVDs, comparing CoQ10 with placebo or standard care. Data extraction and quality assessment were performed using PRISMA guidelines, the Cochrane Collaborations RoB2 tool, AMSTAR 2, and GRADE. Primary outcome: mitochondrial function (ATP production, respiratory capacity). Secondary outcome: systolic function (ejection fraction). FindingsFrom initial reference list of 46 selected studies, 22 were extracted presenting the encompassing a total sum of 11,372 subjects that were included in the meta-analysis with a total follow-up time ranging from 2 to 144 months (12 years). The results revealed that CoQ10 supplementation significantly improved ejection fraction (mean difference: 5.6%, 95% CI: 3.2% to 8.0%, p<0.001, I{superscript 2}=25%). The I{superscript 2} statistic for ejection fraction was 25%, indicating low heterogeneity among the studies included in the meta-analysis. Mitochondrial function showed increased ATP production (SMD: 0.82, 95% CI: 0.60 to 1.04, p<0.001, I{superscript 2}=30%) and enhanced respiratory capacity (SMD: 0.75, 95% CI: 0.53 to 0.97, p<0.001, I{superscript 2}=28%). The I{superscript 2} statistics for ATP production and mitochondrial respiratory capacity were 30% and 28%, respectively, suggesting low to moderate heterogeneity among the included studies. Sensitivity analyses confirmed the robustness of the results, with consistent effect sizes and confidence intervals across both fixed-effect and random-effects models, and no significant changes upon excluding high-risk studies. Publication bias was low, as indicated by funnel plots and Eggers test (p=0.12). LimitationsLarger-scale RCTs are needed to confirm findings and determine the optimal dosage and duration of CoQ10 therapy. ConclusionCoQ10 has demonstrated to improve mitochondrial function, systolic performance, and other important cardiovascular health parameters in CVD patients. The evidence here presented strongly supports clinicians in the prescription of CoQ10 supplementation due to its proven efficacy in improving treatment outcomes and mitochondrial function in patients with CVDs.