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Cardiol J. 2019 Mar 5. doi: 10.5603/CJ.a2019.0022. [Epub ahead of print]

Effect of coenzyme Q10 in Europeans with chronic heart failure: A sub-group analysis of the Q-SYMBIO randomized double-blind trial.

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None, Denmark.
Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia.
Baker Heart and Diabetes Institute, Melbourne, Australia.
1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.



Geographical differences in patient characteristics, management and outcomes in heart failure (HF) trials are well recognized. The aim of this study was to assess the consistency of the treatment effect of coenzyme Q₁₀ (CoQ₁₀) in the European sub-population of Q-SYMBIO, a randomized double-blind multinational trial of treatment with CoQ₁₀, in addition to standard therapy in chronic HF.


Patients with moderate to severe HF were randomized to CoQ₁₀ 300 mg daily or placebo in addition to standard therapy. At 3 months the primary short-term endpoints were changes in New York Heart Association (NYHA) functional classification, 6-min walk test, and levels of N-terminal pro-B type natriuretic peptide (NT-proBNP). At 2 years the primary long-term endpoint was major adverse cardiovascular events (MACE).


There were no significant changes in short-term endpoints. The primary long-term endpoint of MACE was reached by significantly fewer patients in the CoQ₁₀ group (n = 10, 9%) compared to the placebo group (n = 33, 27%, p = 0.001). The following secondary endpoints were significantly improved in the CoQ₁₀ group compared with the placebo group: all-cause and cardiovascular mortality, NYHA classification and ejection fraction. In the European sub-population, when compared to the whole group, there was greater adherence to guideline directed therapy and similar results for short- and long-term endpoints. A new finding revealed a significant improvement in ejection fraction.


The therapeutic efficacy of CoQ₁₀ demonstrated in the Q-SYMBIO study was confirmed in the European sub-population in terms of safely reducing MACE, all-cause mortality, cardiovascular mortality, hospitalization and improvement of symptoms.


chronic heart failure; coenzyme CoQ10; hospitalization; major adverse cardiovascular events; mortality; randomized controlled trial; ubiquinone

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