Coenzyme Q10 supplementation reduces HF admissions and improves survival: Q-SYMBIO

You know the ropes, no self-prescription.
http://www.theheart.org/article/1545585.do
In a study bound to be scrutinized when it is finally published, the Q-SYMBIO randomized, controlled, double-blind clinical trial garnered a fair deal of attention this past week when investigators reported excellent clinical outcomes in chronic heart failure patients treated with coenzyme Q10 (CoQ10).

Metabolic modulation and energetic manipulation in the failing heart is the next frontier of heart-failure management. I want this stuff to work.

Presenting the study at Heart Failure Congress 2013 of the European Society of Cardiology Heart Failure Association, lead investigator Dr Svend Aage Mortensen (Copenhagen University Hospital, Denmark) reported that, at two years, major adverse cardiovascular events (MACE), a composite of unplanned hospitalization due to worsening heart failure, cardiovascular death, and the need for urgent cardiac transplantation and mechanical support, occurred in 14% of patients treated with CoQ10 compared with 25% of patients who received a placebo, a statistically significant difference (p=0.003). All-cause mortality was also significantly lower in the CoQ10-treated patients, with 9% dying compared with 17% in the placebo arm (p=0.01).

In addition to these outcomes, the Q-SYMBIO investigators reported that cardiovascular mortality and admissions for heart failure were significantly lower in those who received CoQ10. In their conclusions, the researchers stated that "CoQ10 should be considered as a part of the maintenance therapy of patients with chronic heart failure."

Yellow light: Go slow, caution urged

Some, however, considered the recommendations to alter clinical practice on the basis of this 420-patient clinical trial premature. Dr Sanjay Kaul (Cedars-Sinai Medical Center, Los Angeles), for example, said he wants to reserve judgment on the data until they have stood up against the scrutiny of the peer-review process. He noted that the mortality data were first presented at the meeting of the International Coenzyme Q10 Association last November, but these are yet to be published.

"Clinicians should view implausibly large treatment effects observed in small underpowered trials with skepticism, as they are seldom replicated in subsequently conducted large controlled trials," Kaul told heartwire. "The examples of vesnarinone in heart failure, [glucose-insulin-potassium] GIK post-STEMI, and perioperative beta-blockers in high-risk vascular surgery quickly come to mind. None of the impressive preliminary results could be replicated. If a finding appears to be 'too good to be true,' it usually is."

One curiosity that also needs to be addressed, added Kaul, is why the Q-SYMBIO trial took more than 10 years to complete. The trial design was first published in 2003. heartwire asked Mortensen to comment on the study and the results, but he declined, saying he wants to wait until after the study is published to discuss the findings. 

More at link.