special subjects
Coenzyme Q10 (CoQ10)
Evidence
A 2012 meta-analysis evaluated 5 randomized, controlled trials with a total of 194 patients and found a significant improvement in endothelial function, as measured by flow-mediated peripheral arterial dilation ( References ). A 2013 meta-analysis of randomized controlled trials suggested that CoQ10 may improve functional status in patients with heart failure ( References ). However, this meta-analysis consisted of trials mainly of small size and short duration of treatment. A 2014 randomized, controlled, multicenter study of 420 patients with heart failure showed that CoQ10, 100 mg orally 3 times a day, when added to standard therapy, was safe, relieved symptoms, and reduced major cardiovascular events ( References ). A Cochrane review of 11 studies (1573 subjects) concluded there was moderate quality evidence that CoQ10 reduces all‐cause mortality and hospitalization for heart failure; however, there was no convincing evidence to support or refute the use of CoQ10 for heart failure ( References ). However, a 2017 meta-analysis of 14 randomized controlled trials (2149 subjects) stated that CoQ10 users had greater exercise capacity and lower mortality than those on placebo ( References ). A clinical controversy is whether CoQ10 supplementation decreases statin-associated muscle symptoms. Some studies have shown decreases, while others have not. A 2018 meta-analysis of 100 to 600 mg daily of CoQ10 for 30 days to 3 months reported significant decreases in muscle symptoms of pain, weakness, cramps, and tiredness, compared to placebo. A limitation was heterogeneity of the included studies ( 