Download Coenzyme Q10 use for the reduction of low

Running head: CAT TOPIC COENZYME Q10
CAT Topic Coenzyme Q10
Jacklene Salwei
University of Mary
Nursing 568
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CAT TOPIC COENZYME Q10
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Critically Appraised Topic
Coenzyme Q10 use for the reduction of low density lipoproteins
Author: Jacklene Salwei
Date: 5/26/16
Clinical Scenario: A 43-year-old white female presents to the office for her yearly check up. She has a
significant risk for cardiovascular disease and has a long-standing history of obesity with little success in
dieting over the years. Assessment findings included a heart rate of 72 beats per minute, blood pressure
145/62 mm Hg, 5'3", weighing 220 pounds. Her fat distribution is "apple-shaped", her waist-hip ratio is more
than the 0.8 normal range. In addition, Patient V lives a fairly sedentary lifestyle and does not have a regular
exercise program. Lipid profile includes total cholesterol of 239 mg/dL, HDL 40 mg/dL, LDL 159 mg/dL, ratio
5.9 mg/dL, and triglycerides 248 mg/dL. Patient V has tried with little success to control her cholesterol with
diet. She was started on atorvastatin 20mg daily 6 months ago by her previous family physician.
PICO Question: In patients with elevated low-density lipoproteins (LDL), does supplementation with
coenzyme Q10 at 100mg-200mg daily compared to a placebo help to reduce LDL in patients?
Articles:
Mohseni, M., Vafa, M., Hajimiresmail, S., Zarrati, M., Forushani, A., Bitarafan, V., & Shidfar, F. (2014). Effects of
Coenzyme Q10 Supplementation on Serum Lipoproteins, Plasma Fibrinogen, and Blood Pressure in
Patients With Hyperlipidemia and Myocardial Infarction. Iranian Red Crescent Medical Journal,
16(10).
Sahebkar, A., Simental-Mendia, L., Stefanutti, C., & Pirro, M. (2016). Supplementation with
coenzyme Q10 reduces plasma lipoprotein(a) concentrations but not other lipid indices:
A systematic review and meta-analysis. Pharmacological Research, 2016(105), 198-209.
Summary and appraisal of key evidence of Mohseni et al, article
This was a double blind randomized control trial conducted over a 12 week long period. Fifty-two patients
were examined in this study, all of which had hyperlipidemia and a history of myocardial infarction (MI). 26
patients were in the intervention group receiving 200 mg of coenzyme Q10 daily and 26 were in the placebo
group. The goal of this study was to investigate the effects of Coenzyme Q10 on serum lipoproteins and blood
pressure in patients with hyperlipidemia and MI after 12 weeks of Coenzyme Q10 supplementation. All
participants had MI and were 35 to 70 years old. Exclusion criteria included smoking and alcohol
consumption, diabetes mellitus (DM), kidney and liver disorders, clinical signs of acute inflammation,
infectious disease during the 12-week period, consumption of antioxidants such as ascorbic acid, αtocopherol, and omega-3 supplements. Any non-steroidal anti-inflammatory drug use for three months
before the study, and any changes to their medications and their dosages during the study. Participants were
instructed not to change their nutritional habits throughout the study. Beta-blocker, thrombolytic, and statin
drugs were administered to all patients during this study.
After 12 weeks of supplementation with coenzyme Q10 at 200mg daily there showed to be an increase in
serum HDL-C and a significant decrease in the LDL-C/HDL-C ratio. Coenzyme Q10 additionally, reduces the
total cholesterol and HDL-C ratio in patients with MI. This study showed a significant increase in the serum
HDL-C levels in the coenzyme Q10 group when compared to the placebo group. There were no significant
changes in serum levels of other lipoproteins between the two groups following the coenzyme Q10
supplementation. The rise in the serum HDL-C initiates cholesterol efflux and aids the removal of excess
cholesterol from the arteries and delivers it to the liver for removal through the reverse cholesterol transport
pathway. When HDL-C is increased it increases fibrinolysis, and inhibits platelet aggregation, and LDL
oxidation. This study had limited time constraints so the measurement of fibrinogen was unchanged from the
start of the study to the end of the study. In this study both systolic and diastolic blood pressures were
reduced in patients taking coenzyme Q10. This is partly due to coenzyme Q10’s ability to alleviate endothelial
dysfunction and modify local oxidative stress (Mohseni et al., 2014).
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This is a level 2 study on the pyramid of evidence triangle. Strengths of this study were the low risk for bias,
and strict inclusion criteria. The weaknesses of this study were the small sample size and no improvement in
external validity. Findings should be interpreted carefully as more research is needed in this specific area of
medicine.
Summary and appraisal of key evidence of Sahebkar, Simental-Mendia, Stefanutti, & Pirro article
This is a systematic review of 7 randomized control trials (RCT’s), with a total of 409 patients. Of these
patient’s, 206 were treated with coenzyme Q10 and 203 were in the control group. Studies were excluded if
they were non-interventional studies, uncontrolled studies, observational studies with case-control, crosssectional or cohort design, and if they lacked sufficient information on baseline or follow-up. The studies
included for this review were published between 1999-2014. The doses of Coenzyme Q10 given to patients
ranged between 100mg daily to 300mg daily and the range of the studies lasted between 4 to 12 weeks. The
overall goal of this review was to find the efficacy of coenzyme Q10 supplementation lipoprotein (Lp (a))
levels.
In patients who underwent coenzyme Q10 supplementation, there was a significantly reportable reduction in plasma
Lp (a) levels (−3.54 mg/dL), but when the patients baseline Lp (a) levels are increased (≥30 mg/dL), an even
greater reduction is seen in Lp (a) levels (−11.72 mg/dL, p = 0.01) .The study did not find any significant
findings on coenzyme Q10’s effects on total cholesterol, HDL, LDL, and triglycerides. This systematic review
was primarily looking at coenzyme Q10’s effects on Lp(a) levels and not lipid fractions. Additional studies on
lipid fractions were not included in this study. However, the findings on lipid fractions coincide with previous
findings from other studies on the benefits of coenzyme Q10 and lipid profiles (Sahebkar, Simental-Mendia,
Stefanutti, & Pirro, 2016).
This is a level 1 study on the pyramid of evidence triangle. Strengths of this study were that it has a low risk
of bias, and a large population size. Some weaknesses of the study were the different lengths of time each
study was conducted over and the different strength of coenzyme Q10 used for each study. It leaves questions
as to what dose would be the best to treat patient’s for an optimal Lp(a) lowering effect? This would be
better answered if one or two doses were used instead of varying amounts along different timelines. More
research on this topic is needed to make stronger clinical recommendations.
Clinical Bottom Line
There is emerging evidence that supplementation with coenzyme Q10 reduces lipoprotein levels, increases
HDL-C levels and decreases the LDL-C/HDL-C ratio. These are all risk factors in cardiovascular disease and
beneficial to patients that have risk for this. Based on the studies conducted further information would need
to be gathered on the best dosage regimes for these patients. Based on the information gathered from these
studies I cannot make a recommendation for coenzyme Q10 for the lowering of LDL on it’s own. One study
showed no benefit and the other only showed a lowering effect that was not statistically significant. Due to
the potential for reduction of cardiovascular disease in patients and the relative inexpensive nature of this
supplement, it is with everyone’s best interest to do more research on this supplements effects on the
cardiovascular system, specifically lipoprotein enzymes and lipid fractions.
Implications for Practice
Lowering lipoprotein enzymes, LDL-C/HDL-C ratio, and increasing HDL-C levels are all important in reducing
the risk for cardiovascular disease and should be discussed with your patient. Cost benefit ratio should be
discussed, and consideration of coenzyme Q 10 supplementation with follow up should be discussed with
patients including risk and benefits. It is still unclear what the best optimal dose should be but research
currently points towards doses of at least 150mg daily for at least 4 weeks. More research is needed in these
CAT TOPIC COENZYME Q10
areas, but with implementation of coenzyme Q10 hopefully patients can reduce the amount of lipid and antihypertensive medication they are currently taking.
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CAT TOPIC COENZYME Q10
References
Mohseni, M., Vafa, M., Hajimiresmail, S., Zarrati, M., Forushani, A., Bitarafan, V., & Shidfar, F. (2014). Effects of
Coenzyme Q10 Supplementation on Serum Lipoproteins, Plasma Fibrinogen, and Blood Pressure in
Patients With Hyperlipidemia and Myocardial Infarction. Iranian Red Crescent Medical Journal,
16(10).
Sahebkar, A., Simental-Mendia, L., Stefanutti, C., & Pirro, M. (2016). Supplementation with coenzyme Q10
reduces plasma lipoprotein(a) concentrations but not other lipid indices: A systematic review and
meta-analysis. Pharmacological Research, 2016(105), 198-209.
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