Frågedatum: 2019-07-11
RELIS database 2019; id.nr. 229, ULIC
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Coenzyme Q 10 och lipidnivåer



Fråga: Jag har en patient som har börjat äta Coenzyme Q 10 för att sänka hennes lipidnivåer. Finns det evidens för detta?

Svar: Trials evaluating the effects of coenzyme Q10 (CoQ10), or ubiquinone, on lipid profiles have reported inconsistent and inconclusive results.

A Cocharane review on CoQ10 supplementation for the primary prevention of cardiovascular disease (CVD) (1) identified one trial (2) (including 51 randomised obese individuals) that looked at the effect of supplementation with CoQ10 alone on lipid levels. The trial showed no evidence of effect of CoQ10 supplementation on lipid profiles; total cholesterol, high-density lipoprotein (HDL)-cholesterol or triglycerides. Of the four trials identified by the Cocharane review (1), that investigated CoQ10 supplementation in patients on statin therapy, three of them showed that simultaneous administration of CoQ10 did not significantly influence lipid levels. In the fourth trial there was no significant difference in the change in HDL-cholesterol and triglycerides after three months between the 4 different groups of the trial. There was a significant increase in the change in total and low-density lipoprotein (LDL)-cholesterol at three months across the four arms of the trial, however the way in which the data were presented unabled the Cocharane reviewer to determine if there was any significant difference between the CoQ10 only and placebo arms (1).

A systematic review and meta-analysis conducted by Suksomboon et al. (3), concluded that CoQ10 supplementation had no beneficial effects on lipid profiles or blood pressure among diabetic patients. Seven trials were included in the meta-analysis, involving 356 patients. CoQ10, alone or in combination with fenofibrate (serum lipid lowering agent), did not alter LDL-C (cholesterol), or HDL-C. Triglycerides levels were significantly reduced with CoQ10 and with CoQ10 plus fenofibrate. CoQ10 plus fenofibrate also effectively reduced total cholesterol.

Another systematic review and meta-analysis determined the effects of CoQ10 supplementation on lipid profile in patients with metabolic disorders (4). A total of twenty-one controlled trials (514 patients and 525 controls) were included. The meta-analysis indicated a significant reduction in serum triglycerides levels. There was no statistically significant change in total-cholesterol, LDL-, or HDL-cholesterol levels.

In a systematic review and meta-analysis conducted by Sahebkar et al. (5), CoQ10 supplementation neither affected total cholesterol, LDL-C, HDL-C, nor triglyceride levels among patients with obesity, T2DM, and CVD. Seven randomized controlled trials with a total of 409 subjects (206 in the CoQ10 arm and 203 in the control arm) were included. However, the analysis showed significant decreased in lipoprotein (a) [Lp(a)] levels, mainly in those with higher baseline Lp(a) levels.

A randomized double-blind placebo-controlled trial (6) (47 patients randomised) examined the effect of CoQ10 on serum lipoprotein(a) levels in patients with coronary artery disease (CAD). The study showed that treatment with CoQ10 was associated with a significant increase in HDL cholesterol without affecting total cholesterol, LDL cholesterol. However, the study showed that treatment with CoQ10 was associated with a significant reduction in plasma lipoprotein(a).

A systematic review and meta-analysis by (7 ) determined the effects of CoQ10 supplementation on lipid profile among patients diagnosed with CAD. A total of eight trials (267 participants in the CoQ10 group and 259 in placebo group) were included in the meta-analysis. The findings showed that taking CoQ10 by patients with CAD significantly decreased total-cholesterol and increased HDL-cholesterol levels. However, no significant effects on LDL-cholesterol, lipoprotein (a) levels and triglycerides levels was found.

Supplementation with CoQ10 increased HDL-cholesterol levels in hyperlipidemic patients with myocardial infarction that have statin therapy, though did not affect other parameters of lipid profiles (LDL-C, total cholesterol and triglyceride) (8).

It has been suggested that differences in study design, study population’s characteristics, the dosage of CoQ10 used and the duration of intervention might explain the discrepancies among current evidence (7).

Several mechanisms have been proposed by which CoQ10 supplements could affect lipid profiles (7). Cell membrane phospholipids and mitochondrial membrane protein protection against free radical-induced damage (intracellular antioxidant effect of CoQ10) so CoQ10 can promote HDL-cholesterol production. Gene expression induction was suggested as well (7).

Referenser:
  1. Flowers N, Hartley L, Todkill D, Stranges S, Rees K. Co-enzyme Q10 supplementation for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2014, Issue 12.
  2. Lee YJ, Cho WJ, Kim JK, Lee DC. Effects of coenzyme Q10 on arterial stiffness, metabolic parameters, and fatigue in obese subjects: a double-blind randomised controlled study. Journal of Medicinal Food 2011;14(4):386–90.
  3. Suksomboon N, Poolsup N, Juanak N. Effects of coenzyme Q10 supplementation on metabolic profile in diabetes: a systematic review and meta-analysis. J Clin Pharm Ther. 2015;40:413–418.
  4. Sharifi N, Tabrizi R, Moosazadeh M, Mirhosseini N, Lankarani KB, Akbari M, et al. The effects of coenzyme Q10 supplementation on lipid profiles among patients with metabolic diseases: a systematic review and meta-analysis of randomized controlled trials. Curr Pharm Des. 2018.
  5. Sahebkar A, Simental-Mendia LE, Stefanutti C, Pirro M. Supplementation with coenzyme Q10 reduces plasma lipoprotein(a) concentrations but not other lipid indices: a systematic review and meta-analysis. Pharmacol Res. 2016;105:198–209.
  6. Singh RB, Niaz MA. Serum concentration of lipoprotein(a) decreases on treatment with hydrosoluble coenzyme Q10 in patients with coronary artery disease: discovery of a new role. Int J Cardiol. 1999;68:23–29. doi: 10.1016/S0167-5273(98)00323-4.
  7. Jorat MV, Tabrizi R, Mirhosseini N, Lankarani KB, Akbari M, Heydari ST, Mottaghi R, Asemi Z. The effects of coenzyme Q10 supplementation on lipid profiles among patients with coronary artery disease: a systematic review and meta-analysis of randomized controlled trials. Lipids Health Dis. 2018 Oct 9;17(1):230. doi: 10.1186/s12944-018-0876-4.
  8. Mohseni M, Vafa M, Zarrati M, Shidfar F, Hajimiresmail SJ, Rahimi FA. Beneficial effects of coenzyme Q10 supplementation on lipid profile and Intereukin-6 and intercellular adhesion Molecule-1 reduction, Preliminary Results of a Double-blind Trial in Acute Myocardial Infarction. Int J Prev Med. 2015;6:73. doi: 10.4103/2008-7802.162461.