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1.  Isolated diastolic dysfunction of the myocardium and its response to CoQ10 treatment. Langsjoen PH, Langsjoen PH, Folkers K Clin Investig 1993;71(8 Suppl):S140-4

     Symptoms of fatigue and activity impairment, atypical precordial pain, and cardiac arrhythmia frequently precede by years the development of congestive heart failure. Of 115 patients with these symptoms, 60 were diagnosed as having hypertensive cardiovascular disease, 27 mitral valve prolapse syndrome, and 28 chronic fatigue syndrome. These symptoms are common with diastolic dysfunction, and diastolic function is energy dependent. All patients had blood pressure, clinical status, coenzyme Q10 (CoQ10) blood levels and echocardiographic measurement of diastolic function, systolic function, and myocardial thickness recorded before and after CoQ10 replacement. At control, 63 patients were functional class III and 54 class II; all showed diastolic dysfunction; the mean CoQ10 blood level was 0.855 micrograms/ml; 65%, 15%, and 7% showed significant myocardial hypertrophy, and 87%, 30%, and 11% had elevated blood pressure readings in hypertensive disease, mitral valve prolapse and chronic fatigue syndrome respectively. Except for higher blood pressure levels and more myocardial thickening in the hypertensive patients, there was little difference between the three groups. CoQ10 administration resulted in improvement in all; reduction in high blood pressure in 80%, and improvement in diastolic function in all patients with follow-up echocardiograms to date; a reduction in myocardial thickness in 53% of hypertensives and 36% of the combined prolapse and fatigue syndrome groups; and a reduced fractional shortening in those high at control and an increase in those initially low.  Isolated diastolic dysfunction associated with moderately low CoQ10 blood levels is an extremely frequent finding in patients with three varied clinical entities sharing similar symptoms and CoQ10 replacement results in clinical improvement, lowering of elevated blood pressures, improved diastolic function, a decrease in myocardial thickness, and a normalization of systolic function.

2.  The Aging Heart: Reversal of Diastolic Dysfunction Through the Use of Oral CoQ10 in the Elderly. Langsjoen P, Langsjoen A, Willis A, Folkers, K Anti-Aging Medical Therapeutics, (1997) R.M.Klatz and R. Goldman eds., Health Quest Publications, pp.113-120.

   The observations on the clinical utility of CoQ10 in cardiology have gradually shifted from an emphasis on systolic left ventricular function towards the broader and more fundamental observations on diastolic function and dysfunction.  Our experience with CoQ10 began in 1981 with the initiation of a double blind placebo controlled trial in idiopathic dilated cardiomyopathy, followed by a six year open label study involving 126 patients.  By 1993, it became apparent that diastolic dysfunction was an easily measured abnormality in early myocardial disease that showed clear improvement with the use of CoQ10.  In 1994, 424 patients with six different diagnostic categories of cardiovascular disease were shown to have a significant improvement in diastolic function as well as a significant reduction in the associated finding of left ventricular hypertrophy.  Overall medication requirement in this group dropped considerably and the quality of life was enhanced both directly by the effects of CoQ10 on myocardial function and indirectly by easing the burden of multi drug therapy.  Our current data demonstrate a significant improvement of diastolic function in patients with advanced age (average age 84 years) when treated with oral CoQ10 (average dose 220 mg/day).  Along with the reversal of diastolic dysfunction, we observed marked improvement in patients' exercise tolerance and quality of life.  This refutes the common assertion that a stiff and non-compliant myocardium is a normal and irreversible aspect of the aged heart.

3.  Treatment of essential hypertension with coenzyme Q10. Langsjoen P, Langsjoen P, Willis R, Folkers K Mol Aspects Med 1994;15 Suppl:S265-72

    A total of 109 patients with symptomatic essential hypertension presenting to a private cardiology practice were observed after the addition of CoQ10 (average dose, 225 mg/day by mouth) to their existing antihypertensive drug regimen. In 80 per cent of patients, the diagnosis of essential hypertension was established for a year or more prior to starting CoQ10 (average 9.2 years). Only one patient was dropped from analysis due to noncompliance. The dosage of CoQ10 was not fixed and was adjusted according to clinical response and blood CoQ10 levels. Our aim was to attain blood levels greater than 2.0 micrograms/ml (average 3.02 micrograms/ml on CoQ10). Patients were followed closely with frequent clinic visits to record blood pressure and clinical status and make necessary adjustments in drug therapy. Echocardiograms were obtained at baseline in 88% of patients and both at baseline and during treatment in 39% of patients. A definite and gradual improvement in functional status was observed with the concomitant  need to gradually decrease antihypertensive drug therapy within the first one to six months. Thereafter, clinical status and cardiovascular drug requirements stabilized with a significantly improved systolic and diastolic blood pressure. Overall New York Heart Association (NYHA) functional class improved from a mean of 2.40 to 1.36 (P < 0.001) and 51% of patients came completely off of between one and three antihypertensive drugs at an average of 4.4 months after starting CoQ10. Only 3% of patients required the addition of one antihypertensive drug. In the 39% of patients with echocardiograms both before and during treatment, we observed a highly significant improvement in left ventricular wall thickness and diastolic function. We observed no side effects or drug interactions from CoQ10.  The time course to improvement in functional class, blood pressure control, and myocardial function is in keeping with an improvement in myocardial bioenergetics by CoQ10 and not a pharmacological effect.  The reduction in blood pressure seems likely to be secondary to a decrease in the neurohumoral response to an early impairment in myocardial function which is primarily diastolic in nature.  The gratifying improvement in patient's quality of life was enhanced by a marked reduction in their need for antihypertensive drugs along with the substantial medical and financial burden that those drugs entail.

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Keywords: study coq10 high blood pressure, study coq10 diastolic function, study coq10 chronic fatigue

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