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CLINICAL RESEARCH: HEART FAILURE

Coenzyme Q₁₀

An Independent Predictor of Mortality in Chronic Heart Failure

Sarah L. Molyneux, PhD^_*, Christopher M. Florkowski, MD^_*,_*, Peter M. George, MB, BS^_*, Anna P. Pilbrow, PhD, Christopher M. Frampton, PhD, Michael Lever, PhD^_* and A. Mark Richards, MD, PhD

^_* Clinical Biochemistry Unit, Canterbury Health Laboratories, Christchurch, New Zealand
The Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago (Christchurch), Christchurch, New Zealand

Manuscript received March 3, 2008; revised manuscript received July 14, 2008, accepted July 21, 2008.

^_* Reprint requests and correspondence: Dr. Christopher M. Florkowski, Clinical Biochemistry Unit, Canterbury Health Laboratories, P.O. Box 151, Christchurch 8140, New Zealand (Email: chris.florkowski{at}cdhb.govt.nz).

Objectives: The aim of this study was to investigate the relationship between plasma coenzyme Q₁₀ (CoQ₁₀) and survival in patients with chronic heart failure (CHF).

Background: Patients with CHF have low plasma concentrations of CoQ₁₀, an essential cofactor for mitochondrial electron transport and myocardial energy supply. Additionally, low plasma total cholesterol (TC) concentrations have been associated with higher mortality in heart failure. Plasma CoQ₁₀ is closely associated with low-density lipoprotein cholesterol (LDL-C), which might contribute to this association. Therefore we tested the hypothesis that plasma CoQ₁₀ is a predictor of total mortality in CHF and could explain this association.

Methods: Plasma samples from 236 patients admitted to the hospital with CHF, with a median (range) duration of follow-up of 2.69 (0.12 to 5.75) years, were assayed for LDL-C, TC, and total CoQ₁₀.

Results: Median age at admission was 77 years. Median (range) CoQ₁₀ concentration was 0.68 (0.18 to 1.75) µmol/l. The optimal CoQ₁₀ concentration for prediction of mortality (established with receiver-operator characteristic [ROC] curves) was 0.73 µmol/l. Multivariable analysis allowing for effects of standard predictors of survival—including age at admission, gender, previous myocardial infarction, N-terminal peptide of B-type natriuretic peptide, and estimated glomerular filtration rate (modification of diet in renal disease)—indicated CoQ₁₀ was an independent predictor of survival, whether dichotomized at the ROC curve cut-point (hazard ratio [HR]: 2.0; 95% confidence interval [CI]: 1.2 to 3.3) or the median (HR: 1.6; 95% CI: 1.0 to 2.6).

Conclusions: Plasma CoQ₁₀ concentration was an independent predictor of mortality in this cohort. The CoQ₁₀ deficiency might be detrimental to the long-term prognosis of CHF, and there is a rationale for controlled intervention studies with CoQ₁₀.

Key Words: chronic heart failure • coenzyme Q₁₀ • mortality

Abbreviations and Acronyms   CHF = chronic heart failure   CI = confidence interval   CoQ10 = coenzyme Q10   GFR = glomerular filtration rate   LDL-C = low-density lipoprotein cholesterol   MDRD = modification of diet in renal disease   MI = myocardial infarction   NT-proBNP = N-terminal peptide of B-type natriuretic peptide   NYHA = New York Heart Association   ROC = receiver-operator characteristic   TC = total cholesterol

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