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Monday, October 9, 2017

Prescribing Pitfalls in Heart Failure With Comorbidities



Interest in the popular supplement coenzyme-Q10 (CoQ10) in heart failure stems in part from its biochemical role in mitochondria, antioxidant effects, and cell-membrane integrity, plus the observation that its levels are reduced in HF patients[4], Chow said.

Clinical trials of CoQ10 in heart failure include a 1993 study with 641 patients in NYHA class 3–4 on medical therapy that was standard for the time[5]. The supplement was associated with significantly reduced risk of HF hospitalization (P<0.001).

Much more recently, the Q-SYMBIO trial randomized 420 patients with NYHA class 3–4 heart failure to receive the supplement or placebo for 2 years on top of standard care, which included ACE inhibitors in 90% and beta-blockers in 72%[6].

Risk of the primary end point (worsening HF, CV death, implantation of a mechanical assist device, or urgent heart transplantation) declined by about half on the supplement (HR 0.50, 95% CI 0.32–0.80; P=0.003). The mortality risk alone went down 42%.

http://www.medscape.com/viewarticle/886762

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