Preventive Medicine Column
Dr. David L. Katz
A study just reported at the Heart Failure 2013 Congress in Lisbon, Portugal indicates that co-enzyme Q10 (co-Q10) is effective in congestive heart failure, improving both function and survival. Over a span of decades, very few medications have been identified that work well to treat CHF, and far fewer that lower the associated mortality risk.
The new study showed that co-enzyme Q10 did both, and that’s just about astounding. Co-enzyme Q10, also known as ubiquinol, is a compound found widely in plants, but in very low concentrations. Our bodies need it, using it to facilitate the vital, energy-generating process of electron transport in our mitochondria, the power-plants residing in our cells. We can make co-Q10, but not with great efficiency, and get much of what we need from food. Levels in our bodies rise and fall with dietary intake, and with other exposures. For example, statin drugs used routinely to treat high cholesterol deplete co-Q10 levels. In my personal clinical experience, and the common clinical experience, supplementation of co-Q10 often ameliorates the muscle soreness that is rate-limiting for use of statins.
Proponents of co-Q10, and there have long been many particularly in the natural medicine world, have asserted its value in treating high cholesterol, high blood pressure, periodontal disease, heart failure, low energy, and more. One always worries when a medical remedy starts sounding like a Ginsu knife: “it slices, it dices, it feeds your fish, it bathes your children…!” But actually, the mechanism of action of co-Q10 is so very near the bedrock of our metabolism, it makes sense that it would affect every organ system, and have implications for almost every condition. As an example, every condition is worsened by a deficiency of oxygen, and improved when we have enough.
The current study, which thus far has only been presented at a conference, albeit a prestigious one, and not yet published in full in the peer-reviewed literature, appears to be a game-changer. The trial was conducted in 9 countries, enrolled hundreds of patients, and followed them for two years. It was randomized, double-blinded, and placebo-controlled.
The punch line was refreshingly straightforward: the coQ10 group had half the mortality rate, and half as many adverse cardiac events, as the placebo group. Both findings were of clear statistical significance. That they were of stunning clinical significance is all but self-evident, but it embellishes the case to note that a drug to lower mortality in congestive heart failure has not been identified in over a decade.
What makes this study truly astonishing, and causes it to reverberate through modern medicine far beyond the topics of either coQ10 or heart failure, is that the very possibility of such an effect was overtly dismissed that same decade ago. In 2000, a paper in the Annals of Internal Medicine purported to show that co-enzyme Q10 did not work for heart failure. An accompanying editorial went further, declaring the co-enzyme Q10 hypothesis dead.
But this was a study of just several dozen patients, followed for a few months. In a tale I’ve told before, this was in contrast to a study of the patented drug, Carvedilol, published around the same time and demonstrating its value in heart failure. The study of Carvedilol enrolled thousands, and lasted years.
And so that 2000 study of co-Q10 did not generate meaningful evidence of absent effects; rather, it left us with a rather meaningless absence of evidence. I have long argued, including at an Institute of Medicine summit, that just such scenarios require us to think of medical evidence more fluidly than just “yes” or “no.” Absence of evidence is not evidence of absence, and thinking it is mistakes the subtleties of incremental advance for the black and white of a light switch. Science doesn’t work that way.
That co-Q10 almost certainly works for heart failure is important to the clinical use of co-Q10, and important to patients and doctors dealing with heart failure. But it is perhaps even more important to all of medicine that co-Q10 is being shown to work more than a decade after the very possibility of it doing so was ruled out. Biomedical advance is forestalled, and the human condition compromised, when absence of evidence is not only tolerated, but mistaken for evidence of absence.
We can avoid the repetition of that mistake by keeping our minds open. Not so open our brains fall out, of course- but carefully open just the same. For we now have an exceptional medical story to prove a rule: a closed mind is a menace to every other organ.
Dr. David L. Katz; www.davidkatzmd.com