Q10

שלום. רציתי לשאול האם מומלץ לחולים שעברו אוטם שריר הלב לקחת Q10 . על מה בדיוק התוסף עובד ואיך יודעים שהוא אומנם עוזר . האם יש התנגשות עם תרופות כלשהן . תודה

למנשה שלום רב, יש מספר מחקרים שניסו להוכיח את היתרונות של תוספי מזון או ויטמינים, בעיקר אצל חולי לב, אך ללא הצלחה. בנוגע ל – 10 – Q עדיין לא הוכח מחקרית יעילותו אצל בני אדם גם לא הוכח כל נזק בנטילת ה – 10 Q. תודה על פנייתך לפורום. ד"ר גרוברג

Internationally, there have been at least nine placebo controlled studies on the treatment of heart disease with CoQ10:two in Japan,two in the United States, two in Italy, two in Germany, AND one in Sweden (17,18,19,20,21,22,23,24,25). All nine of these studies have confirmed the effectiveness of CoQ10 as well as its remarkable safety. There have now been eight international symposia on the biomedical AND clinical aspects of CoQ10 (from 1976 through 1993 (26,27,28,29,30,31,32,33)). These eight symposia comprised over 300 papers presented by approximately 200 different physicians AND scientists from 18 different countries. The majority of these scientific papers were Japanese (34%), with American (26%), Italian (20%) AND the remaining 20% from Sweden, Denmark, Germany, United Kingdom, Belgium, Australia, Austria, France, India, Korea, Netherlands, Poland, Switzerland, USSR, AND Finland. The majority of the clinical studies concerned the treatment of heart disease AND were remarkably consistent in their conclusions: that treatment with CoQ10 significantly improved heart muscle function while producing no adverse effects OR drug interactions. It should be mentioned that a slight decrease in the effectiveness of the blood thinner, coumadin, was noted in a case by a Norwegian clinician (34). This possible drug - CoQ10 interaction has not been observed by other investigators even when using much higher doses of CoQ10 for up to seven years AND involving 25 patients treated with coumadin concomitantly with CoQ10 (this is still, as of this date, unpublished data). The efficacy AND safety of CoQ10 in the treatment of congestive heart failure, whether related to primary cardiomyopathies OR secondary forms of heart failure, appears to be well established (35,36,37,38,39, 40,41,42). The largest study to date is the Italian multicenter trial, by Baggio et al., involving 2664 patients with heart failure (43). The most recent work in heart failure examined the effect of CoQ10 on diastolic dysfunction, one of the earliest identifiable signs of myocardial failure that is often found in mitral valve prolapse, hypertensive heart disease AND certain fatigue syndromes (44,45). Diastolic dysfunction might be considered the common denominator AND a basic cause of symptoms in these three diagnostic groups of disease. Diastole is the filling phase of the cardiac cycle. Diastolic function has a larger cellular energy requirement than the systolic contraction and, therefore, the process of diastolic relaxation is more highly energy dependent AND thus more highly dependent on CoQ10. In simplier terms, it takes more energy to fill the heart than to empty it. Diastolic dysfunction is a stiffening' of the heart muscle which interferes with the heart's ability to function as an effective pump. It is seen early in the course of many common cardiac disorders AND is demonstrable by echocardiography. This stiffening returns towards normal with supplemental CoQ10 in tempo with clinical improvement. It is important to note that in all of the above clinical trials, CoQ10 was used in addition to traditional medical treatments, not to their exclusion. In one study by Langsjoen et al (46), of 109 patients with essential hypertension, 51% were able to stop between one AND three antihypertensive drugs at an average of 4.4 months after starting CoQ10 treatment while the overall New York Heart Association (NYHA) functional class improved significantly from a mean of 2.40 to 1.36. Hypertension is reduced when diastolic function improves. In another study(39), there was a gradual AND sustained decrease in dosage OR discontinuation of concomitant cardiovascular drug therapy: Of 424 patients with cardiovascular disease, 43% were able to stop between one AND three cardiovascular drugs with CoQ10 therapy. The authors conclude that the vitamin-like substance, CoQ10, "may be ushering in the new era of cellular/biochemical treatment of disease, complementing AND extending the systems-oriented, macro AND microscopic approach that has served us well to this point". 17. Hiasa Y., Ishida T., Maeda T., Iwanc K., Aihara T., AND Mori H. (1984) Effects of coenzyme Q10 on exercise tolerance in patients with stable angina pectoris. In: Biomedical and Clinical Aspects of Coenzyme Q, vol. 4 (1984) Folkers K., Yamamura Y., (eds) Elsevier, Amsterdam, pp 291-301. 18. Kamikawa T., Kobayashi A., Yamashita T., Hayashi H., and Yamazaki N. (1985) Effects of coenzyme Q10 on exercise tolerance in chronic stable angina pectoris. In: Am. J. Cardiol.; 56:247-251. 19. Langsjoen Per.H., Vadhanavikit S., Folkers K. (1985) Response of patients in classes III AND IV of cardiomyopathy to therapy in a blind AND crossover trial with coenzyme Q10. In: Proc. Natl. Acad. of Sci., U.S.A., vol. 82, pp 4240-4244. 20. Judy W.V., Hall J.H., Toth P.D., Folkers K. (1986) Double blind-double crossover study of coenzyme Q10 in heart failure. In: Folkers K., Yamamura Y. (eds) Biomedical and clinical aspects of coenzyme Q, vol. 5. Elsevier, Amsterdam, pp 315-323. 21. Rossi E., Lombardo A., Testa M., Lippa S., Oradei A., Littarru G.P., Lucente M. Coppola E., Manzoli U. Coenzyme Q10 in ischaemic cardiopathy. In: Biomedical AND Clinical Aspects of Coenzyme Q, vol. 6 (1991) Folkers K., Yamagami T., AND Littarru G. P. (eds) Elsevier, Amsterdam, pp 321-326. 22. Morisco C., Trimarco B., Condorelli M. Effect of coenzyme Q10 therapy in patients with congestive heart failure: A long-term multicenter randomized study. In: Seventh International Symposium on Biomedical AND Clinical Aspects of Coenzyme Q Folkers K., Mortensen S.A., Littarru G.P., Yamagami T., AND Lenaz G. (eds) The Clinical Investigator, (1993) 71:S 34-S 136. 23. Schneeberger W., Muller-Steinwachs J., Anda L.P., Fuchs W., Zilliken F., Lyson K., Muratsu K., AND Folkers K. A clinical double blind AND crossover trial with coenzyme Q10 on patients with cardiac disease. In: Biomedical and Clinical Aspects of Coenzyme Q, vol. 5 (1986) Folkers K., Yamamura Y., (eds) Elsevier, Amsterdam, pp 325-333. 24. Schardt F., Welzel D., Schiess W., AND Toda K. Effect of coenzyme Q10 on ischaemia-induced ST-segment depression: A double blind, placebo-controlled crossover study. In: Biomedical AND Clinical Aspects of Coenzyme Q, vol. 6 (1991) Folkers K., Yamagami T., AND Littarru G. P. (eds) Elsevier, Amsterdam, pp 385-403. 25. Swedberg K., Hoffman-Berg C., Rehnqvist N., Astrom H. (1991) Coenzyme Q10 as an adjunctive in treatment of congestive heart failure. In: 64th Scientific Sessions American Heart Association, Abstract 774-6. ******************************************************************************************* If CoQ10 is so effective in the treatment of heart failure, why is it not more generally used in this country? The answer to this question is found in the fields of politics AND marketing AND not in the fields of science OR medicine. The controversy surrounding CoQ10 likewise is political AND economic as the previous 30 years of research on CoQ10 have been remarkably consistent AND free of major controversy. Although it is not the first time that a fundamental AND clinically important discovery has come about without the backing of a pharmaceutical company, it is the first such discovery to so radically alter how we as physicians must view disease. While the pharmaceutical industry does a good job at physician AND patient education on their new products, the distributors of CoQ10 are not as effective at this. This education is very costly AND can only be done with the reasonable expectation of patent protected profit. CoQ10 is not patentable. The discovery of CoQ10 was based primarily on support from the National Heart Institute of NIH (National Institute of Health) at the Institute for Enzyme Research, University of Wisconsin.