Ehvidence
Limited data Efficacy (RCT)

CoQ10 in Chronic Heart Failure (Q-SYMBIO)

Coenzyme Q10 (CoQ10) 100 mg TID vs. placebo · for Chronic heart failure (HF) · real-time analysis of 1 studies · updated 2026-05-30

Long-term CoQ10 treatment of patients with moderate to severe chronic HF significantly reduced major adverse cardiovascular events, cardiovascular mortality, and all-cause mortality compared to placebo, with an improved safety profile.

Efficacy (RCT): Efficacy evidence on clinical outcomes. Effects are risk ratios with number-needed-to-treat where a baseline risk is available. Glossary →

Interpretation & tips

The primary long-term endpoint (MACE) was reached by 15% of CoQ10 patients vs. 26% of placebo patients (HR 0.50, 95% CI 0.32–0.80, p=0.003). All-cause mortality was 10% vs. 18% (p=0.018). No significant short-term differences were seen at 16 weeks. Benefits were additive to standard therapy including ACE inhibitors and beta-blockers.

43% lower risk of major adverse cardiovascular events (mace)
Pooled RR 0.57 (95% CI 0.38–0.85) across 1 studies, 420 patients (random-effects, I² 0%).
0.57
Pooled RR
0.38–0.85
95% CI
1
Studies
420
Patients
9
NNT

Forest plot—Major Adverse Cardiovascular Events (MACE)

Mortensen SA et al. 2014 0.57 [0.38–0.85] Pooled (RE) 0.57 [0.38–0.85] 0.1 0.25 0.5 1 2 4 ← favors treatment favors control →

Study results—Major Adverse Cardiovascular Events (MACE)

Study Design Dose / regimen Treatment Control RR [95% CI] Improvement NNT Weight
Mortensen SA et al. 2014 note RCT CoQ10 100 mg three times daily (TID) for 106 weeks 30/202 57/218 0.57 [0.38–0.85] 43% 9 100%

RR < 1 favors treatment for outcomes where lower is better. Rows in gray have a confidence interval crossing 1 (individually inconclusive). “~” marks effects reported as OR/HR and treated as RR-approximations. “excl” = excluded from pooling (e.g. reviews).

Notes & interpretation

  • Mortensen SA et al. 2014—From Table 2 of the paper. Computed RR from the 2x2 is ~0.57; the paper's time-to-event HR was 0.50 (95% CI 0.32-0.80, p=0.003); NNT roughly 9.

Background

CoQ10 is an essential cofactor for mitochondrial energy production and a lipid-soluble antioxidant. Myocardial CoQ10 levels correlate inversely with HF severity. Prior RCTs were underpowered to detect mortality differences.

Topic methodology & caveats

Trial was stopped early (420 of planned 550 patients) due to low recruitment. Partial funding from Pharma Nord and Kaneka Corp (CoQ10 manufacturers). No significant EF improvement was found despite mortality benefit.

Studies