Cochrane for Clinicians

Putting Evidence into Practice

Coenzyme Q10 for Heart Failure


Am Fam Physician. 2021 Nov ;104(5):458-459.

Author disclosure: No relevant financial affiliations.

Clinical Question

Does coenzyme Q10 decrease mortality and hospitalizations in patients with heart failure?

Evidence-Based Answer

In patients with chronic heart failure, supplementation with coenzyme Q10 may reduce all-cause mortality (absolute risk reduction [ARR] = 7.5%; 95% CI, 0.9% to 11.6%; number needed to treat [NNT] = 13; 95% CI, 9 to 111) and heart failure–related hospitalization (ARR = 10.5%; 95% CI, 6.1% to 14.1%; NNT = 10; 95% CI, 7 to 16).1 (Strength of Recommendation [SOR]: B, based on inconsistent or limited-quality patient-oriented evidence.) Adverse effects are generally mild and may be only slightly increased with coenzyme Q10 supplementation.1 (SOR: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Heart failure is associated with high rates of morbidity and mortality and is classified as systolic (reduced ejection fraction) or diastolic (preserved ejection fraction).2 The prevalence of any heart failure classification in the United States in 2012 was 2.4% and is expected to be at least 3% by 2030.3 Serum oxidants are elevated in persons with heart failure, are correlated with severity of disease, and predict mortality.3 Coenzyme Q10 is a nutritional supplement with antioxidant properties. Low plasma concentrations of coenzyme Q10 have been found to be an independent predictor of mortality in patients with heart failure.4 The authors of this Cochrane review sought to assess the safety and effectiveness of coenzyme Q10 supplementation, compared with placebo or conventional therapy, in persons with heart failure.1

This Cochrane review included 11 randomized controlled trials (RCTs) and 1,573 participants (1,535 adults; 38 children).1 The follow-up time ranged from one to 26 months. Primary outcomes included all-cause mortality, risk of myocardial infarction and stroke, heart failure–related hospitalization, improvement in left ventricular ejection fraction, and adverse effects. Study participants included patients with

Author disclosure: No relevant financial affiliations.


show all references

1. Al Saadi T, Assaf Y, Farwati M, et al. Coenzyme Q10 for heart failure. Cochrane Database Syst Rev. 2021;(1):CD008684....

2. Savarese G, Lund LH. Global public health burden of heart failure. Card Fail Rev. 2017;3(1):7–11.

3. Virani SS, Alonso A, Benjamin EJ, et al.; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics–2020 update: a report from the American Heart Association. Circulation. 2020;141(9):e139–e596.

4. Molyneux SL, Florkowski CM, George PM, et al. Coenzyme Q10: an independent predictor of mortality in chronic heart failure. J Am Coll Cardiol. 2008;52(18):1435–1441.

5. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):e240–e327.

6. GoodRx. Coq10. 2021. Accessed September 24, 2021.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at



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