Emer, Third Medical Department, UKGM, University of Giessen, Germany.
Lancisi Heart Institute, Ancona, Italy.
Heart Lung Circ. 2020 Feb;29(2):188-195. doi: 10.1016/j.hlc.2019.08.017. Epub 2019 Sep 20.
Heart failure (HF) is one of the most common causes of death in Western society. Recent results underscore the utility of coenzyme Q (CoQ) addition to standard medications in order to reduce mortality and to improve quality of life and functional capacity in chronic heart failure (CHF). The rationale for CoQ supplementation in CHF is two-fold. One is the well-known role of CoQ in myocardial bioenergetics, and the second is its antioxidant property. Redox balance is also improved by oral supplementation of CoQ, and this effect contributes to enhanced endothelium-dependent relaxation. Previous reports have shown that CoQ concentration is decreased in myocardial tissue in CHF and by statin therapy, and the greater the CoQ deficiency the more severe is the cardiocirculatory impairment. In patients with CHF and hypercholesterolaemia being treated with statins, the combination of CoQ with a statin may be useful for two reasons: decreasing skeletal muscle injury and improving myocardial function. Ubiquinol, the active reduced form of CoQ, presents higher bioavailability than the oxidised form ubiquinone, and should be the preferred form to be added to a statin. The combination ezetimibe/simvastatin may have advantages over single statins. Since ezetimibe reduces absorption of cholesterol and does not affect CoQ synthesis in the liver, the impact of this combination on CoQ tissue levels will be much less than that of high dose statin monotherapy at any target low density lipoprotein-cholesterol (LDL-C) level to be reached. This consideration makes the ezetimibe/statin combination the ideal LDL-lowering agent to be combined with ubiquinol in CHF patients. However, particular caution is advisable with the use of strategies of extreme lowering of cholesterol that may negatively impact on myocardial function. All in all there is a strong case for considering co-administration of ubiquinol with statin therapy in patients with depressed or borderline myocardial function.
心力衰竭（HF）是西方社会最常见的死亡原因之一。最近的结果强调了辅酶 Q（CoQ）与标准药物联合使用的效用，以降低死亡率，并改善慢性心力衰竭（CHF）患者的生活质量和功能能力。CHF 中 CoQ 补充的基本原理有两个。一个是 CoQ 在心肌生物能量学中的众所周知的作用，另一个是其抗氧化特性。口服补充 CoQ 还可以改善氧化还原平衡，这一作用有助于增强内皮依赖性松弛。先前的报告表明，CHF 中的心肌组织和他汀类药物治疗中 CoQ 浓度降低，CoQ 缺乏越严重，心脏循环损害越严重。在接受他汀类药物治疗的 CHF 和高胆固醇血症患者中，CoQ 与他汀类药物联合使用可能有两个原因：减少骨骼肌损伤和改善心肌功能。泛醇，CoQ 的活性还原形式，比氧化形式泛醌具有更高的生物利用度，并且应该是添加到他汀类药物中的首选形式。依折麦布/辛伐他汀的联合使用可能比单一他汀类药物具有优势。由于依折麦布降低胆固醇的吸收，并且不影响肝脏中的 CoQ 合成，因此与任何目标低密度脂蛋白胆固醇（LDL-C）水平相比，这种组合对 CoQ 组织水平的影响将远小于高剂量他汀类药物单药治疗。考虑到这一点，依折麦布/他汀类药物的联合使用是在 CHF 患者中与泛醇联合使用的理想 LDL 降低剂。然而，在使用可能对心肌功能产生负面影响的极端降胆固醇策略时，需要特别谨慎。总而言之，对于存在功能低下或临界功能的患者，考虑 CoQ 与他汀类药物联合治疗是合理的。
