Mareev V Yu, Mareev Yu V, Begrambekova Yu L
Medical Research and Educational Center, Lomonosov Moscow State University; School of Fundamental Medicine, Lomonosov Moscow State University.
Medical Research and Educational Center, Lomonosov Moscow State University; National Medical Research Center for Therapy and Preventive Medicine.
Kardiologiia. 2022 Jun 30;62(6):3-14. doi: 10.18087/cardio.2022.6.n2050.
Aim The aim of the study was evaluation of the effect of the coenzyme Q10 (Q10) treatment on all-cause and cardiovascular mortality of patients with chronic heart failure (CHF). Q-10 increases the electron transfer in the mitochondrial respiratory chain and exerts anti-inflammatory and antioxidant effects. These effects improve the endothelial function and reduce afterload, which facilitates the heart pumping function. Patients with reduced left ventricular (LV) ejection fraction (EF) (CHFrEF) have low Q10.Material and methods Criteria of inclusion in the meta-analysis: 1) placebo-controlled studies; 2) enrollment of at least 100 patients; 3) publications after 2010, which implies an optimal basic therapy for CHF; 4) duration of at least 6 months; 5) reported cardiovascular and/or all-cause mortality; 6) using sufficient doses of Q10 (>100 mg/day). The search was performed in CENTRAL, MEDLINE, Embase, Web of Science, E-library, and ClinicalTrials.gov databases. All-cause mortality was the primary efficacy endpoint in this systematic review and the meta-analysis. The secondary endpoint was cardiovascular mortality. Meta-analysis was performed according to the Mantel-Haenszel methods. The Cochrane criterion (I2) was used for evaluation of statistical heterogeneity. The random effects model was used at I2≥50 %, whereas the fixed effects model was used at I2<50.Results Analysis of studies published from 01.01.2011 to 01.12.2021 identified 357 publications, 23 of which corresponded to the study topic, but only 6 (providing results of four randomized clinical trials, RCT) completely met the predefined criteria. The final analysis included results of managing 1139 patients (586 received Q10 and 553 received placebo). Risk of all-cause death was analyzed by data of four RCTs (1139 patients). The decrease in the risk associated with the Q10 treatment was 36 % (OR=0.64, 95 % CI 0.48-0.87, р=0.004). The heterogeneity of studies was low (Chi2=0.84; p=0.84; I2=0 %). Risk of cardiovascular mortality was analyzed by data of two RCTs (863 patients). The decrease in the risk associated with the Q10 treatment was significant, 55% (OR=0.45, 95 % CI: 0.32-0.64, р=0.00001). In this case, the data heterogeneity was also low (Chi2=0.41; p=0.52; I2=0 %).Conclusion The meta-analysis confirmed the beneficial effect of coenzyme Q10 on the prognosis of patients with CHFrEF receiving the recommended basic therapy.
目的 本研究旨在评估辅酶Q10（Q10）治疗对慢性心力衰竭（CHF）患者全因死亡率和心血管死亡率的影响。Q-10可增加线粒体呼吸链中的电子传递，并发挥抗炎和抗氧化作用。这些作用可改善内皮功能并降低后负荷，从而促进心脏泵血功能。左心室（LV）射血分数（EF）降低的患者（CHFrEF）体内Q10水平较低。
材料和方法 纳入荟萃分析的标准：1）安慰剂对照研究；2）至少招募100名患者；3）2010年后发表的文献，这意味着对CHF采用了最佳基础治疗；4）持续时间至少6个月；5）报告心血管和/或全因死亡率；6）使用足够剂量的Q10（>100 mg/天）。检索了CENTRAL、MEDLINE、Embase、Web of Science、电子图书馆和ClinicalTrials.gov数据库。全因死亡率是本系统评价和荟萃分析的主要疗效终点。次要终点是心血管死亡率。根据Mantel-Haenszel方法进行荟萃分析。采用Cochrane标准（I2）评估统计异质性。I2≥50%时使用随机效应模型，I2<50%时使用固定效应模型。
结果 对2011年1月1日至2021年12月1日发表的研究进行分析，共识别出357篇文献，其中23篇与研究主题相关，但只有6篇（提供了四项随机临床试验，RCT的结果）完全符合预定标准。最终分析纳入了1139例患者的治疗结果（586例接受Q10治疗，553例接受安慰剂治疗）。通过四项RCT（1139例患者）的数据分析全因死亡风险。与Q10治疗相关的风险降低了36%（OR=0.64，95%CI 0.48-0.87，p=0.004）。研究的异质性较低（Chi2=0.84；p=0.84；I2=0%）。通过两项RCT（863例患者）的数据分析心血管死亡风险。与Q10治疗相关的风险显著降低，为55%（OR=0.45，95%CI：0.32-0.64，p=0.00001）。在这种情况下，数据异质性也较低（Chi2=0.41；p=0.52；I2=0%）。
结论 荟萃分析证实了辅酶Q10对接受推荐基础治疗的CHFrEF患者预后的有益作用。
