Posted on: Friday, August 2nd 2024 at 3:00 am
Could a simple supplement be the key to addressing both liver disease and cardiovascular risk in one fell swoop? New research suggests high-dose coenzyme Q10 may offer multiple benefits for patients with metabolic dysfunction-associated steatotic liver disease.
Background and Study Overview
Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is a growing health concern closely linked to obesity and increased cardiovascular risk. As the global obesity epidemic continues, MASLD has become one of the most significant chronic liver disorders worldwide. Despite its prevalence, effective treatment options remain limited.
In this context, Vrentzos et al. conducted a randomized, double-blind, placebo-controlled trial to evaluate the effects of high-dose coenzyme Q10 (CoQ10) supplementation on patients with MASLD. The study aimed to assess improvements in liver steatosis, endothelial function, vascular health, and myocardial function over a 6-month period.
CoQ10 is a lipid-soluble quinone that plays a crucial role in mitochondrial function and acts as a powerful antioxidant. Previous research has shown potential benefits of CoQ10 in various conditions associated with oxidative stress, including cardiovascular disease, dyslipidemia, and hypertension. However, its effects on MASLD and associated cardiovascular risk factors had not been thoroughly investigated.
Study Design and Methods
The trial enrolled 60 patients with MASLD who had at least one additional cardiometabolic risk factor but did not have diabetes mellitus. Participants were randomly assigned to receive either 240 mg of CoQ10 daily or a placebo for 6 months. All patients received dietary guidance based on the Mediterranean diet and were encouraged to engage in at least 150 minutes of moderate exercise per week.
The researchers employed a comprehensive array of diagnostic techniques to assess the effects of CoQ10 supplementation:
- Controlled Attenuation Parameter (CAP): To quantify liver steatosis
- Perfused Boundary Region (PBR): To evaluate endothelial glycocalyx thickness
- Pulse Wave Velocity (PWV): To measure arterial stiffness
- Flow-Mediated Dilation (FMD): To assess endothelial function
- Left Ventricular Global Longitudinal Strain (LV GLS): To evaluate myocardial function
- Coronary Flow Reserve (CFR): To assess coronary microcirculation
These measurements were taken at baseline and after 6 months of treatment.
Key Findings
Liver Steatosis
The study demonstrated a significant reduction in liver steatosis in the CoQ10 group compared to the placebo group. After 6 months of treatment, patients receiving CoQ10 showed a decrease in CAP score from 304.8 ± 37.4 dB/m to 280.9 ± 33.4 dB/m (p = 0.017). In contrast, the placebo group did not exhibit significant changes in liver steatosis.
Vascular Function
CoQ10 supplementation led to notable improvements in various markers of vascular health:
- Endothelial Glycocalyx: The perfused boundary region (PBR) of sublingual artery microvessels decreased from 2.29 ± 0.18 μm to 2.18 ± 0.23 μm (p = 0.035), indicating improved endothelial glycocalyx thickness.
- Arterial Stiffness: Pulse wave velocity (PWV) reduced from 10.2 ± 2.3 m/s to 9.5 ± 2 m/s (p = 0.018), suggesting enhanced arterial elasticity.
- Endothelial Function: Flow-mediated dilation (FMD) of the brachial artery increased from 4.3 ± 2.8% to 6.1 ± 3.8% (p = 0.002), demonstrating improved endothelial function.
- Blood Pressure: Systolic blood pressure decreased by 7 mmHg in the CoQ10 group, from 135 ± 13 mmHg to 128 ± 12 mmHg (p = 0.006).
Myocardial Function
Significant improvements were observed in cardiac function markers:
- Coronary Flow Reserve: CFR increased from 2.8 ± 0.4 to 3.1 ± 0.4 (p = 0.014), indicating enhanced coronary microcirculation.
- Left Ventricular Performance: Global longitudinal strain (GLS) improved from -18.8 ± 1.9% to -19.6 ± 1.6% (p = 0.011), suggesting better left ventricular function.
Lipid Profile
Patients receiving CoQ10 demonstrated a significant reduction in LDL cholesterol levels, decreasing from 113 ± 27 mg/dL to 102 ± 21 mg/dL (p = 0.045).
Correlations and Associations
A notable finding was the association between the reduction in CAP score (indicating improved liver steatosis) and improvements in vascular and cardiac function markers. The percentage reduction in CAP score was positively correlated with reductions in PBR and PWV, and negatively correlated with increases in CFR and FMD.
Safety and Tolerability
The study reported no serious adverse events related to CoQ10 supplementation, suggesting a favorable safety profile for the high-dose regimen used in this trial.
Discussion and Implications
The results of this study provide compelling evidence for the multifaceted benefits of high-dose CoQ10 supplementation in patients with MASLD. The observed improvements span liver health, vascular function, and cardiac performance, addressing several key components of cardiometabolic risk associated with MASLD.
Liver Steatosis Reduction
The significant decrease in liver steatosis, as measured by CAP score, is a crucial finding. This improvement occurred despite no significant changes in body mass index, suggesting that CoQ10 may directly influence hepatic fat accumulation. The mechanism may involve CoQ10's antioxidant properties and its role in mitochondrial function, potentially mitigating the oxidative stress and mitochondrial dysfunction associated with MASLD.
Vascular Health Improvements
The comprehensive assessment of vascular health in this study revealed improvements across multiple parameters. The reduction in PBR indicates enhanced endothelial glycocalyx integrity, which plays a vital role in vascular homeostasis. The decreased PWV and increased FMD suggest improved arterial elasticity and endothelial function, respectively. These changes collectively point to a significant positive impact on overall vascular health, which is particularly relevant given the increased cardiovascular risk in MASLD patients.
Cardiac Function Enhancement
The improvements in coronary flow reserve and left ventricular global longitudinal strain are particularly noteworthy. These changes indicate enhanced coronary microcirculation and better left ventricular performance, which could translate to reduced cardiovascular risk in this patient population.
Lipid Profile Improvement
The reduction in LDL cholesterol levels adds to the cardiovascular benefits observed in the study. This improvement in lipid profile, combined with the vascular and cardiac function enhancements, suggests that CoQ10 supplementation may offer a comprehensive approach to reducing cardiovascular risk in MASLD patients.
Mechanistic Insights
The observed correlations between improvements in liver steatosis and various cardiovascular parameters highlight the interconnected nature of metabolic dysfunction in MASLD. This finding supports the concept of MASLD as a systemic condition with effects beyond the liver, and suggests that interventions targeting liver health may have broader cardiometabolic benefits.
Comparison with Previous Studies
This study builds upon and extends previous research on CoQ10 supplementation in metabolic disorders. While earlier studies have shown benefits of CoQ10 in conditions like diabetes and hypertension, this trial is one of the first to comprehensively assess its effects in MASLD patients. The longer duration (6 months) and higher dose (240 mg daily) used in this study may explain the more pronounced effects observed compared to some previous trials.
Limitations and Future Directions
Despite its promising results, the study has some limitations. The sample size was relatively small, and the follow-up period was limited to 6 months. Larger, long-term studies are needed to confirm the durability of these effects and to assess potential impacts on hard clinical endpoints such as cardiovascular events or liver disease progression.
Future research could also explore the optimal dosing of CoQ10 for MASLD patients, investigate potential synergistic effects with other interventions, and elucidate the precise mechanisms underlying the observed benefits.
Conclusion
This randomized, double-blind, placebo-controlled trial provides strong evidence for the beneficial effects of high-dose CoQ10 supplementation in patients with MASLD. The observed improvements in liver steatosis, vascular function, and cardiac performance suggest that CoQ10 may offer a multi-targeted approach to addressing the complex cardiometabolic risk profile associated with MASLD.
The study's findings open up new avenues for managing MASLD and its associated cardiovascular complications. Given the growing prevalence of MASLD and the limited treatment options currently available, CoQ10 supplementation represents a promising and potentially widely applicable therapeutic strategy.
As research in this field continues to evolve, integrating CoQ10 supplementation into comprehensive management plans for MASLD patients may become an important consideration for clinicians seeking to address both hepatic and cardiovascular aspects of this challenging condition.
To learn more about the health benefits of CoQ10, visit our database on the subject here.
References
1. Vrentzos, Emmanouil, Ignatios Ikonomidis, George Pavlidis, Konstantinos Katogiannis, Emmanouil Korakas, Aikaterini Kountouri, Loukia Pliouta, et al. "Six-Month Supplementation with High Dose Coenzyme Q10 Improves Liver Steatosis, Endothelial, Vascular and Myocardial Function in Patients with Metabolic-Dysfunction Associated Steatotic Liver Disease: A Randomized Double-Blind, Placebo-Controlled Trial." Cardiovascular Diabetology 23, no. 1 (2024): 245. https://doi.org/10.1186/
2. Gutierrez-Mariscal, Francisco Miguel, Adrián de la Rosa Cuenca, Elena María Yubero-Serrano, and José López-Miranda. "Coenzyme Q10 Supplementation for the Reduction of Oxidative Stress: Clinical Implications in the Treatment of Chronic Diseases." International Journal of Molecular Sciences 21, no. 21 (October 23, 2020): 7870. https://doi.org/10.3390/
3. Hargreaves, Iain P., Angelo Antonietta Mantle David, and Richard A. Heaton. "Disorders of Human Coenzyme Q10 Metabolism: An Overview." International Journal of Molecular Sciences 21, no. 18 (September 11, 2020): 6695. https://doi.org/10.3390/
4. Rinella, Mary E., Zobair Younossi, Helena Cortez-Pinto, Jacob George, Giulio Marchesini, Anna Mae Diehl, Lisa B. VanWagner, et al. "A Multisociety Delphi Consensus Statement on New Fatty Liver Disease Nomenclature." Hepatology 78, no. 6 (December 2023): 1966-86. https://doi.org/10.1002/hep.
5. Watts, Gerald F., David A. Playford, Kevin D. Croft, Natalie C. Ward, Trevor A. Mori, and Valerie Burke. "Coenzyme Q(10) Improves Endothelial Dysfunction of the Brachial Artery in Type II Diabetes Mellitus." Diabetologia 45, no. 3 (March 2002): 420-26. https://doi.org/10.1007/
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