Ubidecarenone (coenzyme Q10)

In chronic heart failure, coenzyme Q10 has been studied as add-on therapy to guideline-directed treatment (ACE inhibitors/ARNI, β-blockers, mineralocorticoid receptor antagonists). The Q-SYMBIO trial (Mortensen 2014, n=420, 2 years) showed 43% reduction in the composite endpoint (mortality + adverse cardiovascular events) at 300 mg/day. The result is criticized for small sample size and design issues. ESC 2021 HF guidelines do not include CoQ10 as mandatory therapy but describe it as an «acceptable add-on option». AHA/ACC 2022 guidelines do not mention CoQ10.

Coenzyme Q10 is widely used as an «antidote» to statin myalgia based on the theory of CoQ10 depletion during statin therapy. Evidence is conflicting. Banach 2015 meta-analysis (12 RCTs, n=575) showed significant muscle pain score reduction. Later and larger Taylor 2015 (5 RCTs, n=253) and Qu 2018 (12 RCTs) analyses did not confirm the effect. ESC/EAS 2019 and AHA/ACC 2018 guidelines do not recommend CoQ10 as evidence-based therapy for statin myalgia; the supplement is permissible as an «option when statin switch is contraindicated» but not first-line. First-line management of statin myalgia: dose reduction, statin switch (pravastatin, fluvastatin), alternate-day dosing.