Correspondence

Rosuvastatin in Older Patients with Systolic Heart Failure

N Engl J Med 2008; 358:1301March 20, 2008

Article

To the Editor:

The Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA), as reported by Kjekshus et al. (Nov. 29 issue),1 failed to show a reduction in major vascular events with the use of rosuvastatin in older patients with systolic heart failure. One explanatory variable may be a reduction in coenzyme Q10, which is known to be caused by statins, as the authors mention in their introduction. Coenzyme Q10 is important in mitochondrial electron transport and energy generation, and depletion of coenzyme Q10 in myocardial tissue has been correlated with an increased clinical severity of heart failure.2 More recently, a meta-analysis of coenzyme Q10 intervention trials has shown significant improvements in ejection fraction (an increase of 3.7%; 95% confidence interval [CI], 1.59 to 5.77) and cardiac output (an increase of 0.28 liter per minute; 95% CI, 0.03 to 0.53) in patients with systolic heart failure,3 and the randomized, controlled Q-SYMBIO study,4 which addresses symptoms, biochemical markers, and clinical outcomes, is ongoing. Moreover, we have recently shown that coenzyme Q10 levels, but not statin therapy, are an independent predictor of total mortality in an observational study of 236 patients with heart failure.5 Future trials incorporating a group treated with coenzyme Q10 supplementation together with a statin may be postulated to result in the improved clinical outcomes that CORONA did not show.

Christopher M. Florkowski, M.D.
Sarah L. Molyneux, Ph.D.
Peter M. George, M.D.
Canterbury Health Laboratories, Christchurch 8140, New Zealand
chris.florkowski@cdhb.govt.nz

5 References

1. 1

   Kjekshus J, Apatrei E, Barrios V, et al. Rosuvastatin in older patients with systolic heart failure. N Engl J Med 2007;357:2248-2261
   Full Text | Web of Science | Medline

2. 2

   Folkers K, Vadhanavikit S, Mortensen SA. Biochemical rationale and myocardial tissue data on the effective therapy of cardiomyopathy with coenzyme Q10. Proc Natl Acad Sci U S A 1985;82:901-904
   CrossRef | Web of Science | Medline

3. 3

   Sander S, Coleman CI, Patel AA, Kluger J, White CM. The impact of coenzyme Q10 on systolic function in patients with chronic heart failure. J Card Fail 2006;12:464-472
   CrossRef | Web of Science | Medline

4. 4

   Mortensen SA. Overview on coenzyme Q10 as adjunctive therapy in chronic heart failure: rationale, design and end-points of “Q-symbio” -- a multinational trial. Biofactors 2003;18:79-89
   CrossRef | Web of Science | Medline

5. 5

   Florkowski CM, Molyneux SL, Richards AM, George PM. Plasma coenzyme Q10 is an independent predictor of mortality in chronic heart failure. In: Proceedings of the Australasian Association of Clinical Biochemists 45th Annual Scientific Conference, Melbourne, Australia, September 24–27, 2007. Clin Biochem Rev 2007;28:Suppl (i):S15.
   

Author/Editor Response

The reports on coenzyme Q10 and possible interactions with heart failure and statins are intriguing. As part of our analysis plan, we are currently analyzing coenzyme Q10 in a subgroup of the CORONA population, at baseline and 3 months after inclusion.

John Kjekshus, M.D., Ph.D.
Rikshospitalet University Hospital, 0027 Oslo, Norway
john.kjekshus@medisin.uio.no

John J.V. McMurray, M.D.
British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow G11 6NT, United Kingdom

John Wikstrand, M.D., Ph.D.
Wallenberg Laboratory for Cardiovascular Research, 431 83 Mølndal, Sweden

Citing Articles (2)

Citing Articles

1. 1

   David A. Brealey, Mervyn Singer, Marius Terblanche. (2011) Potential metabolic consequences of statins in sepsis*. Critical Care Medicine 39:6, 1514-1520
   CrossRef

2. 2

   Kristopher S. Lyons, Gary E. McVeigh, Mark T. Harbinson. (2011) Statins in Heart Failure—Where Do We Stand?. Cardiovascular Drugs and Therapy 25:1, 99-104
   CrossRef