By Mary Jane Dittmar
Often, it is bewildering to know what is really good for us and what might harm us even though it seems to be the Gold Standard for medical care. Of course, we have to look at all information and then evaluate it the best we can. We should not change our medications without discussing it with our medical providers; that can do great harm. On the other hand, if we just ignore the new information, it can harm us as well. The best thing to do is to discuss it with your medical provider and do as much research on it as you can, making sure that all points of view are covered. As discussed in previous columns, check the sponsor of the study, look for conflicts of interest, and assess the information’s validity as best as you can.
Statins and Exercise Results
With all this in mind, let’s look at the results of the study “Simvastatin impairs exercise training adaptations,” which raises the question, Can statins interfere with the positive effects of exercise for obese and overweight adults? Here’s what John Thyfault, associate professor of nutrition and exercise physiology at Missouri University (MU) and lead author of the study, has to say:
If patients start exercising and taking statins at the same time, it seems that statins
block the ability of exercise to improve the patients’ fitness levels. Fitness has proven
to be the most significant predictor of longevity and health because it protects people
from a variety of chronic diseases.
Thyfault says that cardiologists should consider the benefits and risks of statins in view of the new data revealed in a research study. Not everyone should be prescribed statins, he says, if they interfere with improving or maintaining fitness.
The UM study involved the use of the widely prescribed simvastatin (a generic type of statin previously sold under the brand name Zocor) to lower cholesterol and prevent heart disease in individuals with obesity, diabetes, and metabolic syndrome–a combination of medical disorders including excess body fat and high levels of blood pressure, blood sugar, or cholesterol–to determine its effect on exercise.
Thirty-seven previously sedentary obese individuals between the ages of 25 and 59 with low fitness levels participated in the study. The researchers measured cardiorespiratory fitness. The study subjects followed the same exercise regimen on the MU campus for 12 weeks; 18 of the 37 people also took 40 mg. of simvastatin daily.
The statin was found to significantly affect participants’ exercise outcomes. The exercise-only group increased their cardiorespiratory fitness by an average of 10 percent compared to a 1.5 percent increase among participants who also were prescribed statins. Thyfault suggests that future research be conducted to determine whether lower doses of simvastatin or other types of statins similarly affect people’s exercise outcomes and, consequently, their risk for diseases such as Type 2 diabetes. Starting a statin regimen after exercising and obtaining a higher fitness level may reduce the drugs’ effects on fitness, he says.
The study was published in the Journal of the American College of Cardiology. Funding was provided by a grant from the MU Research Board, the Veterans Affairs’ Career Development Award, an American Heart Association Midwest Affiliate Clinical Research Award, and the National Institutes of Health. Additional information is available from Jesslyn Chew, ChewJ@missouri.edu, (573) 882-8353, and http://munews.missouri.edu.
Heart failure mortality: Coenzyme Q10 halves all-cause mortality in trial
At Heart Failure 2013, the annual meeting of the Heart Failure Association of the European Society of Cardiology (ESC), held in May in Lisbon, Portugal, the results of the “Q-SYMBIO” study were revealed: Coenzyme Q10 (CoQ10) decreases all-cause mortality by half. “CoQ10 is the first drug to improve heart failure mortality in over a decade and should be added to standard treatment,” according to study’s lead author Professor Svend Aage Mortensen (Copenhagen, Denmark).
“CoQ10, which occurs naturally in the body, is essential to survival,” according to the ESC, which explains: “It works as an electron carrier in the mitochondria, the powerhouse of the cells, to produce energy and is also a powerful antioxidant. It is the only antioxidant that humans synthesize in the body.”
CoQ10 levels are decreased in the heart muscle of patients with heart failure; the deficiency becomes more pronounced as heart failure worsens. Statins are used to treat many patients with heart failure because statins block the synthesis of cholesterol, but these drugs also block the synthesis of CoQ10, which further decreases levels in the body.
Double-blind controlled trials have shown that CoQ10 improves symptoms, functional capacity, and quality of life in patients with heart failure, with no side effects. But until now, no trials have been statistically powered to address effects on survival.
The study randomized 420 patients with severe heart failure [New York Heart Association (NYHA) Class III or IV] to CoQ10 or placebo and followed them for two years. The primary endpoint was time to first major adverse cardiovascular event (MACE), which included unplanned hospitalization because of worsening of heart failure, cardiovascular death, urgent cardiac transplantation, and mechanical circulatory support. Participating centers were in Denmark, Sweden, Austria, Slovakia, Poland, Hungary, India, Malaysia, and Australia.
CoQ10 halved the risk of MACE: 29 (14%) of patients in the CoQ10 group reached the primary endpoint compared to 55 (25%) patients in the placebo group. CoQ10 also halved the risk of dying from all causes, which occurred in 18 (9%) patients in the CoQ10 group compared to 36 (17%) patients in the placebo group.
CoQ10 treated patients had significantly lower cardiovascular mortality (p=0,02) and lower occurrence of hospitalizations for heart failure (p=0.05). There were fewer adverse events in the CoQ10 group compared with the placebo group (p=0.073).
Mortensen further explained: “Other heart failure medications block rather than enhance cellular processes and may have side effects. Supplementation with CoQ10, which is a natural and safe substance, corrects a deficiency in the body and blocks the vicious metabolic cycle in chronic heart failure called the energy-starved heart.”
CoQ10 is present in food, including red meat, plants, and fish, but levels are insufficient to impact heart failure. CoQ10 is also sold over the counter as a food supplement. Mortensen cautioned: “Food supplements can influence the effect of other medications, including anticoagulants, and patients should seek advice from their doctor before taking them.”
Patients with ischemic heart disease who use statins may also benefit from CoQ10 supplementation. According to Mortensen: “We have no controlled trials demonstrating that statin therapy plus CoQ10 improves mortality more than statins alone; but statins reduce CoQ10, and circulating CoQ10 prevents the oxidation of LDL (low-density lipids) effectively, so I think ischemic patients should supplement statin therapy with CoQ10.”
- Heart Failure 2013
- SA Mortensen, A Kumar, P Dolliner, et al. “The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure.” Results from the Q-SYMBIO study. Presented at Heart Failure Congress 2013 Final Programme Number 440.
The full title of the Q-SYMBIO study is: “Coenzyme Q10 as adjunctive treatment of chronic heart failure: a randomised double blind multicentre trial with focus on changes in symptoms, biomarker status with BNP and long term outcome.”
Photos courtesy of http://photos8.com.
MARY JANE DITTMAR is senior associate editor of Fire Engineering and conference manager of FDIC. Before joining the magazine in January 1991, she served as editor of a trade magazine in the health/nutrition market and held various positions in the educational and medical advertising fields. She has a bachelor’s degree in English/journalism and a master’s degree in communication arts.