After learning that many of his patients were taking a nutritional supplement to relieve the symptoms of congestive heart failure, cardiologist Stephen Gottlieb set out to determine whether the product did any good.
There were theoretical reasons why Coenzyme Q10, a supplement sold widely in health food stores, pharmacies and over the Internet, might increase the efficiency of a weakened heart. But does it?
"We found zilch," said Gott-lieb, director of the cardiac care unit at the University of Maryland Medical Center. "I would not suggest to patients that they spend a lot of money on something that shows absolutely no benefit."
In his study, people with congestive heart failure who took the supplement with standard heart medications did no better than those who took a placebo with their usual drugs. Gottlieb reported the results of his study Friday at a national heart-failure conference in San Francisco.
He might not have become interested were it not for the fact that an astonishing number of his patients said they had begun taking the supplement, made by several manufacturers and known also as CoQ10 or ubiquinone. Many had read about it in magazines or on the Internet, or heard the buzz from friends.
Gottlieb said about a third of the 400 to 500 heart-failure patients he sees during a year said they had taken the capsules. When he looked for information, he found several studies that suggested it relieved symptoms. But the studies, he said, were either too small to produce meaningful results or asked the wrong questions.
400,000 cases a year
Anything that adds to existing therapies would be big news. About 400,000 cases of congestive heart failure are diagnosed each year. And while standard drugs, which include ACE inhibitors and diuretics, help to ease symptoms, an estimated 70 percent of sufferers die of the disease within 10 years.
Congestive heart failure is the inability of the heart to pump as much blood as the body needs. People feel tired and weak during normal exercise because their muscles don't get enough oxygen. In some cases, a buildup of blood behind the heart leads to swelling in the feet, ankles, legs and liver. Sometimes, fluids accumulate in the lungs, causing shortness of breath.
In publications and on Internet sites dealing with alternative medicine, CoQ10 is presented as a useful treatment for angina, chronic fatigue, high blood pressure and high cholesterol, but most prominently as a remedy for heart failure. The supplement has the same chemistry as a naturally occurring enzyme that helps to supply cells with their energy needs.
Brian Sanderoff, a pharmacist at the Riverhill Wellness Center in Clarksville, said CoQ10 has been sold for about 20 years, "but its popularity has increased dramatically in the last five years."
"I have seen some amazing turnarounds of patients with heart failure," said Sanderoff, adding that his impressions are based mainly on what patients have told him. "Their shortness of breath goes away. The heart pumps faster and more efficiently, and they lose the fluid overload in their body."
Joe Graedon, the author of "Graedon's Best Medicine" and other books on alternative medicine, said he knows a prominent corporate executive who was "a semi-cardiac cripple" as a result of congestive heart failure but took up tennis again after taking CoQ10.
For his study, Gottlieb enrolled 50 people who were suffering from congestive heart failure, assigning them randomly to receive CoQ10 or a placebo for six months. None of the patients or the doctors treating them knew who was taking what until the study was finished.
After the study, doctors found that patients who had taken the supplement absorbed it into their bloodstream. And the chemical was safe. But there was absolutely no difference in how much they could exercise and how much blood their hearts pumped.
Some patients, he said, might feel better because they think they are doing something positive for themselves -- a phenomenon known as the placebo effect. "If they think it's going to work, it probably will," Gottlieb said.
Weight loss 'best medicine'
Jerry Rock, a patient from Stevenson, said he started taking the supplement after reading that it was "good for the heart, good for the lungs." He thought he noticed a slight improvement, but stopped taking the capsules when Dr. Michael Fisher, a cardiologist involved in the study, told him about the test results.
"When I stopped, I can't say that I noticed any difference," Rock said. Later, he found something that really worked: He lost 20 pounds. "My energy is better, my breathing is better. That's been the best medicine."