Building ATP Levels for Patients With Heart Failure

Heart failure is a progressively debilitating disease that impacts 5.7 million US adults.1 Past treatment approaches have focused on symptom management, but researchers now say it is likely that the function of cardiomyocytes can be rescued from their ‘metabolically stunned’ state.2 Since the heart maintains specialized cellular processes that demand high but varying levels of energy, and because it stores only a small amount of energy substrate, the focus of current research is on developing treatment strategies for meeting those fluctuating workload demands.3,4

IFM Certified Practitioner Michael Stone, MD, discusses key nutrients to improve energy levels in heart failure patients.

Among the nutrients supported by the research is coenzyme Q10 (CoQ10), an essential compound of the human body that is synthesized in the mitochondrial inner membrane.5 A review of 14 randomized controlled trials on the efficacy of CoQ10 found that patients had a lower mortality rate and improved exercise capacity compared to study participants receiving a placebo.6 Supplementing with CoQ10 daily can improve a patient’s New York Heart Association Class rating.7,8  

In a 2018 review of the literature, Zozina et al suggest that, overall, there seems to be a beneficial role of CoQ10 co-administration as a supplemental therapy in different cardiac and metabolic conditions.5 CoQ10 may improve outcomes and quality of life and decrease morbidity and mortality; however, the authors point out that some findings in their review are based on preclinical or clinical studies with surrogate endpoints.5 Furthermore, the reported dosage of CoQ10 differs in a wide range from 100-300 mg for cardiovascular diseases. Future studies should be aimed at assessment of higher dosage of CoQ10 administration as well as evaluation of its pharmacokinetics and pharmacodynamics.5

Another review found that heart failure patients may benefit from receiving nutraceuticals such as hawthorn, beet nitrates, L-carnitine, and vitamin D.9 However, despite several studies exploring the association of the various supplements to the cardiovascular risk, there is still a lack of consensus in the medical literature.10

Patients with heart failure have decreased ATP production in heart cells as well as other abnormalities in cardiac metabolism, including cell death.4,11-13 Some innovative therapies consider this energy deficiency as both cause and effect at the level of gene expression.3 The electron transport chain and phosphorylation apparatus is now thought to be where the mitochondrial defects are found. Reduced ATP production is caused by progressively reduced mitochondrial respiratory pathway activity, which reduces pump function, stimulating soaring energy demand as functionality decreases.13

Preclinical models of therapies targeting the mitochondria have produced encouraging results, as have iron and exercise therapies that target mitochondrial biology.14 Mitochondrial biogenesis means stimulating the production of new mitochondria through transcription of peroxisome proliferator–activated receptor gamma co-activator (PGC1α) in order to maintain the volume and flow of the mitochondrial network.2

Research into supporting mitochondrial health for cardiometabolic patients and patients with migraines, fatigue, and other conditions continues to evolve. Learn the latest interventions through IFM’s certification program.

Learn More About Cardiometabolic Function

For more information, please continue to the following IFM-authored articles:

The cardiometabolic-focused physical exam

Lifestyle interventions to modify cardiovascular disease risk

Nutritional controversies in heart disease: a Functional Medicine cardiologist’s perspective

  1. Mozzafarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics—2016 update: a report from the American Heart Association. 2016;133(4):e38-e360. doi:10.1161/CIR.0000000000000350
  2. Bayeva M, Gheorghiade M, Ardehali H. Mitochondria as a therapeutic target in heart failure. J Am Coll Cardiol. 2013;61(6):599-610. doi:1016/j.jacc.2012.08.1021
  3. Huss JM, Kelly DP. Mitochondrial energy metabolism in heart failure: a question of balance. J Clin Invest. 2005;115(3):547-555. doi:1172/JCI24405
  4. Sabbah HN. Targeting the mitochondria in heart failure: a translational perspective. JACC Basic Transl Sci. 2020;5(1):88-106. doi:1016/j.jacbts.2019.07.009
  5. Zozina VI. Covantev S, Goroshko OA, Krasnykh LM, Kukes VG. Coenzyme Q10 in cardiovascular and metabolic diseases: current state of the problem. Curr Cardio Rev. 2018;14(3):164-174. doi:2174/1573403X14666180416115428
  6. Lei L, Liu Y. Efficacy of coenzyme Q10 in patients with cardiac failure: a meta-analysis of clinical trials. BMC Cardiovasc Disord. 2017;17(1):196. doi:1186/s12872-017-0628-9
  7. Rosenfeldt F, Hilton D, Pepe S, Krum H. Systematic review of effect of coenzyme Q10 in physical exercise, hypertension and heart failure. 2003;18(1-4):91-100. doi:10.1002/biof.5520180211
  8. Madmani ME, Yusuf Solaiman A, Tamr Agha K, et al. Coenzyme Q10 for heart failure. Cochrane Database Syst Rev. 2014;(6):CD008684. doi:1002/14651858.CD008684.pub2
  9. Cicero AFG, Colletti A. Nutraceuticals and dietary supplements to improve quality of life and outcomes in heart failure patients. Curr Pharm Des. 2017;23(8):1265-1272. doi:2174/1381612823666170124120518
  10. Bronzato S, Durante A. Dietary supplements and cardiovascular diseases. Int J Prev Med. 2018;9:80. doi:4103/ijpvm.IJPVM_179_17
  11. Davidson SM, Adameová A, Barile L, et al. Mitochondrial and mitochondrial-independent pathways of myocardial cell death during ischaemia and reperfusion injury. J Cell Mol Med. Published online March 10, 2020. doi:1111/jcmm.15127
  12. Doenst T, Nguyen TD, Abel ED. Cardiac metabolism in heart failure: implications beyond ATP production. Circ Res. 2013;113(6):709-724. doi:1161/CIRCRESAHA.113.300376
  13. Rosca MG, Hoppel CL. Mitochondrial dysfunction in heart failure. Heart Fail Rev. 2013;18(5):607-622. doi:1007/s10741-012-9340-0
  14. von Hardenberg A, Maack C. Mitochondrial therapies in heart failure. Handb Exp Pharmacol. 2017;243:491-514. doi:1007/164_2016_123

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