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rection of coenzyme Q-10 deficiencies and the scaveng- ing of free radicals has been suggested (1).   HAS IT BEEN STUDIED IN HEART DISEASE? Congestive Heart Failure Clinical trials suggest that coenzyme Q-10 can signifi- cantly improve the quality of life and decrease hospitaliza- tion rates for patients with mild to severe congestive heart failure.  The signs and symptoms associated with the condition’s symptoms such as shortness of breath, lower extremity edema (accu- mulation of fluids in the legs), an enlarged liver and insom- nia are reduced as well (11- 13).  However, coenzyme Q- 10 does not appear to improve the strength of the heart's contraction (which is measured as the ejection fraction) or the exercise tol- erance in congestive heart failure patients (8,12,14,15). Angina Coenzyme Q-10 has been shown to improve the symptoms of chest pain, (angina pectoris), and to improve exercise tolerance in patients with chronic sta- ble angina (16).  In a place- bo-controlled study of 12 patients, there was a trend toward reduced angina and decreased use of the drug nitroglycerin in patients tak- ing coenzyme Q-10.  In treated patients, there was a significant increase in exercise capacity, with less Coenzyme Q-10 has been used in heart disease to treat:   • congestive heart failure • chest pain (angina) • high blood pressure (hypertension) • mitral valve prolapse (a condition characterized by blood flow back into the heart's upper chamber) and to prevent:   • heart toxicity associated with doxorubicin (Adriamycin) chemotherapy (9).   Coenzyme Q-10 has also demonstrated benefits in patients undergoing coronary artery bypass surgery (10). coenzyme Q-10 found inside the body is significantly  less than is felt to represent a therapeutic dosage.   When administered orally, coen- zyme Q-10 reaches its maxi- mum concentration within the blood in five to 10 hours and remains at relatively high lev- els for up to 34 hours. Patients with certain dis- eases, including congestive heart failure (CHF), have low levels of coenzyme Q-10, with the lowest levels found in those with the most severe symptoms.  In addition, patients who benefit most from a coenzyme Q-10 sup- plement have the lowest nat- ural levels of coenzyme  Q- 10 (1, 5-7).  Supplementation appears to raise these levels in the serum (8). In addition, coenzyme Q-10:   • prevents oxidative stress, which seems to be the bene- ficial mechanism at work in treating congestive heart fail- ure.   • is associated with increased ATP synthesis, membrane protection and the reduction of free radicals in the treat- ment of angina (chest pain) (1).    • may protect against heart toxicity associated with the chemotherapy drug doxoru- bicin (Adriamycin).  While no mechanism has been estab- lished for this effect, the cor-

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