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Coenzyme Q10 (CoQ10) plays a crucial role in the electron transport chain, ensuring an adequate and efficient energy supply. Additionally, it functions as an antioxidant in mitochondria, cell compartments, and plasma lipoproteins. CoQ10 deficiency is common in chronic and age-related diseases, particularly in cardiovascular diseases (CVDs). The bioavailability of CoQ10 is significantly reduced by statins, a common class of lipid-lowering drugs that inhibit the shared pathway of CoQ10 endogenous biosynthesis and cholesterol biosynthesis. Clinical trials have explored the effects of CoQ10 supplementation to address these deficiencies within the context of CVDs.

CoQ10 was first isolated by Festenstein et al. in 1955 and Crane et al. in 1957. Chemically, it is a lipid-soluble quinone with a benzoquinone ring and an isoprenoid sidechain consisting of ten isoprenoid units. CoQ10 is integral to the mitochondrial electron transport chain, where it shuttles electrons from complex I and II to complex III. Over the years, CoQ10 has been attributed with multiple functions, including regulating the cellular redox state through its antioxidant properties and generating oxidant signals. It also plays a role in proton gradient formation at endomembranes and plasma membranes, which helps maintain membrane structure and phospholipid status.

The primary function of CoQ10 in energy metabolism is significant, as it leads to more efficient electron transport within the mitochondrial inner membrane, resulting in increased ATP production. This is particularly important for the cardiac muscle and the proper functioning of the heart. The direct impact of CoQ10 on conditions such as heart failure (HF) or myocardial infarction is further enhanced by its potent antioxidant properties. These properties are due to CoQ10’s redox forms (ubiquinone, semi-ubiquinone, and ubiquinol), which act within the mitochondrial membrane, other cell membranes, plasma, and cytoplasm. CoQ10’s antioxidant properties not only support the electron transport chain in mitochondria but also aid in recycling other antioxidants like vitamins C and E.

In addition to its role in energy metabolism, CoQ10’s functions significantly impact cardiovascular health, influencing the endothelial and vascular systems. This, in turn, affects the incidence, etiology, and progression of other CVDs, such as coronary artery disease (CAD). Given these critical roles, this review examines the latest research on CoQ10’s effects on cardiovascular health, exploring current knowledge and future perspectives.

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