The heart muscle tissue is frequently the first tissue in humans to suffer damage caused by selenium deficiency. When the cell membranes in the heart muscle tissue are damaged by the action of harmful free radicals (this is called oxidative damage), many of the healthy heart muscle cells are replaced by fibrous tissue. The resulting condition is called cardiomyopathy.
Cardiomyopathy is a disease of the heart muscle in which the heart is enlarged, thick, and rigid [Mayo Clinic]. As the cardiomyopathy worsens, the weakened heart muscle is less and less able to pump adequate quantities of blood to carry oxygen and nutrients to the cells and tissues throughout the body. Eventually, symptoms such as shortness of breath, early fatigue, and swelling in the legs and feet and abdomen appear, the symptoms of chronic heart failure.
6 million cases of chronic heart failure in the USA
Cardiomyopathy is one of the major causes of chronic heart failure. Approximately six million Americans suffer from chronic heart failure. Approximately 700,000 new cases of heart failure develop each year [Columbia Doctors]. Quality of life is often severely diminished for chronic heart failure patients.
Selenium’s antioxidant defense function
One of the major biological functions of selenium is to be incorporated into the amino acid selenocysteine, which, itself, becomes a constituent component of antioxidant enzymes such as the glutathione peroxidases, the thioredoxin reductases, and selenoprotein P. These selenoproteins serve to neutralize the oxidative damage caused by harmful free radicals. If unchecked, the free radicals will damage proteins and cell membranes, cell DNA, and cell lipids.
Selenium’s anti-inflammatory effect
The antioxidant function of selenium is a critical one for all of us and especially for individuals at risk of heart disease. Additionally, selenium has an anti-inflammatory effect, which may help to lessen the impact of heart disease. For example, lowered selenium levels are known to be common following heart surgery; administration of selenium can have anti-inflammatory effects and can prevent endothelial dysfunction [Fink].
What is endothelial dysfunction? The endothelium is the layer of cells lining the inside of the blood vessels and the heart. These endothelial cells release factors that have the effect of dilating or constricting the blood vessels and thus increasing or decreasing blood pressure. Both Coenzyme Q10 and the selenium containing glutathione peroxidases and thioredoxin reductases are known to be necessary for the proper functioning of the endothelial cells.
Oxidative damage in heart disease
Professor Urban Alehagen, Linköping University, Sweden, states that increased oxidative stress is strongly implicated in the development and severity of both ischemic heart disease and chronic heart failure [Alehagen & Aaseth, 2015].
We have described heart failure above. Ischemic heart disease is heart disease caused by reduced blood supply to the heart. Typically, ischemic heart disease is caused by reduced or blocked blood flow in the coronary arteries, which is a consequence of atherosclerosis (the build-up of plaque inside the walls of the arteries).
Selenium’s special interaction with Coenzyme Q10
Both selenium, in the antioxidant selenoproteins glutathione peroxidase and selenoprotein P, and Coenzyme Q10, in its reduced form ubiquinol, have an antioxidant function. Both serve to lessen the extent of oxidative stress [Alehagen & Aaseth 2015].
Selenium and Coenzyme Q10 and oxidative stress
Oxidative stress can be defined as an unhealthy imbalance between harmful free radicals and protective antioxidants. Oxidative damage is, then, the damage caused to cells by a surplus of harmful free radicals.
Oxidative damage is implicated both in chronic diseases such as heart disease and in the ageing process. The mitochondria – the so-called “energy factories” inside the cells – and other components of the cells are necessarily producing free radicals as they perform their intended metabolic functions.
Selenium and Coenzyme Q10 and free radicals
Free radicals are unstable and very reactive molecules that can trigger harmful chains of chemical reactions. Some free radicals are needed for cell signaling activities and for gene expression and for apoptosis (programmed cell death that eliminates ageing cells and damaged cells in a controlled way).
The theory of oxidative damage holds that a surplus of free radicals can cause extensive cell and DNA damage, leading to chronic degenerative diseases and to accelerated ageing. Antioxidants such as the selenium-dependent enzymes and Coenzyme Q10 neutralize the excesses of free radical activity.
The KiSel-10 study supplementation with selenium and Coenzyme Q10
Beginning in 2013, Professor Alehagen and his team of researchers have been reporting the results of the KiSel-10 study, a well-controlled, four-year study in which healthy elderly citizens were given a daily supplement consisting of 200 micrograms of an organic high-selenium yeast preparation and 200 milligrams of Coenzyme Q10 or matching placebos. The Coenzyme Q10 used was the same Coenzyme Q10 used in the Q-Symbio study done with chronic heart failure patients [Mortensen 2014].
Research results of the KiSel-10 selenium and Coenzyme Q10 study
Professor Alehagen and his research team have reported the following results for the study participants taking the selenium and Coenzyme Q10 supplements as compared with the study participants taking placebo supplements [Alehagen 2013, 2105]:
- A 54% reduction in the risk of dying from heart disease
- A reduction in the concentration of the NT-proBNP protein, which is a bio-marker for heart disease
- A reduction in the concentrations of the C-reactive protein and the sP-Selectin protein, which are bio-markers for inflammation and for oxidative stress, respectively
- A reduction in hospitalizations and improvements in physical performance, vitality, and cognitive function
- A reduction in the decline in heart function that is normally associated with ageing
Reduced risk of death from heart disease ten years later
Follow-up studies carried out by Dr. Alehagen and his fellow researchers have shown that the protective effect of the supplementation with selenium and Coenzyme Q10 has persisted to the point ten years following the beginning of the four-year intervention [Alehagen, Aaseth, & Johansson 2015].
What have we learned from the KiSel-10 study?
What did supplementation of healthy elderly citizens with a combination of high selenium yeast and Coenzyme Q10 (ubiquinone form) accomplish?
- reduced the risk of death from heart disease
- slowed the rate of decline of the ageing heart
- reduced the extent of inflammation and oxidative stress
- gave a better quality of life
Alehagen, U., Johansson, P., Björnstedt, M., Rosén, A., & Dahlström, U. (2013). Cardiovascular mortality and N-terminal-proBNP reduced after combined selenium and coenzyme Q10 supplementation: a 5-year prospective randomized double-blind placebo-controlled trial among elderly Swedish citizens. International Journal of Cardiology, 167(5), 1860-1866.
Alehagen, U., & Aaseth, J. (2015). Selenium and coenzyme Q10 interrelationship in cardiovascular diseases–A clinician’s point of view. Journal of Trace Elements in Medicine and Biology, 31157-162.
Alehagen, U., Aaseth, J., & Johansson, P. (2015). Less increase of copeptin and MR-proADM due to intervention with selenium and coenzyme Q10 combined: Results from a 4-year prospective randomized double-blind placebo-controlled trial among elderly Swedish citizens. Biofactors (Oxford, England), 41(6), 443-452.
Alehagen, U., Lindahl, T. L., Aaseth, J., Svensson, E., & Johansson, P. (2015). Levels of sP-selectin and hs-CRP Decrease with Dietary Intervention with Selenium and Coenzyme Q10 Combined: A Secondary Analysis of a Randomized Clinical Trial. Plos One, 10(9), e0137680.
Alehagen, U., Aaseth, J., & Johansson, P. (2015). Reduced Cardiovascular Mortality 10 Years after Supplementation with Selenium and Coenzyme Q10 for Four Years: Follow-Up Results of a Prospective Randomized Double-Blind Placebo-Controlled Trial in Elderly Citizens. Plos One, 10(12), e0141641.
Columbia Doctors. (2106). Cardiomyopathy and congestive heart failure. Retrieved from http://columbiasurgery.org/conditions-and-treatments/cardiomyopathy-and-congestive-heart-failure.
Fink, K., Moebes, M., Vetter, C., Bourgeois, N., Schmid, B., Bode, C., & … Busch, H. (2015). Selenium prevents microparticle-induced endothelial inflammation in patients after cardiopulmonary resuscitation. Critical Care (London, England), 19, 58.
Johansson, P., Dahlström, Ö., Dahlström, U., & Alehagen, U. (2013). Effect of selenium and Q10 on the cardiac biomarker NT-proBNP. Scandinavian Cardiovascular Journal: SCJ, 47(5), 281-288.
Johansson, P., Dahlström, Ö., Alehagen, U. (2015). Improved health-related quality of life, and more days out of hospital with supplementation with selenium and coenzyme Q10 combined. Results from a double blind, placebo-controlled prospective study. The Journal of Nutrition, Health & Aging, 19,4, 1-8.
Mayo Medical Laboratories. (2017.) Test ID: SES; selenium, serum. Retrieved from http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/9765.
Mortensen, S. A., Rosenfeldt, F., Kumar, A., Dolliner, P., Filipiak, K. J., Pella, D., & Littarru, G. P. (2014). The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: results from Q-SYMBIO: a randomized double-blind trial. JACC. Heart Failure, 2(6), 641-649.