Selenium and Coenzyme Q10 Combination

The Swedish cardiologist Dr. Urban Alehagen has written persuasively that there exists a special inter-relationship between selenium and Coenzyme Q10 in the prevention of cardiovascular diseases.

Professor Urban Alehagen
Professor Urban Alehagen lecturing about the therapeutic cardiovascular benefits of combined selenium and Coenzyme Q10 supplementation.

Briefly, Prof. Alehagen, together with the Norwegian professor Jan Aaseth, makes the point that low selenium intakes and status could restrict the cells’ ability to get optimal concentrations of Coenzyme Q10 and that the cells need adequate of Coenzyme Q10 to permit optimal function of selenium [Alehagen & Aaseth 2015a].

The clinical outcomes of the KiSel-10 intervention study in which community living Swedish citizens, average age 78 years, were administered selenium and Coenzyme Q10 daily for four years show that combined selenium and Coenzyme Q10 supplementation, compared to placebo treatment, can be beneficial in populations that have low selenium status: read more

Selenium Status and Inflammation and Heart Disease

Low plasma selenium status is significantly associated with heart disease risk and with elevated blood bio-markers of chronic inflammation.  A 2021 cross-sectional study of elderly individuals in central Italy has revealed that individuals with a plasma selenium status lower than 60 mcg/L are especially at risk of heart disease [Giacconi 2021].

Ancona, Italy
Researchers in Ancona, Italy, have done a cross-sectional study that shows that low plasma selenium status is associated with increased risk of heart disease and with elevated levels of blood bio-markers for chronic inflammation.

Moreover, in the peripheral blood mononuclear cells of elderly individuals diagnosed with heart disease, the researchers found that low plasma selenium status was significantly associated with enhanced gene expression of inflammatory cytokines and chemokines and with a downregulation of sirtuins SIRT-1, SIRT-5, SIRT-6, and SIRT-7 [Giacconi 2021].

Note: The peripheral blood mononuclear cells are lymphocytes (e.g., T cells, B cells, NK cells) and monocytes as distinguished from such blood cells as erythrocytes, granulocytes, and platelets. read more

Selenium Status and Mortality and Type 2 Diabetes

Higher serum selenium concentrations are associated with a statistically significant 31% lower all-cause mortality and a statistically significant 34% lower heart disease mortality in individuals with type-2 diabetes [Qiu 2021].

This is the conclusion of researchers who conducted a relatively large cohort study of patients with diabetes with a long follow-up period. They analyzed the data from 3199 American adults with type-2 diabetes; the average follow-up period was 12.6 years [Qiu 2021].

During that follow-up period, 1693 deaths were documented, including 425 heart disease deaths [Qiu 2021].

Highest Quartile of Serum Selenium Compared to Lowest Quartile

Individuals in the highest quartile of serum selenium concentration had significantly lower all-cause mortality rates and significantly lower heart disease mortality rates when compared with individuals in the lowest quartile of serum selenium concentration [Qiu 2021]. read more

Plasma Selenoprotein P Levels and the Risk of Cardiovascular Disease

Research conclusion: “The 20% with lowest SELENOP concentrations in a N orth European population without history of cardiovascular disease have markedly increased risk of cardiovascular morbidity and mortality” [Schomburg 2019].

Heart attack
Selenoprotein-P deficiency predicts cardiovascular disease and death. Low selenium intakes result in sub-optimal bio-synthesis of selenoprotein P in the liver. Now, research shows that low selenoprotein P concentrations are associated with increased risk of cardiovascular disease and mortality.

This is the conclusion from the Malmö Preventive Project, a population-based prospective cohort study in southern Sweden, that examined the relationship between plasma selenoprotein P status and 1) risk of all-cause mortality, 2) risk of cardiovascular mortality, and 3) risk of a first cardiovascular event in 4366 study participants.

Note that this was a study done with study participants who had no history of cardiovascular disease. It was truly a study of the relationship between selenium status and the risk of heart disease. read more

Selenium and Heart Failure Risk

Cardiologists at the University of Groningen in The Netherlands have published a comprehensive review of the current knowledge about selenium deficiency and the role of selenoproteins in heart failure patients [Al-Mubarak 2021].

Cardiologist
Heart failure is a form of heart disease with high morbidity and mortality and with increasing prevalence. It is estimated that there are more than 26 million heart failure patients worldwide. Suboptimal selenium intakes and status adversely affect heart muscle function.

The key points in their review are as follows:

  • Selenium is an essential micronutrient. It is incorporated into 25 different selenoproteins that have many biological functions in the body.
  • Suboptimal selenium intakes and status lead to the impaired cellular synthesis of these selenoproteins and to the diminished function of selenoproteins, which may aggravate oxidative stress and inflammation, both of which are associated with greater severity of heart failure.
  • 70% of patients diagnosed with heart failure have suboptimal serum selenium levels (below 100 micrograms per liter).
  • The heart failure patients with suboptimal serum selenium concentrations have lower exercise capacity, lower quality of life, and a worse prognosis than heart failure patients with serum selenium concentrations above 100 mcg/L.
  • Clinical trials of the efficacy of selenium supplementation in patients with heart failure have shown improved clinical symptoms such as improvements in NYHA function class, in left ventricular ejection fraction, and in lipid profile.
Selenium Deficiency and Heart Failure
Observational Studies of Selenium Concentration and Heart Failure

Three meta-analyses have provided evidence of a relationship between selenium status and the risk of heart disease:

Studies of Selenium Supplementation – the KiSel-10 Study

The most interesting clinical study is the KiSel-10 study in which elderly community living citizens, average age 78 years, with low selenium status (mean baseline status: 67.1 mcg/L), were treated with a combination of 200 mcg of an organic high-selenium yeast preparation and 200 mg of Coenzyme Q10 daily for four years. read more

Selenium Deficiency A Big Risk Factor for Heart Disease

Ash tray with cigarette butts
In the Italian study (Giacconi et al. 2021), only smoking ranked above selenium deficiency as a risk factor for heart disease. Age, BMI, cholesterol and triglyceride levels, and gender all ranked lower than selenium deficiency as risk factors for heart disease.

Results from an Italian study have added to the evidence that adequate selenium status is necessary to prevent heart disease, especially in elderly individuals.

The Italian study data showed that study participants with plasma selenium concentrations below 60 micrograms per liter were 1.9 times more likely to suffer from cardiovascular disease compared to study participants with higher selenium status [Giacconi 2021].

Reduced plasma selenium status was associated with elevated levels of biomarkers of inflammation, increased expression of cytokines, and down-regulation of sirtuins in peripheral blood mononuclear cells [Giacconi 2021].

Selenium Status and Risk of Cardiovascular Disease

The KiSel-10 Study Results

In a clinical trial with combined selenium and Coenzyme Q supplementation of elderly citizens, average age: 78 years, with low selenium status (mean: 67.1 micrograms per liter), for 48 months, researchers found reduced cardiovascular mortality after 10 and 12 years of follow-up [Alehagen 2018, 2015). read more

Selenium and Antioxidants to Prevent Heart Disease

Heart trouble
Selenium deficiency (< 70 mcg/L) and low selenium status (70 – 100 mcg/L) are associated with reduced exercise capacity and higher risk of death in heart failure patients [Bomer 2019].
Canadian researchers have concluded that the addition of selenium should be considered for antioxidant supplements if the antioxidant mixtures are to be associated with reductions in the risk of heart disease and all-cause mortality [Jenkins 2020].

How did they arrive at this conclusion? First, they did a preliminary analysis of the available research literature and found that antioxidant supplements seemed to reduce incidence of all-cause death when the supplements included selenium [Jenkins 2020].

Systematic Review of Supplements With and Without Selenium

Next, they did a systematic review and meta-analysis of randomized controlled trials to evaluate the effect of selenium supplementation alone and the effect of antioxidant mixtures with or without selenium on the risk of heart disease and all-cause mortality [Jenkins 2020]. read more

Effect of Selenium Supplementation on Heart Health

Chambers of the heart
The American Heart Association defines heart failure as a condition in which the heart muscle cannot pump enough blood out to the body to keep the tissues and organs sufficiently supplied with oxygen. Heart failure is a condition for which there is no known cure. Selenium deficiency is associated with worsening heart failure.

Selenium is an essential antioxidant trace element that is necessary for key activities in human metabolism [Djalalinia 2019]. Meta-analyses of randomized controlled trials of selenium supplementation reveal that selenium supplementation is a cost-effective and simple-to-use intervention that can play an important role in the prevention of heart disease risk factors [Hasani 2018; Hasani 2019; Mahdavi 2019; Tabrizi 2017].

These results from meta-analyses of randomized controlled trials reaffirm the outcomes in the Bomer multinational observational cohort study. In that study, heart failure patients with serum selenium concentrations below 70 micrograms per liter were more likely to have the following characteristics [Bomer 2019]: read more

Selenium and Coenzyme Q10 for Senior Citizens

Professor Urban Alehagen
Like a good detective inspector, Professor Urban Alehagen has investigated the biological mechanisms that could explain how combined selenium and Coenzyme Q10 supplementation reduces the risk of death from heart disease in senior citizens. Among the suspects that he has investigated are oxidative stress, systemic inflammation, fibrosis, and endothelial function.

Four years of daily supplementation with 200 micrograms of a patented high-selenium yeast and 200 milligrams of Coenzyme Q10 (in divided doses: 2 x 100 milligrams) has lowered the risk of dying from cardiovascular disease significantly by 54% (p=0.02) [Alehagen 2013].

The study participants were senior citizens aged 70-88 years (average age: 78 years) who were still able to live at home.

Professor Urban Alehagen and a team of researchers from Linköping University in Sweden randomly assigned the senior citizens to take the active treatment (selenium plus Coenzyme Q10) or matching placebos in a double-blind clinical study named the KiSel-10 Study [Alehagen 2013].

Improved Heart Function with Coenzyme Q10 and Selenium

Compared to the senior citizens in the placebo group, the senior citizens in the active treatment group had a significant improvement in heart function as measured on echocardiograms compared to placebo (p=0.03) and a significant improvement in a biochemical marker, NT-proBNP (p=0.014). NT-proBNP is a reliable indicator for heart disease; the heart muscle typically produces more of the NT-proBNP protein whenever the heart is exposed to stress or injury [Alehagen 2013]. read more

Selenium Status and Heart Failure

Heart failure patients with low serum selenium levels are much more likely to be re-hospitalized and/or to die than are heart failure patients with serum selenium levels above 100 micrograms per liter.

A multi-national cohort study has shown that selenium deficiency in heart failure patients is associated with impaired exercise tolerance and with a 50% higher mortality rate [Bomer].

In-vitro studies of cultured human heart muscle cells from the heart failure patients show that  low selenium levels in the heart muscle cells are associated with impaired mitochondrial function [Bomer].

Recent information shows that up to 50% of heart failure patients suffer from some form of micronutrient insufficiency, e.g. selenium, zinc, iron, or iodine [Bomer].

Selenium: An Essential Micronutrient

Selenium intakes and status vary considerably from geographical region to region according to the content of selenium in the soil and in the food.

Sufficient intakes of selenium are necessary for important biological functions: read more