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.
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:
- significantly reduced cardiovascular mortality
- significantly better heart function shown on echocardiograms
- significantly lower concentrations of the pro-hormone NT-proBNP, a biomarker for heart failure
- significantly improved health-related quality of life and fewer days in hospital
Moreover, the beneficial effect of the combined selenium and CoQ10 supplementation persisted through year 12 of follow-up in the supplemented group and also in supplemented subgroups with diabetes, hypertension, ischemic heart disease, and reduced functional capacity due to impaired cardiac function [Alehagen 2018a].
The KiSel-10 Study of Combined Selenium and Coenzyme Q10 Supplementation
In the KiSel-10 study, the researchers enrolled 443 elderly Swedish citizens with low selenium and CoQ10 status. They randomly assigned the study participants to an active treatment group (200 mcg selenium and 200 mg Coenzyme Q10 daily) or to a placebo treatment group [Alehagen 2020a].
- Serum selenium status at the start of the study: 67.1 mcg/L
- Serum selenium status after 48 months of supplementation: 210.3 mcg/L in the active treatment group and 72 mcg/L in the placebo group
- Coenzyme Q10 status at the start of the study: 0.82 mg/L
- Coenzyme Q10 status after 48 months of supplementation: 2.17 mg/L in the active treatment group and no significant change in the placebo group
Significant Outcomes of Combined Selenium and Coenzyme Q10 Supplementation
The data from the KiSel-10 study showed the following significant outcomes in the active treatment group compared to the placebo group:
- reduced plasma levels of two bio-markers for oxidative damage [Alehagen 2015b]
- reduced plasma levels of six bio-markers for systemic inflammation [Alehagen 2015c; Alehagen 2019]
- reduced serum levels of eight bio-markers for fibrosis [Alehagen 2018b]
- reduced plasma levels of the von Willebrand factor and the plasminogen activator inhibitor-1, both bio-markers for endothelial dysfunction [Alehagen 2020b]
- reduced fructosamine concentration compared with the concentration in the placebo group, which tended to increase. Fructosamine concentration is positively associated with incidence of diabetes and increased blood glucose level [Alehagen 2020a]
- improved renal function in elderly citizens deficient in selenium [Alehagen 2020c]
- prevented an increase in D-dimer levels, which are associated with increased risk of thrombotic disorders [Alehagen 2021 ]
In addition, the data from the KiSel-10 study showed that cardiovascular mortality was higher in the subgroup with the lower serum selenium concentrations (<65 μg/L) in comparison with the subgroup having a higher serum selenium concentration (>85 μg/L) [Alehagen 2016].
Summary: Documented Selenium and Coenzyme Q10 Supplements
We need to remember that retail selenium and CoQ10 supplements are not all equally good.
Based on the available evidence, the selenium-enriched yeast product seems to be the better choice of selenium supplements [Richie 2014].
Absorption and bioavailability of CoQ10 supplements can vary considerably; it is best to choose a CoQ10 supplement with documented absorption and clinical effects [Lopez-Lluch 2019; Mortensen 2014].
Alehagen U, Johansson P, Björnstedt M, Rosén A, Dahlström U. 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. Int J Cardiol. 2013 Sep 1;167(5):1860-6.
Alehagen U, Aaseth J. Selenium and coenzyme Q10 interrelationship in cardiovascular diseases–A clinician’s point of view. J Trace Elem Med Biol. 2015a;31:157-62.
Alehagen U, Aaseth J, Johansson P. 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. 2015b Nov-Dec;41(6):443-52.
Alehagen U, Lindahl TL, Aaseth J, Svensson E, Johansson P. 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. 2015c Sep 16;10(9):e0137680.
Alehagen U, Alexander J, Aaseth J. Supplementation with Selenium and Coenzyme Q10 Reduces Cardiovascular Mortality in Elderly with Low Selenium Status. A Secondary Analysis of a Randomised Clinical Trial. PLoS One. 2016 Jul 1;11(7):e0157541.
Alehagen U, Aaseth J, Alexander J, Johansson P. Still reduced cardiovascular mortality 12 years after supplementation with selenium and coenzyme Q10 for four years: A validation of previous 10-year follow-up results of a prospective randomized double-blind placebo-controlled trial in elderly. PLoS One. 2018a Apr 11;13(4):e0193120.
Alehagen U, Aaseth J, Alexander J, Svensson E, Johansson P, Larsson A. Less fibrosis in elderly subjects supplemented with selenium and coenzyme Q10-A mechanism behind reduced cardiovascular mortality? Biofactors. 2018b Mar;44(2):137-147.
Alehagen U, Alexander J, Aaseth J, Larsson A. Decrease in inflammatory biomarker concentration by intervention with selenium and coenzyme Q10: a subanalysis of osteopontin, osteoprotergerin, TNFr1, TNFr2 and TWEAK. J Inflamm (Lond). 2019 Mar 18;16:5.
Alehagen U, Aaseth J, Alexander J, Johansson P. Supplemental selenium and coenzyme Q10 reduce glycation along with cardiovascular mortality in an elderly population with low selenium status. Journal of Trace Elements in Medicine and Biology. 2020a;61:126541.
Alehagen U, Alexander J, Aaseth J, Larsson A, Lindahl TL. Significant decrease of von Willebrand factor and plasminogen activator inhibitor-1 by providing supplementation with selenium and coenzyme Q10 to an elderly population with a low selenium status. Eur J Nutr. 2020b Dec;59(8):3581-3590.
Alehagen U, Aaseth J, Alexander J, Brismar K, Larsson A. Selenium and Coenzyme Q10 Supplementation Improves Renal Function in Elderly Deficient in Selenium: Observational Results and Results from a Subgroup Analysis of a Prospective Randomised Double-Blind Placebo-Controlled Trial. Nutrients. 2020c Dec 9;12(12):3780.
Alehagen U, Aaseth J, Lindahl TL, Larsson A, Alexander J. Dietary Supplementation with Selenium and Coenzyme Q10 Prevents Increase in Plasma D-Dimer While Lowering Cardiovascular Mortality in an Elderly Swedish Population. Nutrients. 2021 Apr 17;13(4):1344.
Johansson P, Dahlström Ö, Dahlström U, Alehagen U. 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. J Nutr Health Aging. 2015 Nov;19(9):870-7.
López-Lluch G, Del Pozo-Cruz J, Sánchez-Cuesta A, Cortés-Rodríguez AB, Navas P. Bioavailability of coenzyme Q10 supplements depends on carrier lipids and solubilization. Nutrition. 2019 Jan;57:133-140.
Mortensen SA, Rosenfeldt F, Kumar A, Dolliner P, Filipiak KJ, Pella D, Alehagen U, Steurer G, Littarru GP; Q-SYMBIO Study Investigators. The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: results from Q-SYMBIO: a randomized double-blind trial. JACC Heart Fail. 2014 Dec;2(6):641-9.
Richie JP Jr, Das A, Calcagnotto AM, Sinha R, Neidig W, Liao J, Lengerich EJ, Berg A, Hartman TJ, Ciccarella A, Baker A, Kaag MG, Goodin S, DiPaola RS, El-Bayoumy K. Comparative effects of two different forms of selenium on oxidative stress biomarkers in healthy men: a randomized clinical trial. Cancer Prev Res (Phila). 2014 Aug;7(8):796-804.
The information presented in this review article is not intended as medical advice and should not be used as such.
30 January 2022