Leading cardiologists in Sweden conducted a four-year study — the KiSel-10 study — of 443 of the elderly Swedish citizens and found that a prophylactic treatment with 200 micrograms of high-selenium yeast and 200 milligrams of Coenzyme Q10 daily reduces the risk of dying from heart disease by over 50 per cent. This is an immensely interesting study result because heart disease is the number one killer in Western countries.
The KiSel-10 Study
The KiSel-10 clinical trial — a randomized, double-blind, placebo-controlled study– investigated the effect of a combination of high-selenium yeast tablets and Coenzyme Q10 capsules, as compared with matching placebo capsules and tablets, on the following outcomes:
- risk of death from heart disease
- risk of age-related decline in heart function
- risk of changes in blood concentrations of proteins known to be bio-markers for heart failure
In the period from 2013 to 2018, the KiSel-10 researchers published 12 papers analyzing and explaining the data from the KiSel-10 study. In the text that follows, I summarize the lessons from the KiSel-10 clinical study.
Low serum selenium concentrations and increased risk of mortality
Professor Alehagen and the Linköping University researchers measured the serum selenium levels of 668 healthy elderly citizens in a rural community in southern Sweden. The mean serum selenium concentration in the group was 67.1 micrograms per liter, well below the minimum recommended level of 100 – 120 micrograms per liter and the estimated beneficial range of 120-150 micrograms per liter [Hurst 2010].
An analysis of a sub-set of the 668 participants, after nearly seven years of follow-up, showed that placement in the lowest quartile of serum selenium concentration – below 57 micrograms per liter – was significantly associated with a 43% greater risk of death from all causes and a 56% greater risk of death from heart disease. The researchers recommended selenium supplementation for Swedish citizens with low serum selenium concentrations [Alehagen 2016].
Supplementation with high-selenium yeast and Coenzyme Q10 combination
The researchers enrolled and randomly assigned 443 healthy elderly Swedish citizens to either an active treatment group or a placebo control group. The participants in the active treatment group took 200 micrograms of the enriched selenium yeast preparation and 200 milligrams of the Coenzyme Q10 preparation daily for four years.
In 2013, the researchers published the first statistically significant results from the study data [Alehagen 2013; Johansson 2013]:
- reduction of the risk of death from heart disease by 54%
- improvement of heart function as seen on echocardiograms
- reduction in the levels of a known bio-marker for heart failure
Selenium and Coenzyme Q10 and inflammation
Next, the researchers mined the study data for evidence of a significant association between the active treatment with high-selenium yeast and Coenzyme Q10 and a bio-marker for inflammation – C-reactive proteins – and a bio-marker for oxidative stress – soluble platelet sP-selectin proteins. The supplementation with high-selenium yeast and Coenzyme Q10 over a four-year period showed beneficial changes in the bio-markers [Alehagen 2015].
Selenium and Coenzyme Q10 and oxidative stress
Further mining of the study data revealed beneficial effects of the combination supplementation on additional bio-markers for oxidative stress. Compared to the participants in the placebo group, the participants in the active treatment group had significantly better outcomes in the measurement of the bio-markers for oxidative stress: copeptin and adrenomedullin [Alehagen 2015].
Selenium and Coenzyme Q10 and hospitalization and quality of life
Then, the researchers did a sub-analysis of the data in which they matched study participants for age, gender, and baseline cardiac wall tension. They discovered that the average number of days not hospitalized was significantly higher for the active treatment study participants compared to the average number of days the placebo group participants did not need hospitalization [Johansson 2015].
Moreover, the data showed that study participants in the selenium and Coenzyme Q10 treatment group did not have the age-related declines in cognitive function, nervous system function, physical activity, and overall quality of life that the study participants in the placebo group did [Johansson 2015].
Ten-year follow-up of the effect of selenium and Coenzyme Q10
Ten years after the beginning of the KiSel-10 study, the Swedish researchers used death certificate and autopsy report information to track the study participants who had died in the intervening years. Their research showed that the effect of the combination supplementation – significantly reduced risk of death from heart disease – had persisted for the entire ten-year follow-up period in both males and females [Alehagen 2015].
Selenium and Coenzyme Q10 for individuals with low serum selenium
Continuing to analyze the study data in ever greater depth, the researchers found that the combination supplementation with high-selenium yeast and Coenzyme Q10 had conferred the greatest heart health protection benefits on study participants with serum selenium levels below 85 micrograms per liter [Alehagen 2016].
Special inter-relationship of selenium and Coenzyme Q10
In 2015, Professor Alehagen (Sweden) and Professor Aaseth (Norway) wrote a theoretical explanation for the clinical success of the supplementation of elderly Swedish citizens with high-selenium yeast and Coenzyme Q10. They stressed the antioxidant role of various selenoproteins, including the glutathione peroxidases and selenoprotein P, and of Coenzyme Q10 in its reduced form. In addition, they cited research that has showed that inadequate concentrations of selenium can prevent the cells from getting sufficient quantities of Coenzyme Q10 and that inadequate levels of Coenzyme Q10 may inhibit the optimal selenium function. They asserted that there exists a special inter-relationship between selenium and Coenzyme Q10 in the body [Alehagen & Aaseth 2015].
Selenium and Coenzyme Q10 and heart protection
In 2017, the Swedish researchers continued to search for biological mechanisms by which the combination of high-selenium yeast and Coenzyme Q10 confers heart protection benefits on elderly people. They found 1) that, compared to the placebo, the high-selenium yeast and Coenzyme Q10 supplementation was associated with significant differences the expression of as many as 70 different microRNAs and 2) that, compared to placebo, the high-selenium and Coenzyme Q10 treatment was associated with significantly increased insulin-like growth factor-1 levels [Alehagen 2017].
Note: MicroRNAs are thought to play an important role in the development of heart disease and diabetes. Insulin-like growth factor proteins are thought to have anti-inflammatory and anti-oxidative effects.
Selenium and Coenzyme Q10 and fibrosis
Analysis of study data showed significantly reduced blood concentrations of seven of the eight bio-markers of fibrogenic activity in the selenium and Coenzyme Q10 treatment group as compared to the placebo group. The association between the combination supplementation and the reduction in the bio-markers of fibrosis may partially explain the reduced risk of death from heart disease in the elderly study participants in the active treatment group. The development of excess fibrous tissue depositions in the heart muscle or heart valves can increase the risk of heart failure.
Summary
Daily supplementation with a combination of high-selenium yeast tablets and Coenzyme Q10 capsules reduced the risk of death from heart disease in elderly healthy citizens.
Sources
Alehagen, U., Johansson, P., Björnstedt, M., Rosén, A., Post, C., & Aaseth, J. (2016). Relatively high mortality risk in elderly Swedish subjects with low selenium status. European Journal of Clinical Nutrition, 70(1), 91-96. doi:10.1038/ejcn.2015.92
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. doi:10.1016/j.ijcard.2012.04.156
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. doi:10.1371/journal.pone.0137680
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. doi:10.1002/biof.1245
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. doi:10.1371/journal.pone.0141641
Alehagen, U., Alexander, J., & Aaseth, J. (2016). 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, 11(7), e0157541. doi:10.1371/journal.pone.0157541
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. doi:10.1016/j.jtemb.2014.11.006
Alehagen, U., Johansson, P., Aaseth, J., Alexander, J., & Wågsäter, D. (2017). Significant changes in circulating microRNA by dietary supplementation of selenium and Coenzyme Q10 in healthy elderly males. A subgroup analysis of a prospective randomized double-blind placebo-controlled trial among elderly Swedish citizens. Plos One, 12(4), e0174880. doi:10.1371/journal.pone.0174880
Alehagen, U., Johansson, P., Aaseth, J., Alexander, J., & Brismar, K. (2017). Increase in insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 1 after supplementation with selenium and Coenzyme Q10. A prospective randomized double-blind placebo-controlled trial among elderly Swedish citizens. Plos One, 12(6), e0178614. doi:10.1371/journal.pone.0178614
Alehagen, U., Aaseth, J., Alexander, J., Svensson, E., Johansson, P., & Larsson, A. (2017). Less fibrosis in elderly subjects supplemented with selenium and coenzyme Q10-A mechanism behind reduced cardiovascular mortality? Biofactors (Oxford, England), doi:10.1002/biof.1404
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. doi:10.3109/14017431.2013.820838
Hurst, R., Armah, C. N., Dainty, J. R., Hart, D. J., Teucher, B., Goldson, A. J., & Fairweather-Tait, S. J. (2010). Establishing optimal selenium status: results of a randomized, double-blind, placebo-controlled trial. The American Journal of Clinical Nutrition, 91(4), 923-931.
Johansson, P., Dahlström, Ö., Dahlström, U., & 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(9), 870-877. doi:10.1007/s12603-015-0509-9
Disclaimer: The information presented in this review article is not intended as medical advice and should not be construed as such.