The notion that the greatest biohack of all is to extend lifespan and healthspan is centuries old but is the focus of many researchers and companies. I recently co-moderated a symposium on immortality and the roundtable conversation centered on an optimal lifestyle combined with the possibility of stem cell and exosome therapy, senolytic drugs like methotrexate, and parabiosis (infusing young blood products into the elderly). While there is much hope for these types of treatments, none are established in the medical literature, nor are they widely available or affordable for most.
What if there was an easier approach right now, of low cost and high safety, proven in the peer reviewed medical literature, but largely ignored in practice? I suggest that there is at least one to add to an optimal lifestyle and it involves supplementation with a combination of selenium and coenzyme Q10 (Se/coQ10). What is the background and evidence for this combination? Selenium is an essential constituent of several proteins, including the glutathione peroxidases and selenoprotein P (SEPP1) necessary for optimal anti-oxidant defenses. A deficiency in anti-oxidative capacity is a part of the pathophysiology of various illnesses, in particular atherosclerotic disease. Ischemic heart disease and heart failure are two conditions where increased oxidative stress has been demonstrated. Coq10 reduces oxidative stress, minimizes damage to mitochondria, and helps generate new mitochondria.
The combination of Se/coQ10 should lead to a more “fuel-efficient” body better equipped to carry out functions with less damage. This may be especially important for the protection of the heart. Unfortunately, some regions have soil values and diets low in selenium (particularly European countries) and natural levels of coQ10 begin to fall as early as age 20. Therefore, the idea of supplementing Se/coQ10 makes sense in optimizing cardiovascular function. But does it work?
Indeed, no guesswork is needed as the study has been done and long-term follow up is remarkable. Prior to the current series of studies, an investigation of the effect of coQ10 on survival in a population of patients with congestive heart failure proved to reduce mortality. Similarly, adequate selenium intake has been associated with reduced mortality in meta-analyses, but the dose may matter and excessive amounts may actually be adverse to survival in some studies.
The Swedish Study: Results at 5 Years
Researchers in Sweden designed a 5-year prospective randomized double-blind placebo-controlled trial among citizens aged 70 to 88. They enrolled 443 healthy participants that were given a combined supplementation of Se 200 ug/Q10 200 mg or a placebo for 4 years. Clinical examinations, echocardiography and biomarker measurements were performed. Participants were monitored every 6th month throughout the intervention. The study flow was described in a figure below.
During a follow up time of 5.2 years a significant reduction of cardiovascular mortality was found in the active treatment group vs. the placebo group (5.9% vs. 12.6%; P=0.015). NT-proBNP levels, a biomarker elevated in the presence of cardiac dysfunction, were significantly lower in the active group compared with the placebo group (mean values: 214 ng/L vs. 302 ng/L at 48 months; P=0.014). The results of the proBNP levels were reported separately. Using echocardiography a significant better cardiac function score was found in the active supplementation compared to the placebo group (P=0.03). The figure below demonstrates the differences in the survival curves.
The Swedish Study: Results at 10 Years
Even though 443 initially healthy study participants were enrolled on active supplementation or placebo for 4 years, follow-up at 10 years was quite instructive. Significantly reduced cardiovascular mortality could be seen in those on Se/coQ10 intervention that was statistically significant. Subgroup analysis showed positive effects in both genders. A risk reduction could be seen in those with ischemic heart disease. The protective action was not confined to the intervention period but persisted during the follow-up period as can be seen below. A reduced all-cause mortality was also observed.
The Swedish Study: Results at 12 years
After 12 years of follow-up a significantly reduced CV mortality could be seen in those supplemented with Se/coQ10 for the first 4 years (in a randomized, double-blind manner), with a cardiovascular mortality of 28.1% in the active treatment group, and 38.7% in the placebo group. In the study subjects with ischemic heart disease, diabetes, hypertension and impaired functional capacity it was also demonstrated a significantly reduced CV mortality risk. The researchers indicated that while the mechanisms behind this effect remain to be fully elucidated, various effects on cardiac function, oxidative stress, fibrosis and inflammation have been identified. The survival curves in terms of cardiovascular mortality are shown here.
What About Quality of Life with Se/coQ10?
To study hospital admissions and quality of life (QoL) in these older study participants, all admissions to the Department of Internal Medicine or Cardiology were assed. QoL was measured with the Short Form-36 (SF-36), the Cardiac Health Profile (CHP) and one item overall-quality of life (overall-QoL). A total of 206 participants were evaluated after 48 months. The mean number of days out of hospital was 1779 for those taking the active substance compared to 1533 for those taking the placebo (p=0.03). Those with active substance declined significantly less in the QoL measures of physical role performance (p=0.001), vitality (p=0.001), physical component score (p=0.001), overall QoL (p=0.001), somatic dimension (p=0.001), conative dimension (p=0.001) and global function. In a match-group analysis Se/CoQ10 increased the number of days out of hospital and slowed the deterioration in QoL.
Are There Any Further Clues to How Se/coQ10 Provide Benefit?
In order to study whether the combination of Se/coQ10 result in changes in microRNA levels, providing potentially important information on the mechanisms behind the clinical effects of supplementation, 25 participants from each group were randomized and evaluated regarding levels of microRNA. Significant difference in microRNA expression between the two groups. When comparing the post-treatment microRNAs in the active and the placebo groups, 70 microRNAs exhibited significant differences in expression, also after adjustment for multiple measurements. For the 20 microRNAs with the greatest difference in expression the difference was up to more than 4-fold. The authors indicated that the changes in microRNA could be a part of mechanisms underlying the clinical effects earlier reported that reduced cardiovascular mortality, gave better cardiac function, and showed less signs of inflammation and oxidative stress following the intervention.