A randomised, double-blind, placebo-controlled trial of L-carnitine in suspected acute myocardial infarction

Abstract

SummaryIn a randomised, double-blind placebocontrolled trial, the effects of the administration of oral L-carnitine (2 g/ day) for 28 days were compared in the management of 51 (carnitine group) and 50 (placebo group) patients with suspected acute myocardial infarction. At study entry, the extent of cardiac disease, cardiac enzymes and lipid peroxides were comparable between the groups, although both groups showed an increase in cardiac enzymes and lipid peroxides. At the end of the 28-day treatment period, the mean infarct size assessed by cardiac enzymes showed a significant reduction in the carnitine group compared to placebo. Electrocardiographic assessment of infarct size revealed that the QRS-score was significantly less in the carnitine group compared to placebo (7.4 ± 1.2 vs 10.7 ± 2.0), while serum aspartate transaminase and lipid peroxides showed significant reduction in the carnitine group. Lactate dehydrogenase measured on the sixth or seventh day following infarction showed a smaller rise in the carnitine group compared to placebo. Angina pectoris (17.6 vs 36.0%), New York Heart Association class III and IV heart failure plus left ventricular enlargement (23.4 vs 36.0%) and total arrhythmias (13.7 vs 28.0%) were significantly less in the carnitine group compared to placebo. Total cardiac events including cardiac deaths and nonfatal infarction were 15.6% in the carnitine group vs 26.0% in the placebo group. It is possible that L-carnitine supplementation in patients with suspected acute myocardial infarction may be protective against cardiac necrosis and complications during the first 28 days.

New Developments in Coenzyme Q10 Research Contributed by A Single Group. Editorial

“…Finally, Singh et al conducted a randomized, double blind, placebo controlled trial of CoQ10 in patients with acute myocardial infarction showing significant decrease in cardiac end points for the first time in the literature [21]. Effect of hydrosoluble CoQ10 causing a decline in insulin levels in hypertensive patients with coronary artery disease and reduction in serum concentration of lipoprotein(a) among acute myocardial infarction (AMI) patients were also observed for the first time by Singh et al in 1999 [22,23].…”

Randomized, Double Blind, Placebo Controlled Trial of Hydrosoluble Ubiquinol and Carnitine in Patients with Heart Failure: Longterm Follow up Results in the Tishcon Study

“…In chronic heart failure, endothelial dysfunction contributes to functional impairment, which may be modulated by oral CoQ supplementation resulting into better endothelial-dependent relaxation of coronary as well as peripheral arteries causing better functional capacity of the patients [4,10]. There is evidence that coenzyme Q and carnitine may be beneficial in patients with heart failure [4][5][6][7][8][9][10][11][12][13][14][15]18].…”

Synthesis of Coenzyme Q10

“…The fact that the levels of endogenous CoQ 10 in the heart decreases during ischemic heart disease including heart failure prompted clinical trials with CoQ 10 in patients that suffered from heart failure [3] . Randomized, double blind, placebo-controlled trials of oral administration of CoQ 10 have confirmed the effectiveness of CoQ 10 in improving angina episodes, arrhythmias and left ventricular function in patients with acute myocardial infarction [4] . CoQ 9 is found in rodents like mice and rats, while CoQ 6 , CoQ 7 and CoQ 8 , are found in yeast and bacteria [5,6] The majority of CoQ 9 in rat liver is present in its reduced form (ubiquinol), which exerts its antioxidative function [7] .…”