Coenzyme Q10 in patients undergoing CABG: Effect of statins and nutritional supplementation.

BACKGROUND: The hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) are effective cholesterol lowering medications, however, statins may interfere with CoQ(10) biosynthesis. We examined the effect of statin therapy as well as nutritional supplements on plasma, cardiac and skeletal muscle concentrations of CoQ(10). METHODS: Forty patients with left ventricular dysfunction had fasting blood samples collected at baseline and following four weeks of supplementation (150mg/day of CoQ(10)). Cardiac and skeletal muscle biopsies were collected at the time of surgery and frozen in liquid nitrogen until analyzed for CoQ(10) levels by high performance liquid chromatography. RESULTS: Nutrient supplementation significantly increased plasma [(1.8 (1.2, 2.7) vs 0.8 (0.6, 0.94) mug/ml plasma, median+IQR; p=0.001)] and cardiac tissue concentrations of CoQ(10) [(120.5 (76.5, 177.1) vs 87.3 (60.5, 110.8) nmol/g wet weight, p=0.04)]. No effect of supplementation was seen on samples of skeletal muscle from the chest wall. Statin therapy was not found to influence plasma, cardiac or chest wall levels of CoQ(10). CONCLUSION: Nutrient supplementation significantly increased plasma and cardiac tissue levels of CoQ(10) but did not influence chest wall muscle concentrations. Statin therapy did not significantly influence tissue concentrations of CoQ(10). Longer term studies are needed to confirm this observation.

Thrombotic microangiopathy in association with cytomegalovirus infection in a renal transplant patient: a new treatment strategy.

BACKGROUND: Cytomegalovirus (CMV) associated with thrombotic microangiopathy (TMA) in transplant patients has not been extensively described. This case illustrates an association between CMV and TMA in a transplant patient with resolution of the latter after treatment of the CMV. METHODS AND RESULTS: At 6 weeks after renal transplantation, a 57-year-old woman presented with TMA. Cyclosporine was discontinued, and plasmapheresis was started. However, the patient continued to deteriorate and developed CMV pneumonitis. Plasmapheresis was discontinued, and intravenous ganciclovir was initiated. Both the TMA and the CMV resolved after initiation of the ganciclovir. CONCLUSION: This case identifies another potential etiological factor in the development of TMA after renal transplantation. It is the first reported case of TMA being cured with treatment of CMV.

Panic disorder and the heart: a cardiology perspective.

Panic disorder is a common condition that includes symptoms that may masquerade as a primary cardiovascular disorder. In addition, many patients with cardiovascular disease may also have panic disorder. To date, no definitive pathophysiological mechanism for panic disorder has been found; however, there are several hypotheses in the literature. Patients with syndrome X, coronary artery disease and/or palpitations, in addition to panic disorder all present to cardiologists. However, many patients go undiagnosed and ultimately place large costs on the health care system as a result. Panic disorder is a treatable condition, and cardiologists could easily identify patients with panic disorder and initiate appropriate therapy and/or referral.