Peter H. Langsjoen, M.D., F.A.C.C. ( Physician, Biochemist and Researcher.)
Dr. Langsjoen launched his career as a specialist in CoQ10 and cardiology with his paper titled, Introduction to Coenzyme Q10, in 1994. Even then, the role of Coenzyme Q10 in mitochondrial oxidative phosphorylation was well known and he correctly credited other researchers as first having identified Coenzyme Q10 deficiency as a factor in heart disease.
Only in the mid-seventies did Coenzyme Q10 become widely available to researchers through Japanese techniques for manufacture. Then came the vital techniques for measurements of Coenzyme Q10 in blood and tissue. Soon young Langsjoen was joining his father, Per Langsjoen, who already was involved in clinical research of this vital substance.
There was little doubt that CoQ10, so concentrated in cardiac muscle, correlated perfectly with heart failure. When blood levels were high, congestive heart failure was rare. This father - son research team soon proved the value of Coenzyme Q10 by oral supplementation. Then came statin drugs.
Langsjoen and others already had proved a tendency in our society for Coenzyme Q10 deficiency with age. Once maturity is reached most people lose their ability to synthesize sufficient CoQ10 for their energy needs and must depend increasingly upon dietary sources alone. With age, dietary sources become inadequate and bioavailability of CoQ10 becomes deficient for many.
With the statins came an entirely new ball game for statins are reductase inhibitors working to lower cholesterol through their effect on mevalonate pathway blockade of cholesterol synthesis. Unfortunately other vital functions are also mediated via the mevalonate pathway and CoQ10 is one of these casualties of the war on cholesterol.
Only in this past decade with its new measurement techniques have reliable determination of blood and tissue values permitted the documentation of substantial reduction of CoQ10 with the implementation of statin therapy. Some report values as high as 50% reduction.
When added to age and dietary deficiency, statins have increasingly been identified as a final trigger factor in provoking congestive cardiac failure. Langsjoen has now repeatedly documented this and shown the value of supplemental CoQ10 or reduction or elimination of statins in the treatment of this often lethal illness.
With the publication of "Supplemental ubiquinol in patients with advanced congestive heart failure" Peter H. and Alena M. Langsjoen of Tyler, Texas have capped two decades of research into the role of ubiquinone in the human body and the negative implications of statin therapy on this ubiquitous substance.
Most think of ubiquinone as having three main functions in the human body. The first of these is in cell wall integrity. The second is its important role as part of the mitochondria in ATP energy production and the third is its equally important role as an anti-oxidant with location right in the zone of maximum production of reactive oxygen species (ROS). It is at this point where these so-called free radicals cause maximum DNA damage in adjacent tissue.
This recent Langsjoen study has to do with the role of ubiquinone in energy production. In the absence of sufficient ubiquinone, energy production is impaired. Every organ in the body and, indeed, every cell in the body demands energy. When the heart is deprived of sufficient ubiquinone, heart failure results.
The Langsjoen's have demonstrated the association of advanced congestive heart failure with low blood levels of uniquinone and shown, unequivocally, that replenishing ubuiquinone dramatically helps the failing heart. And of particular importance they have demonstrated that the ubiquinol form of ubiquinone appears to be far superior to other forms in bio-availability and effectiveness.
Those of you who have seen my mevalonate pathway diagram will recall that the inevitable effect of all statin drugs is blockade of the mevalonate pathway. This is how statins work to block cholesterol synthesis. Unfortunately ubiquinone also uses this same pathway and it is impossible to block cholesterol without having some negative impact on ubiquinone synthesis as well. This is why the Langsjoens have long cautioned statin users about heart failure complications.
Since the original seminal paper, Introduction to Coenzyme Q10, Dr. Langsjoen and his wife have co-authored dozens of papers dealing with the consequences of lack of sufficient bioavailability of Coenzyme Q10. Out of this abundance of papers I have chosen the following few, best depicting the efforts of the Langsjoens to communicate their views and research findings to the medical community.
1.) Supplemental Ubiquinol in Patients with Advanced Congestive Heart Failure
Peter H. Langsjoen - East Texas Medical Center and Trinity Mother Francis Hospital, TX, USA
Alena M. Langsjoen - Coenzyme Q10 Laboratory, Inc., Tyler, TX, USA
Patients with moderately advanced (New York Heart Association class IV) congestive heart failure (CHF), often fail to achieve adequate plasma CoQ10 levels on supplemental ubiquinone at dosages up to 900 mg/day.
These patients often have plasma total CoQ10 levels of less than 2.5 μg/ml and have limited clinical improvement. It is postulated that the intestinal edema in these critically ill patients may impair CoQ10 absorption.
We identified seven patients with advanced CHF (mean ejection fraction (EF) of 22%) with sub-therapeutic plasma CoQ10 levels with mean level of 1.6 μg/ml on an average dose of 450 mg of ubiquinone daily (150-600 mg/day).
All seven of these patients were changed to an average of 580 mg/day of ubiquinol (450-900 mg/day) with follow-up plasma CoQ10 levels, clinical status, and EF measurements by echocardiography.
Mean plasma CoQ10 levels increased from 1.6 μg/ml (0.9-2.0 μg/ml) up to 6.5 μg/ml (2.6-9.3 μg/ml).
Mean EF improved from 22% (10-35%) up to 39% (10-60%) and clinical improvement has been remarkable with NYHA class improving from a mean of IV to a mean of II (I to III).
Ubiquinol has dramatically improved absorption in patients with severe heart failure and the improvement in plasma CoQ10 levels is correlated with both clinical improvement and improvement in measurement of left ventricular function.
2.) Statin Induced Cardiomyopathy
By Peter H. Langsjoen , M.D., F.A.C.C.
In this paper Peter Langsjoen directed his primary attention to the effect of statins on cardiac muscle performance. In the final paragraph of this report he states, "Statin-induced CoQ10 depletion is the topic of a recent petition to the FDA requesting that this drug / nutrient interaction be identified in a black box warning as part of statin package insert information. A comprehensive review of animal and human trials addressing this issue has been submitted to the FDA as a supporting document. We, of course, do not expect any response from the FDA, but 10 years from now when the full extent of statin toxicity becomes painfully evident, at least we can, in good conscience, know that we tried and who knows, sometimes small sparks may spread in dry grass."
3.) Statins Contraindicated in Heart Failure
By Peter H. Langsjoen , M.D., F.A.C.C.
In this paper Langsjoen makes one of the strongest early warnings of the relationship between statins and congestive cardiac failure. With researchers Eddie Voss, MEng and Luca Mascitelli, MD of THINCS ( The International Network of Cholesterol Skeptics) the aggravation and even causation of congestive heart failure by statin drugs was brought to light and introduced to the medical community.
In this report they drew attention to the fact that statins lowered serum LDL cholesterol and CoQ10 both by 51% in one study and emphasized that without CoQ10, mitochondria cannot produce adenosine triphosphate, which provides the energy for muscle heart contraction. They concluded by saying, "Based on the foregoing, we conclude that statins are contraindicated in patients with borderline and full-blown heart failure."
4.) Treatment of Heart Disease with Coenzyme Q10
By Peter H. Langsjoen , M.D., F.A.C.C.
In the text of this early paper, Langsjoen describes his clinical research. "CoQ10 was added to standard treatments for heart failure such as fluid pills (diuretics), digitalis preparations (Lanoxin), and ACE inhibitors. Several trials involved the comparison between supplemental CoQ10 and placebo on heart function as measured by echocardiography. CoQ10 was given orally in divided doses as a dry tablet chewed with a fat containing food or an oil based gel cap swallowed at mealtime. Heart function, as indicated by the fraction of blood pumped out of the heart with each beat (the ejection fraction), showed a gradual and sustained improvement in tempo with a gradual and sustained improvement in patients' symptoms of fatigue, dyspnea, chest pain, and palpitations. The degree of improvement was occasionally dramatic with some patients developing a normal heart size and function on CoQ10 alone."
Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor
Peter Langsjoen - A Cardiologist looks at CoQ10
Peter H. Langsjoen Short Biography
Peter H. Langsjoen, M.D., F.A.C.C. has been practicing cardiology since 1985. After five years of invasive cardiology at the University of Texas Health Center at Tyler, Texas, he set up a private cardiology practice in Tyler and for the past 16 years has worked exclusively as a non-invasive cardiologist, specializing in congestive heart failure, primary & statin-induced diastolic dysfunction, and other diseases of the heart muscle.
Dr. Langsjoen has been involved with the clinical application of Coenzyme Q10 (CoQ10) since 1983 when he began working with his father, Per H. Langsjoen, M.D., F.A.C.C., the cardiologist who pioneered clinical research with CoQ10 in the United States and who performed the first human double blind controlled heart failure study with CoQ10 in the United States. They practiced and performed research trials together up until Per's death in 1993.
Dr. Peter Langsjoen is a founding member of the Executive Committee of the International Coenzyme Q10 Association, he is a Fellow of the American College of Cardiology, a member of the Alpha Omega Alpha Honor Society, American College of Physicians, Association of American Physicians and Surgeons, Texas Club of Cardiologists, Texas Medical Association, Smith County Medical Society, and of the International Network of Cholesterol Skeptics.
Coenzyme Q10 continues to be a major part of Dr. Langsjoen's clinical practice as well as an ongoing research endeavor. Over the past three years Dr. Langsjoen and his wife Alena have established a research laboratory in Tyler, Texas, for the measurement of both reduced and oxidized CoQ10 in both plasma and heart muscle.
Dr. Langsjoen lectures on coenzyme Q10 all over the world.
PETER H. LANGSJOEN, M.D., F.A.C.C.
DATE/PLACE OF BIRTH: May 3, 1954, San Francisco, California
The University of Texas at Austin,1972-1975; Bachelor of Science in Chemistry with Honors.
The University of Texas Health Science Center, San Antonio, Texas, 1976-1980; M.D.degree 1980.
The University of North Dakota, Fargo, North Dakota, Internal Medicine Residency, 1980-1983.
Scott & White Memorial Hospital, Temple, Texas, Cardiology Fellowship, 1983-1985.
1983-1985: Involved in the first controlled study of coenzyme Q10 in cardiomyopathy with Per H. Langsjoen, M.D., F.A.C.C. during cardiology fellowship at Scott and White Hospital, Temple, Texas.
1985-1990: Associate Professor of Medicine and staff invasive cardiologist at The University of Texas Health Center at Tyler, Tyler, Texas.
1986-1987: Performed the first exploratory treatment of AIDS patients with Coenzyme Q10 at the University of Texas Health Center in Tyler, Texas.
1990-present: Private practice of non-invasive cardiology, Tyler, Texas, specializing in congestive heart failure, diastolic dysfunction and other diseases of the heart muscle.
Presentations at many conferences in countries worldwide, including the 6th, 8th and 9th International Symposiums on the Biomedical and Clinical Aspects of Coenzyme Q in Rome, Italy, 1990, in Stockholm, Sweden, 1993 and in Ancona, Italy, 1996, respectively and at the First and Third Conferences of the International Coenzyme Q10 Association in Boston, USA, 1998 and in London, UK in 2002.
1997: Became a Founding Member of the Executive Committee of the International Coenzyme Q10 Association, based in Ancona, Italy and has served on the Executive and Scientific Committee of this Association since then.
Ongoing research into application of coenzyme Q10 to the treatment of broad range of cardiovascular diseases, including long term follow up study in heart failure, in primary and statin-induced diastolic dysfunction, hypertrophic cardiomyopathy and in hypertensive heart disease.
1. Langsjoen, P.H. and Langsjoen, A.M. Supplemental ubiquinol in patients with advanced congestive heart failure.
2. Langsjoen, P.H. Alleviating Congestive Heart Failure with Coenzyme Q10. Life Extension Magazine 2008(Feb);14(2):48-55.
3. Littarru G.P., Langsjoen P. Coenzyme Q10 and statins: biochemical and clinical implications.
Mitochondrion. 2007 Jun;7 Suppl:S168-74.
4. Langsjoen P.H., Langsjoen J.O., Langsjoen A.M., Lucas L.A. Treatment of statin adverse effects with supplemental Coenzyme Q10 and statin drug discontinuation. Biofactors. 2005;25(1-4):147-52.
5. Langsjoen, P.H., Littarru. G.P., Silver, M.A. Role of concomitant coenzyme Q10 with statins for patients with hyperlipidemia, Current Topics in Nutriceutical Research 2005;3(3):149-158.
6. Silver, M.A., Langsjoen, P.H., Szabo, S., Patil, H., Zelinger, A. Effect of atorvastatin on left ventricular diastolic function and ability of coenzyme Q10 to reverse that dysfunction. American Journal of Cardiology 2004; 94:1306-1310.
7. Langsjoen P.H, Langsjoen, A.M. The clinical use of HMG CoA-reductase inhibitors and the associated depletion of coenzyme Q10. A review of animal and human publications. BioFactors 2003;18:101-111.
8. Langsjoen P.H. Comment. J Am Coll Cardiol 2000 Mar 1;35(3):816-7.
9. Langsjoen P.H., Langsjoen A.M. Overview of the Use of CoQ10 in Cardiovascular Disease. BioFactors 1999;9:273-284.
10. Langsjoen P.H., Langsjoen A.M. Review of Coenzyme Q10 in Cardiovascular Disease with Emphasis on Heart Failure and Ischemia Reperfusion. Asia Pacific Heart J. 1998;7(3):160-168.
11. Langsjoen P.H., Langsjoen A., Willis A, Folkers, K. The Aging Heart: Reversal of Diastolic Dysfunction Through the Use of Oral CoQ10 in the Elderly. Anti-Aging Medical Therapeutics, 1997, R.M.Klatz and R. Goldman eds., Health Quest Publications, pp.113-120.
12. Langsjoen P.H., Langsjoen A., Willis R., Folkers K. Treatment of Hypertrophic Cardiomyopathy with Coenzyme Q10. Mol Aspects Med, 1997;18 Suppl.:s145-s151.
13. Langsjoen P.H., Langsjoen P.H., Willis R., Folkers K. Treatment of essential hypertension with coenzyme Q10. Mol. Aspects of Med. 1994;15 Suppl. s265-s272.
14. Langsjoen H.A., Langsjoen P.H., Langsjoen P.H., Willis R., Folkers K. (1994) Usefulness of coenzyme Q10 in clinical cardiology, a long-term study. Mol. Aspects of Med. 15 Suppl. s165-s175.
15. Langsjoen P.H., Langsjoen P.H., Folkers K. Isolated diastolic dysfunction of the myocardium and its response to CoQ10 treatment. Folkers, K., Mortensen S.A., Littarru G.P., Yamagami T., and Lenaz G. (eds) The Clinical Investigator, 1993;71:S140-S144.
16. Folkers K., Langsjoen P.H., Langsjoen P.H. Therapy with coenzyme Q10 of patients in heart failure who are eligible or ineligible for a transplant. Biochem Biophys Res Commun 1992 Jan 15, 182(1):247-53.
17. Folkers K; Hanioka T; Xia LJ; McRee JT Jr; Langsjoen P. Coenzyme Q10 increases T4/T8 ratios of lymphocytes in ordinary subjects and relevance to patients having the AIDS related complex. Biochem Biophys Res Commun, 176: 2, 1991 Apr 30, 786-91.
18. Langsjoen P.H., Langsjoen P.H., Folkers K., Richardson P. (1991) Treatment of patients with human immunodeficiency virus infection with coenzyme Q10. Folkers K., Littarru G.P., and Yamagami, T., (eds) Biomedical and Clinical Aspects of Coenzyme Q, 6:409-415.
19. Langsjoen P.H., Langsjoen P.H., Folkers K. A six-year clinical study of therapy of cardiomyopathy with Coenzyme Q10. Int. J. Tiss. Reac. 1990; XII, vol. 3 pp. 169-171.
20. Langsjoen P.H., Langsjoen, P.H., Folkers, K. Long term efficacy and safety of coenzyme Q10 therapy for idiopathic dilated cardiomyopathy. The American Journal of Cardiology, 1990;65:521 - 523.
21. Folkers K; Langsjoen P; Willis R; Richardson P; Xia LJ; Ye CQ; Tamagawa H. Lovastatin decreases coenzyme Q levels in humans. Proc Natl Acad Sci U S A, 87: 22, 1990 Nov, 8931-4.
22. Langsjoen PH, Folkersn K, Lyson K, Muratsu K, Lyson T, Langsjoen P. Pronounced increase of survival of patients with cardiomyopathy when treated with coenzyme Q10 and conventional therapy. Int. J. Tissue React. 1990;12(3):163-8.
23. Langsjoen P.H., Folkers K., Lyson K., Muratsu K., Lyson T., Langsjoen Peter H. (1988) Effective and safe therapy with coenzyme Q10 for cardiomyopathy. Klin. Wochenschr. 66:583-593.
24. Folkers K., Langsjoen P.H., Langsjoen P.H., Nara Y., Muratsu K., Komorowski J., Richardson P., Smith T.H. (1988) Biochemical Deficiencies of Coenzyme Q10 in HIV-Infection and Exploratory Treatment. Biochemical and Biophysical Research Communications,153(2):888-896.
25. Langsjoen P.H., Langsjoen P.H., Morishita M., Muratzu K., Lyson K., Folkers K. The long-term value of Coenzyme Q10 in patients with cardiomyopathy. Biomedical and Clinical Aspects of Coenzyme Q, Folkers K., Yamamura Y.,(eds), Elsevier, Amsterdam 1986;5:303-308.