Preventing myocardial injury following non‐cardiac surgery: A potential role for preoperative antioxidant therapy with ubiquinone

Over 240 million non‐cardiac operations occur each year and are associated with a 15–20% incidence of adverse perioperative cardiovascular events. Unfortunately, preoperative therapies that have been useful for chronic ischemic heart diseases, such as coronary artery revascularization, antiplatelet agents, and beta‐blockers have failed to improve outcomes. In a pre‐clinical swine model of ischemic heart disease, we showed that daily administration of ubiquinone (coenzyme Q10, CoQ10) enhances the antioxidant status of mitochondria within chronically ischemic heart tissue, potentially via a PGC1α‐dependent mechanism. In a randomized controlled trial, among high‐risk patients undergoing elective vascular surgery, we showed that NT Pro‐BNP levels are an important means of risk‐stratification during the perioperative period and can be lowered with administration of CoQ10 (400 mg/day) for 3 days prior to surgery. The review provides background information for the role of oxidant stress and inflammation during high‐risk operations and the potential novel application of ubiquinone as a preoperative antioxidant therapy that might reduce perioperative adverse cardiovascular outcomes.