If you have a personal or family history of high cholesterol and/or cardiovascular disease, you likely already know that cholesterol levels get subdivided. The types of cholesterol most commonly discussed are low density lipoprotein (LDL) cholesterol and high density lipoprotein (HDL) cholesterol. More simply, LDL is “bad cholesterol” and HDL is “good cholesterol” when they are considered in determining cardiovascular risk. LDL cholesterol can contribute to plaque build-up in artery walls, which can narrow arteries and set the stage for heart attacks and strokes.
If you have a high LDL cholesterol level, you have likely been advised to take medicine to lower your LDL, and thereby, lower you risk.
Hopefully, you have also been advised to improve your diet, increase your exercise, and control your weight. Heart-healthy diets, including Mediterranean diets which emphasize healthy fats, lots of fruits, vegetables and whole grains and the DASH diet, significantly reduce the risk of heart disease. We need to remember that food is medicine.
This is especially true for people who have chosen one or more of six commercial dietary supplements widely promoted for lowering LDL cholesterol.
For many reasons, some people choose to take over-the-counter (OTC) supplements rather than prescription medicine to bring down their LDL. However, recent research suggests that OTC supplements did not do the job any better than placebo in a randomized trial of adults without cardiovascular disease but at increased cardiovascular risk.
In contrast, those who took the low dose of a high-potency statin prescription drug in the eight-arm comparative study showed a significant 38% drop in LDL cholesterol levels over 28 days, which was much better than the six supplements containing fish oil, cinnamon, garlic, turmeric, plant sterols, or red yeast rice in other arms of the study.
The supplements showed little or no effect on any measured lipid biomarkers or C-reactive protein (CRP), which reflects systemic inflammation.
Almost $50 billion are spent on dietary supplements annually in the U.S. and recent data suggest that more than three-fourths of the population use them.
The research findings were from the Supplements, Placebo, or Rosuvastatin Study (SPORT) published in the Journal of the American College of Cardiology.
Patients assigned to low-dose rosuvastatin (Crestor, Ezallor Sprinkle) also showed a 24.4% drop in total cholesterol levels over 28 days, and a 19.2% decrease in serum triglycerides. None of the six supplements was significantly different from placebo for change in levels of either total cholesterol or triglycerides.
There were no significant differences in adverse events across the groups, including no adverse changes in liver or kidney function tests or glucose levels, and no signs of musculoskeletal symptoms.
In a recent study of patients who did not take their prescribed statins, 80% were worried about statin side effects as the primary reason for not taking their statin, and 72% preferred using “natural” supplements instead of taking their prescription therapy.
Prior to this study, there has not been much high-quality research done regarding these OTC products and their effectiveness regarding LDL cholesterol and other fats in the bloodstream.
The SPORT study reinforces the idea that using a low dose of a high-potency statin is associated with a very low risk of side effects.
On the other hand, supplements have a monetary cost with little or no effect. They also have potential for drug-drug interactions, not only with cardiovascular medicines, but those taken for other reasons.
There are 90,000 supplements on the market in the U.S. today where they are not as stringently regulated and monitored compared to prescription drugs. There may be all kinds of potential safety issues associated with them.
In the study, patients were assigned to receive rosuvastatin 5 mg daily, placebo, or daily doses of supplements, with 25 patients per group, except the fish-oil group of 24 patients.
The daily supplement dosages were 2,400 mg for fish oil (Nature Made) or 2,400 mg for cinnamon (NutriFlair) or 5,000 mcg allicin for the garlic (Garlique) or 4,500 mg for turmeric curcumin (BioSchwartz) or 1,600 mg plant sterols (CholestOff Plus, Nature Made) or 2,400 mg red yeast rice (Arazo Nutrition).
The maker of Crestor, Astra Zeneca sponsored the study, but the researchers worked independently to design the study and run the statistical analysis.
Levels of LDL cholesterol in the statin group fell by 37.9% in 28 days, and by 35.2% relative to the placebo group, whereas any changes in LDL cholesterol among patients taking most of the supplements were not significantly different from the placebo group. LDL cholesterol levels actually increased by 7.8% compared with placebo among the group assigned to the garlic supplement.
No apparent effect on the good HDL cholesterol levels was noted in any of the study arms except in patients taking the plant sterol supplement where HDL went the wrong way and decreased compared to placebo.
None of the non-control groups, including those assigned to rosuvastatin, showed significant changes in high-sensitivity CRP levels compared with the placebo group at 28 days duration. But long-term studies are recommended to see if inflammation improves or not.
If your healthcare provider prescribes a cholesterol treatment drug, please give it a chance to work for you since it may contribute to a longer, healthier life.