Which is more effective against cholesterol?

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Herbal supplements may not be as effective as believed. Xvision/Getty Images
  • A new study compares the effectiveness of so-called cholesterol-lowering supplements to a statin, rosuvastatin.
  • While the statin lowered the participants’ LDL cholesterol over a 28-day period, the supplements did not work better than a placebo.
  • It is important to note that the maker of rosuvastatin, AstraZeneca, funded the study.

To assess a patient’s risk of heart disease and stroke, an annual physical exam regularly screens for high blood cholesterol levels. If cholesterol levels are too high, your doctor will likely recommend that you get them under control to promote good health.

High cholesterol levels – when total blood cholesterol is at or above 200 mg/dL – can be treated in several ways. The objective is to reduce so-called “bad” cholesterol, low-density lipoprotein cholesterol, LDL or LDL-C. LDL comprises most of its overall cholesterol.

A doctor is more likely to recommend a heart-healthy diet and may prescribe a statin, a drug that lowers LDL.

Various non-pharmaceutical supplements have also become popular for lowering LDL. However, as cardiologist Dr. Jennifer Wong has said Medical News Today“We see a lot of anecdotal reports about the benefits of supplements and not what they actually do to LDL.”

Dr. Wong is Medical Director of Noninvasive Cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, California.

A new study funded by AstraZeneca, the maker of Crestor (rosuvastatin), a statin, is investigating the effects of these supplements on LDL levels.

The supplements tested in the study were fish oil, cinnamon, garlic, turmeric, plant sterols, and red yeast rice. Their effect on LDL was compared to that of rosuvastatin and a placebo, in what Dr. Wong – who was not involved in the study – called a “head-to-head statin-drug- against-the-supplements”. [competition].”

The study found that the supplements tested did no better than the placebo at lowering LDL levels. However, rosuvastatin reduced LDL levels by 35.2% compared to placebo.

The study is published in the Journal of the American College of Cardiology.

The study’s first author and principal investigator, Dr. Luke Laffin, co-director of the Center for Blood Pressure Disorders at the Cleveland Clinic in Ohio, recounts the American Heart Association Newsroom:

“According to a 2020 market research analysis, Americans spend approximately $50 billion annually on dietary supplements, and many are marketed for ‘heart protection’ or ‘cholesterol management.’ Yet there is little to no research demonstrating these benefits.

“Some people also think supplements are as effective or more effective than cholesterol-lowering statins,” says Dr. Laffin.

“Obviously, not everyone needs to take a statin, but those with high LDL-C and high cardiovascular risk (as studied in our trial) should at least have a discussion with their doctor about the potential benefits of statin therapy in combination with a healthy lifestyle choice. I see no benefit in taking a supplement for ‘heart health’.”
— Dr. Luke Laffin, speaking to Medical News Today

Michelle Routhenstein, cardiology dietitian at EntirelyNourished.com, who was not involved in the study, said DTM:

“This study did not provide new information, but it does reinforce the lack of validity for the unregulated supplement market.”

The study tracked LDL levels in 199 adult participants. Their ages ranged from 40 to 75 years old. Each had no history of cardiovascular disease.

Their LDL levels ranged from 70 mg/dL to 189 mg/dL – optimal LDL levels are below 100 and levels above 160 are considered moderately high. The researchers estimated that their risk of developing atherosclerotic cardiovascular disease over the next 10 years ranged from 5% to 20%.

Researchers randomly selected participants to take either a placebo each day, 5 mg of rosuvastatin each day, or a daily dose of:

  • Nature Made® Fish Oil, 2400mg
  • Nutriflair™ brand cinnamon, 2400 mg
  • Garlique™ brand garlic with 5,000 mcg of allicin
  • BioSchwartz Brand Turmeric Curcumin with Bioperine 4,500mg
  • Nature Made® CholestOff Plus™ with 1600 mg of plant sterols
  • Arazo Nutrition brand of red yeast rice, 2400 mg.

The study lasted 28 days.

Dr Laffin said the duration of the trial was “consistent with widely accepted guidelines endorsed by the Cardiovascular Society. The most recent AHA/ACC lipid guidelines state: “Assess adherence and percent response to anti-LDL medications and lifestyle changes with repeated measurement of lipids [after] four to twelve weeks.

“In some cases, lowering LDL cholesterol [in a] timely [manner] is imperative, and therefore [the study is] a good preliminary assessment,” noted Routhenstein.

The study focused on lowering LDL rather than improving heart health more generally, Dr. Wong pointed out.

“I think for cardiac parameters you would need much longer studies, you know, to know if there is a real reduction in deaths, heart attacks and strokes,” she said. declared.

“But one could extrapolate that if you don’t lower LDL with the drug, you might not see as many of these heart parameters with the supplements as you do with the statins,” she pointed out.

“In fact, many drugs that lower LDL have not necessarily been able to show these cardiac parameters even after decades, whereas statins have been shown to not only lower LDL but improve cardiac parameters by deaths, heart attacks and strokes.”
— Dr. Jennifer Wong

When it comes to supplements, “there may be cardiovascular benefits and anecdotal evidence of supplement benefits, and certainly reassurance that supplements don’t harm you,” Dr. Wong noted.

Dr. Laffin said that certain statins may have different efficacies in lowering LDL-C, depending on their percentage decrease. “They are usually grouped into low, moderate and high intensity,” he said.

“In general, the most effective, potent statins are rosuvastatin, which was used in this study, and atorvastatin,” Dr. Wong said.

Dr Laffin said statins are generally very safe. While some people taking statins complain of muscle soreness, previous research suggests this is partly due to a “nocebo” effect.

Although almost 30% of the people studied dropped out of treatment due to muscle pain, the researchers found that the true incidence of discomfort was only about 5% higher in patients taking a statin, compared to compared to patients receiving a placebo.

“The nocebo effect of statins – and the studies that rigorously demonstrate it – actually show that muscle symptoms associated with statins are quite rare.“, Dr Laffin said.

However, Dr. Wong added that myopathy can be a side effect of statins in some people.

“Some studies show more than 25%. In terms of life-threatening complications from statins, the incidence is very low,” she said.

When it comes to preserving and promoting heart health, nutrition may be a more effective long-term strategy, rather than relying on supplements.

“Adopting a heart-healthy diet that is truly nutrient-focused is a beneficial approach to optimizing heart and blood vessel health. You can be on a statin or a slew of supplements and still have a plaque in the arteries if we don’t implement truly heart-healthy, science-based nutrition and lifestyle,” Routhenstein said.

Dr. Wong said healthy eating is important “whether or not you take a statin. Anyone, even if they don’t yet have a cardiovascular problem, should be in a [preventive] fashion.

“[It’s] primary prevention before an event occurs and secondary prevention for those who have already had a heart attack and stroke. A heart-healthy diet has been shown in multiple trials to improve outcomes,” she added.

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