Study – For Lowering Cholesterol, Statins Work, Supplements Don’t

The risk of heart disease can be increased by having high levels of "bad" cholesterol. The risk of atherosclerotic cardiovascular disease is reduced with higher risk patients having more of a benefit. This is very convenient because we can study the effects of a treatment on the cardiovascular system. Tracking health outcomes that have a lot of variables and take a long time is not as easy as following a marker in the blood.

There are a lot of options for people who want to improve their cardiovascular health by raising their cholesterol numbers. Regular exercise has been shown to improve cholesterol profile and other health benefits, so it's a good idea. There is a complicated relationship between diet and cholesterol. Most people don't seem to have a significant effect on their cholesterol levels from eating cholesterol-laden food. The basic advice is to have a healthy diet with lots of fruits and vegetables. A lean body mass is useful.

Maintaining a healthy cholesterol profile can be accomplished with diet, exercise, and a healthy weight. Everyone can have a healthy lifestyle. Many people are genetically prone to high cholesterol and no amount of healthy lifestyle will change that. Adding a drug or a supplement to improve cholesterol profile is a strategy that many people would benefit from. That is the focus of a recent study.

190 people are included in the study which is small.

It was a single-center, prospective, randomized, single-blind clinical trial among adults with no history of atherosclerotic cardiovascular disease (ASCVD), an LDL-C of 70-189 mg/dL and an increased 10-year risk of ASCVD. Participants were randomized to 5 mg daily of rosuvastatin, placebo, fish oil, cinnamon, garlic, turmeric, plant sterols or red yeast rice.

The primary endpoint was change in LDL-C from baseline at 28 days. The rosuvastatin group confirmed that this medication is effective, with a 35.2% decrease in LDL-C from baseline. That is both clinically significant and statistically significant (<0.001).>

The study was small. The study was large enough to detect a clinically significant effect. It's true that the trial was too small to rule out a small beneficial effect from any of the supplements, but it's not worth it in the long run. The only outcome measure that mattered was the blood test result, even though the study was single blind. A bigger, double-blinded, and multi-center trial would be great. I don't think it would change anything.

The negative results for the supplements are expected. There was no good evidence for these supplements. It suffers from insignificant bioavailability. The brands of red yeast rice that are available in the US do not contain lovastatin, a proven cholesterol-lowering drug. There is no effect on cholestero l if you don't have lovastatin. It has been shown that garlic is not effective in lowering cholesterol. There is no evidence for cinnamon.

There is more to the story of plant sterols. The evidence shows that there is a small effect on the level of LDL. The effect may have been missed. It takes 2 grams of plant sterols twice a day to do this. There are still issues of the net clinical effects of these doses, so relying entirely on a marker such as bloodLDL may not be the whole story. The benefits of margarines with plant sterols can be wiped out. This option is difficult but may be useful. It is not a substitute for a vastatin drug.

Fish oil is not easy to understand. The evidence shows that it doesn't lower total cholesterol, but it does increase good HDL cholesterol, which is the main benefit. This is a situation where we need evidence from net clinical outcomes, but they are very difficult to document with modest interventions because they take a long time to get to statistical significance. You can't just use fish oil on your steak. It's not a substitute for a good diet. Helping to increase HDL may have some benefits.

It is not definitive, but it adds to a growing body of evidence that shows the same thing. There are two ways to improve cholesterol profile and cardiovascular health. The noise of the evidence makes it hard to pin down the effectiveness of supplements. The first two strategies don't rely on supplements.

This makes sense because supplements are not drugs, they are just drugs that have been poorly purified and have poor pharmaceutical attributes. They have effective marketing.

• Steven Novella is the founder and currently Executive Editor of Science-Based Medicine. The Great Courses and The Skeptics Guide to the Universe were both written by Dr. Novella.

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