Six supplements people commonly take for heart health don’t help lower “bad” cholesterol or improve cardiovascular health, according to a study published Sunday, but statins do.
Some people believe that simple dietary supplements—fish oil, garlic, cinnamon, turmeric, plant sterols, and red yeast rice—will lower their “bad” cholesterol. “Bad” cholesterol, known in the medical community as low-density lipoprotein, or LDL, can cause fatty deposits to build up in the arteries. Fatty deposits can block the flow of oxygen and blood that the heart needs to work, and the blockage can lead to a heart attack or stroke.
For this study, which was presented at the 2022 American Heart Association Scientific Sessions and simultaneously published in the Journal of the American College of Cardiology, researchers compared the effects of these particular supplements to those of a low-dose statin — a cholesterol-lowering drug — or a placebo. , which does nothing.
Researchers made this comparison in a randomized, single-blind clinical trial that included 190 adults with no history of cardiovascular disease. Study participants were aged 40 to 75, and different groups received low doses of a statin called rosuvastatin, a placebo, fish oil, cinnamon, garlic, turmeric, plant sterols, or red yeast rice for 28 days.
The statin had the greatest impact and significantly lowered LDL compared to supplements and placebo.
The mean reduction in LDL after 28 days on a statin was almost 40%. The statin also had an additional benefit on total cholesterol, which fell by an average of 24%, and on blood triglycerides, which fell by 19%.
None of the people who took the supplements saw a significant decrease in LDL cholesterol, total cholesterol, or blood triglycerides, and their results were similar to those of the people who took the placebo. Although there were similar side effects in all groups, there was a numerically greater number of problems among those taking plant sterols or red yeast rice.
“We created this study because many of us have had the same experience of trying to recommend evidence-based therapies that reduce cardiovascular risks to patients and then having them say ‘no thanks, I’ll just try that supplement ” said study co-author Dr. Carol Watson, professor of medicine/cardiology and co-director of the UCLA Preventive Cardiology Program. “We wanted to design a very rigorous, randomized, controlled trial to prove what we already know and show it in a rigorous way.”
Dr. Steven Nissen, a cardiologist and researcher at the Cleveland Clinic and co-author of the study, said patients are often unaware that nutritional supplements have not been tested in clinical trials. He calls these supplements the “snake oil of the 21st century.”
In the United States, the Dietary Supplement and Health Education Act of 1994 sharply limited the US Food and Drug Administration’s ability to regulate supplements. Unlike pharmaceutical products, which must be proven safe and effective for their intended purpose before a company can market them, the FDA does not have to approve dietary supplements before they can be sold. Only after they are on the market and proven to be unsafe can the FDA step in to regulate them.
“Patients believe that studies have been done and that they’re as effective as statins and can save them because they’re natural, but natural doesn’t mean safe and doesn’t mean they’re effective,” Nissen said.
The study was funded by an unrestricted grant from AstraZeneca, which manufactures rosuvastatin. The company had no input on the methodology, data analysis and discussion of clinical implications, according to the study.
Dr. James Chiredu, an invasive cardiologist and medical director of University Hospitals Harrington Heart & Vascular Institute at University Hospitals Bedford Medical Center, said the work will be helpful.
“They did a good job collecting data and looking at the results,” said Sireddu, who did not work on the study. “The patients will probably like it. I get asked about supplements all the time. I think this does a good job of providing evidence.
Dr. Amit Khera, chair of the AHA Scientific Sessions Program Committee, did not work on the study, but said he thought it was an important study to include in this year’s presentations.
“Every day I take care of patients with exactly these questions. Patients are always asking about supplements instead of or in addition to statins,” said Kera, who is professor and director of preventive cardiology at UT Southwestern Medical Center. “I think if you have high-quality evidence and a well-done study, it’s really important to help educate patients about the value, or in this case, the lack of value, of some of these cholesterol-lowering supplements.”
Statins have been around for more than 30 years and have been studied in more than 170,000 people, he said. Studies have consistently shown that statins reduce the risk.
“The good news is that we know statins work,” Kera said. “That doesn’t mean they’re perfect. That doesn’t mean everyone needs one, but for those at higher risk, we know they work and it’s well-proven. If you’re going to do something different, you have to make sure it works.
With supplements, he said he often sees misinformation online.
“I think people are always looking for something ‘natural’, but you know there are a lot of issues with that terminology and the most important thing is to ask, do they work? That’s what this study does,” Kera adds. “It’s important to ask if you’re taking something that’s proven, and if you’re taking it and it’s not, whether it’s in place of a proven treatment. It’s a real concern.”