Six supplements people commonly take for heart health don’t help lower “bad” cholesterol or improve cardiovascular health, according to a study released Sunday, but statins did.
Some people believe that common dietary supplements – fish oil, garlic, cinnamon, turmeric, plant sterols, and red rice yeast – 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. Fat deposits can block the flow of oxygen and blood that the heart needs to function, and the blockage can lead to heart attack or stroke.
For this study, which was presented at the American Heart Association Scientific Sessions 2022 and simultaneously published in the Journal of the American College of Cardiology, the researchers compared the impact of these particular supplements with the impact of a low dose of a statin. – a cholesterol-reducing drug – or a placebo, which does nothing.
The researchers made this comparison in a single-blind, randomized clinical trial involving 190 adults with no history of cardiovascular disease. Study participants were aged between 40 and 75, and several groups took a low-dose statin called rosuvastatin, a placebo, fish oil, cinnamon, garlic, turmeric, plant sterols, or fermented red rice for 28 days.
The statin had the greatest impact and significantly reduced LDL compared to supplements and placebo.
The mean reduction in LDL after 28 days with a statin was nearly 40%. The statin also has an additional benefit on total cholesterol, which fell by an average of 24%, and 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 people who took a placebo. Although there were similar adverse events in all groups, there was a numerically higher number of problems among those taking plant sterols or red yeast rice.
“We designed this study because many of us had the same experience trying to recommend evidence-based therapies that reduce cardiovascular risks to patients and then had them say ‘no thanks, I’ll just try this supplement,'” said the co-author Dr. Karol Watson, professor of medicine / cardiology and co-director, UCLA Program in Preventive Cardiology. “We wanted to design a very rigid, randomized, controlled trial study to prove what we already knew and rigorously show it.”
Dr. Steven Nissen, a cardiologist and researcher at the Cleveland Clinic and co-author of the study, said patients often don’t know that dietary supplements aren’t tested in clinical trials. He calls these supplements “21st century snake oil”.
In the United States, the Dietary Supplement and Health Education Act of 1994 severely limited the US Food and Drug Administration’s ability to regulate supplements. Unlike pharmaceutical products that must be proven safe and effective for their intended use before a company can market them, the FDA does not have to approve dietary supplements before they can be sold. It is only after they are on the market and are shown not to be sure that the FDA can step in to regulate them.
“Patients believe that the studies have been conducted and that they are as effective as statins and can save them because they are natural, but natural does not mean safe and it does not mean that they are effective,” Nissen said.
The study was funded through an unlimited grant from AstraZeneca, which manufactures rosuvastatin. According to the study, the company had no input on the methodology, data analysis, and discussion of clinical implications.
The researchers recognized some limitations, including the study’s small sample size, and that its 28-study period may not capture the effect of the supplements when used for a longer duration.
In a statement on Sunday, the Council for Responsible Nutrition, a trade association for the dietary supplement industry, said “supplements are not intended to replace drugs or other medical treatments.”
“Dietary supplements are not intended to be quick fixes and their effects may not be revealed in a study lasting only four weeks,” Andrea Wong, senior vice president of the group for scientific and regulatory affairs, said in a statement.
Dr. James Cireddu, an invasive cardiologist at the Harrington Heart & Vascular Institute Cleveland, Ohio, said the work will be helpful.
“They did a good job collecting data and looking at the results,” said Cireddu, who did not work on the study. “It will probably resonate with patients. They constantly ask me for supplements. I think this does a good job of providing evidence. ”
Dr Amit Khera, chair of the AHA Science Session Scheduling Committee, did not work on the research, but said he felt this was an important study to include in this year’s presentations.
“I take care of patients every day with these exact questions. Patients are always asking for supplements in place of or in addition to statins, “said Khera, 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 vital 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 over 170,000 people, he said. Consistently, studies show that statins reduce risk.
“The good news, we know statins work,” Khera said. “That doesn’t mean they’re perfect. That doesn’t mean everyone needs them, but for people at higher risk we know they work and this is well proven. If you’re going to do something different, you need to make sure it works. ”
With the 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 problems with that terminology and most importantly, we should ask ourselves if they work? This is what this study does, ”adds Khera. “It’s important to ask, are you taking something that’s proven, and if you’re doing it and it’s not, it’s that instead of a proven treatment. It is a real concern ”.