About 94 million U.S. adults have cholesterol levels higher than normal laboratory values, yet only a little more than half of these individuals use pharmacological approaches to treat it. A new study found that six popular supplements didn’t lower “bad” cholesterol levels or improve cardiovascular health, but statin medications did.
The study, presented at the American Heart Association’s Scientific Sessions and published in the Journal of the American College of Cardiology, sheds light on the effectiveness of statin drugs in lowering LDL cholesterol versus supplements. It was conducted at the Cleveland Clinic and funded by AstraZeneca, which makes the statin that was used in the study.
The trial followed 190 adults between the ages of 40 to 75 with no history of cardiovascular disease for 28 days. Individuals were randomized into groups and given either a low-dose statin medication (5mg of rosuvastatin daily), placebo or supplement. The supplements included fish oil, cinnamon, garlic, turmeric, plant sterols or red yeast rice. At the end of the trial, researchers assessed the percentage change in LDL cholesterol from baseline. Researchers found that the statin drug reduced LDL cholesterol by more (a 37.9% decrease in LDL cholesterol and a 24% decrease in total cholesterol) than all the supplements and the placebo.
In fact, none of the supplements showed any significant reductions in LDL cholesterol compared to the placebo and each supplement. As an added benefit, the statin drug was also found to reduce triglycerides (a marker of fat in the blood) and total cholesterol.
Dr. Luke Laffin was the lead author on the trial and is a cardiologist and co-director for the Center for Blood Pressure Disorders at Cleveland Clinic. Laffin said that the popularity of supplements among his patients as a motivating factor in conducting the study. He explained that “we see our patients taking all the tested supplements for ‘heart health’ or ‘cholesterol management’ — and that’s why we chose to evaluate them in the study.” Laffin said the most common that he sees in clinical practice are fish oil, red yeast rice, turmeric, and garlic.
There were several limitations to the trial. For example, the duration of the intervention was only 28 days in length. Although this time frame falls within the timeline of assessing the impact of statins based on the 2018 American College of Cardiology and American Heart Association guidelines, more studies may be needed to determine more long-term results. “We cannot definitively say that supplements would not have an impact if taken for longer,” Laffin said.
Dr. Paul Jurgens, preventative cardiologist at South Denver Cardiology Associates in Littleton, Colorado, was not involved with the study but is familiar with the findings. Jurgens said he was not surprised by the results, noting that “there have been some studies in the past looking at red yeast rice and garlic. These studies have not shown significant reductions in LDL cholesterol which is a major risk factor for heart attack and stroke.”
What to know about supplements and cardiovascular health
While supplements have often received mixed data in terms of effectiveness for lowering lipids, other studies have demonstrated potential benefits to other cardiac risk factors. A 2022 study, for example, showed that fish oil supplementation might help lower blood pressure. A study in the Journal of the American Medical Association found that folic acid and B12 supplementation may reduce the risk of heart attack and stroke.
Despite some positive data, the Food and Drug Administration regulates supplements differently than foods and drug products so consumers may need professional guidance in identifying which options are high quality, appropriate — and without added risk.
Laffin cautioned that patients need to assess the risk of treating high cholesterol with supplements. “One potential risk of supplements is that patients are not addressing a known cardiovascular risk factor — high cholesterol. Another risk of supplements is drug to drug interactions. We often do not know what is in these products, and they can interact with medications taken for any number of medical conditions,” he explained.
Lifestyle changes and, for some, medication play a role in lowering cholesterol
Lifestyle approaches, such as diet, exercise, and stress management, have also been cited as contributing factors in lowering and managing high cholesterol. Studies have shown that specific dietary patterns, such as the Nordic diet, may also help reduce cholesterol. Particular foods such as avocados, walnuts, and soy have also been implicated in reductions and incorporation of physical activity, and relaxation techniques such as yoga may also play a role.
Laffin explained that lifestyle changes “clearly play a role and can help not only with cholesterol reduction but reducing overall cardiovascular risk.” He also pointed out that genetics play a role as well, stating that a “large contribution to cholesterol levels are genetically mediated so certain individuals even with great lifestyle habits also need cholesterol-lowering medications.”
Jurgens agreed that lifestyle intervention is a key factor in management, stating, “For all of my patients, regardless of where they are in their heart health, I always recommend a combination of dietary interventions and physical activity.” He also frequently uses statins in his practice as well, explaining that, for his patients, he “calculates a unique and personalized risk assessment and then potentially recommends statins from there.”
Laffin explained that “cholesterol management is not one thing or another but rather a combination of factors. “An important point to remember is that it’s not a question of medications or lifestyle — the two go hand in hand. As I say to my patients, cardiovascular risk reduction takes a three-pronged approach: nutrition, exercise, and in certain cases, medications.”
Some studies have shown statin medication has benefits beyond improving cholesterol levels. A 2002 study showed that statin drugs might help reduce the risk of depression, and a 2022 analysis showed that they might even plan a role in preventing cancer cell metastasis. Statins have even been cited to positively impact the severity of COVID-19.
A 2018 review examining the treatment of cardiovascular disease found that diets heavy in plant-based foods, which provide a natural source of vitamins and minerals, should be reinforced as a treatment over the supplemental form. This advice aligns with the current trial’s findings: Eat more plants, move, and, if necessary, consider discussing stains with your physician. There is no one size fits all approach to health. Working with your physician on sustainable approaches that lead you towards a path of happiness, health, and longevity is perhaps the first step to better cholesterol levels.
Editor’s note: The author is a registered dietitian who works at the Cleveland Clinic, but had no role in the study.