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According to a study published Sunday, six supplements people commonly take for heart health do not help lower “bad” cholesterol or improve cardiovascular health, but statins did.
Some people believe that common 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 function, and the blockage can lead to heart attack or stroke.
For this study, which was presented at the American Heart Association’s 2022 Scientific Sessions and concurrently published in the Journal of the American College of Cardiology, researchers compared the impact of these particular supplements to the impact of low dose of a statin – a cholesterol-reducing drug – or a placebo, which does nothing.
The researchers made this comparison in a randomized, single-blind clinical trial that involved 190 adults with no history of cardiovascular disease. Study participants ranged in age from 40 to 75, and different groups were given a low-dose statin called rosuvastatin, a placebo, fish oil, cinnamon, garlic, turmeric, sterols vegetables or red yeast rice for 28 days.
The statin had the greatest impact and significantly lowered LDL compared to supplements and placebo.
The average reduction in LDL after 28 days on a statin was almost 40%. The statin also had an added benefit on total cholesterol, which dropped an average of 24%, and blood triglycerides, which dropped 19%.
None of the people who took the supplements saw significant decreases 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 effects in all groups, there were a numerically higher number of problems among those taking the plant sterols or red yeast rice.
“We designed this study because many of us have had the same experience of trying to recommend evidence-based therapies that reduce cardiovascular risk for patients, then having them say ‘no thanks, I’ll just try this supplement,” said study co-author Dr. Karol Watson, professor of medicine/cardiology and co-director of the UCLA program in preventive cardiology. “We wanted to design a very rigid, randomized, controlled trial study to prove what we already knew and show it rigorously.”
Dr. Steven Nissen, a cardiologist and researcher at the Cleveland Clinic and co-author of the study, said patients are often unaware that dietary supplements are not 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 severely limited the ability of the United States Food and Drug Administration to regulate supplements. Unlike pharmaceuticals which 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. Only once 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 that they are as effective as statins and can save them because they are natural, but natural does not mean safe and that does not mean they are effective,” said Nissen said.
The study was funded by an unrestricted grant from AstraZeneca, which manufactures rosuvastatin. The company had no input on methodology, data analysis and discussion of clinical implications, according to the study.
The researchers acknowledged some limitations, including the study’s small sample size, and that its 28-study period may not capture the effect of supplements when used for a longer duration.
In a statement on Sunday, the Council for Responsible Nutrition, a dietary supplement industry trade association, said “supplements are not intended to replace medication or other medical treatment.”
“Dietary supplements are not intended to be magic bullets and their effects may not be revealed during a study that spans only four weeks,” said Andrea Wong, the group’s senior vice president for scientific and regulatory affairs, in a press release.
Dr James Cireddu, an invasive cardiologist and medical director of University Hospitals Harrington Heart & Vascular Institute at University Hospitals Bedford Medical Center, said the work would be helpful.
“They did a good job collecting data and reviewing the results,” said Cireddu, who did not work on the study. “It will probably resonate with patients. I get asked about supplements all the time. I think it does a good job of providing evidence.
Dr. Amit Khera, chair of the AHA Scientific Sessions Programming Committee, did not work on the research, but said he thought it was an important study to include in presentations. This year.
“I deal with patients every day with these exact questions. Patients always ask about supplements instead of or in addition to statins,” said Khera, who is professor and director of preventive cardiology at UT Southwestern Medical Center. “I think if you have high-quality evidence and a well-conducted study, it’s really critical to help educate patients about the value, or in this case lack of value, of some of these supplements for reduce cholesterol.”
Statins have been around for more than 30 years and they have been studied in more than 170,000 people, he said. Consistently, studies show that statins reduce the risk.
“The good news, we know statins work,” Khera said. “That doesn’t mean they’re perfect. That’s not to say everyone needs them, but for those at high risk, we know they work and it’s well proven. If you want to do something different, you need 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 problems with that terminology and more importantly we should ask ourselves, do they work? This study does that,” Khera adds. “It’s important to ask if you’re taking something that’s been proven to work, and if you’re taking it and it’s not, is it replacing a proven treatment. It’s a real concern. »
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