A Sunday study found that six common supplements for heart health do not lower “bad” cholesterol, or improve cardiovascular health. Statins did.
People believe that common dietary supplements, such as fish oil and garlic, ginger, turmeric, plant steroids, and red yeast rice, will reduce their “bad” cholesterol. Bad cholesterol, also known in medicine as low-density lipoproteins (LDL), can lead to fatty deposits in the arteries. These fatty deposits can prevent the flow of oxygenate blood and blood to the heart, leading to a stroke or heart attack.
This study was presented at the American Heart Association’s Scientific Sessions in 2022. The Journal of the American College of Cardiology also published it. Researchers compared the effect of these supplements to the impact of a low dosage of a statin – a cholesterol-lowering medication – or a placebo which does nothing.
This was done in a single-blind, randomized trial. It involved 190 people with no previous history of cardiovascular disease. Participants ranged in age from 40 to 75. Each group received a low-dose statin called rosuvastatin, as well as fish oil, cinnamon, and garlic. For 28 days, each group also received fish oil, fish sterols, red yeast rice, or fish sterols.
Statin had the greatest effect and significantly reduced LDL levels compared to placebo or supplements.
A statin reduced LDL by nearly 40% in 28 days. Statins have also been shown to reduce total cholesterol by nearly 40% and blood triglycerides by 19% on average.
People who took the supplements did not experience any decreases in LDL cholesterol, total cholesterol, or blood cholesterol. Their results were also similar to those who took placebos. There were no adverse effects in any of the groups. However, there was a higher incidence of problems with those who took red yeast rice or plant sterols.
“We designed the study because many of us had had the same experience in trying and recommending evidence-based therapies for patients that reduce cardiovascular risks. Then having them say, ‘no, thank you, I’ll just take this supplement.'” said Dr. Karol, co-author of the study and professor at UCLA Program in Preventive Cardiology. “We wanted to show what we already knew in a rigid, randomized controlled trial study.”
Steven Nissen is a Cleveland Clinic researcher and cardiologist. He was a co-author of the study and said that patients are often unaware that dietary supplement products have not been subject to clinical trials. These supplements are “21st-century snake oils,” says Nissen.
The United States Dietary Supplement and Health Education Act (1996) severely restricted the US Food and Drug Administration’s ability to regulate supplements. Contrary to pharmaceutical products which have to be approved for use by a company before they can market them, dietary supplements don’t need to be approved by the FDA before they can be sold. Only after they are available on the market, and have been proven to be unsafe, can the FDA regulate them.
Nissen stated, “Patients believe that studies have been done and that these drugs are as effective as statins. They can save patients because they’re naturally safe. It doesn’t mean they will be effective.”
AstraZeneca, the company that makes rosuvastatin, provided unrestricted funding. According to the study the company did not participate in data analysis or discussions about the clinical implications.
Although the researchers recognized some limitations to their study, they also acknowledged that it was limited by the small sample size. They also noted that the 28-study period could not capture the effect on supplements when used for longer periods.
Council for Responsible Nutrition (a trade association for the dietary supplement industry) stated in a Sunday statement that supplements are not meant to replace medications or other treatments.
Andrea Wong (the group’s senior vice-president for scientific and regulatory affairs), stated that dietary supplements are not meant as quick fixes.
Dr. James Cireddu (an invasive cardiologist at University Hospitals Harrington Heart & Vascular Institute, University Hospitals Bedford Medical Center) said the work will prove to be useful.
Cireddu said, “They did an excellent job collecting data and looking into the outcomes.” He did not participate in the study. “It will likely resonate with the patients. Every day I get asked about supplements. This does a great job of providing evidence.”
While Dr. Amit Khara, chair of the AHA Scientific Sessions programming committee did not participate in the research, he said that it was an important study and should be presented.
“I see patients every day with these exact questions. Khera is a professor and director at UT Southwestern Medical Center in preventive cardiology. Patients often ask about supplements instead of or in addition to statins. “I think patients must be informed about the potential benefits and risks of taking cholesterol-lowering supplements if they have good evidence.
Statins are known to have been in use for over 30 years and they have been studied in more than 170,000 people. Studies consistently show that statins have a lower risk.
Khera said, “The good thing is that we know statins work.” However, they are not perfect. While they may not be the best option for everyone, it does mean that some people at greater risk need them. However, their effectiveness has been well documented. It’s important to test your idea before you do something new.
He stated that supplements are often misinformed online.
“I think people are always looking to find something ‘natural’, but you know there are a lot of problems with that terminology. And most importantly, we need to ask if they work. Khera agrees. “It is important to ask whether you are using a proven treatment or something you haven’t. It is a concern.