Can I go off the statins and just take supplements?

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Q: My doctor recently recommended that I take a statin to lower my cholesterol, but I won’t start the drug unless I absolutely have to. A friend said he takes an over-the-counter supplement for his cholesterol – does it really work?

Statins are one of the most widely prescribed drugs, taken by one in four adults age 40 and older in the United States. Medicines are used to lower cholesterol and reduce the risk of heart disease. Cardiologists favor statins, which are supported by four decades of research and considered safe and effective.

Yet some patients are reluctant to take them, citing concerns about possible side effects such as muscle soreness or an increased risk of developing diabetes, or saying they may want to lower their cholesterol without taking a prescription drug. would like to reduce As a result, many people have turned to over-the-counter supplements, such as plant stanols and sterols (also known as phytosterols), red yeast rice, niacin, fiber and fish oils that contain omega-3 fatty acids. .

Studies have shown that although these supplements may lower cholesterol slightly, they are not as potent as statins. There’s also little evidence that these supplements reduce people’s risk of heart attack or stroke — the ultimate goal when treating high cholesterol.

“The percentage you lose is not achieved by taking statins and other drugs,” said Dr. Joseph Yeboa, associate professor of cardiology at Wake Forest University School of Medicine.

In a study published in January in The Journal of the American College of Cardiology, for example, researchers randomly assigned nearly 200 adults who had an increased risk of heart disease to one of eight treatment groups: one that received a low-dose One took a statin, another that took a placebo and six other groups took fish oil, cinnamon, turmeric, garlic, phytosterols or red yeast rice supplements, all of which claimed to lower cholesterol or otherwise improve heart health. .

After four weeks, people taking statins lowered their LDL (or “bad”) cholesterol levels by an average of 38 percent. Among the supplement groups, red yeast rice showed the greatest benefit, reducing LDL levels by about 7 percent, followed by phytosterols, which improved LDL cholesterol by about 4 percent. For comparison, those taking the placebo reduced their cholesterol levels by an average of 3 percent.

Some supplements resulted in measurable changes in cholesterol, but they weren’t enough to have a meaningful effect on cardiovascular health, said Dr. Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic and lead author of the study. “These differences are trivial compared to the needs of the people,” he said.

Most of a person’s cholesterol comes from the liver, and statins work by reducing the amount of cholesterol produced there. The goal of taking statins is to lower blood cholesterol levels by 30 to 50 percent.

When too much cholesterol is present in the bloodstream, it can begin to build up in the form of plaque in the arteries and block blood flow. Over time, this increases the risk of stroke, heart attack, and other forms of heart disease.

An LDL cholesterol level over 190 is considered dangerously high and almost always warrants a statin prescription, Dr. Nissen said. But many people with low cholesterol levels are also prescribed statins. Doctors recommend drugs based on a person’s overall risk for heart disease, which includes age, cholesterol levels and blood pressure, and whether the person smokes or has diabetes. The US Preventive Services Task Force recommends statins when a person’s risk of developing heart disease within the next decade is 10 percent or greater.

“We’ve spent decades developing guidelines to make sure the right people get cholesterol-lowering drugs,” Dr. Nissen said.

If someone has a moderate risk of heart disease but isn’t yet eligible for a statin, experts often recommend switching to a Mediterranean diet, which is rich in fruits, vegetables, legumes, whole grains, nuts, seeds, lean proteins and whole grains. Gives priority to healthy fats.

“If you are concerned about the health of your heart, a better approach would be to work on your diet and start physical activity rather than taking supplements,” says Dr. Salim Virani, vice provost for research at the Aga Khan University in Pakistan. he said. a cardiologist at the Texas Heart Institute in Houston. “If you’re on a very strict diet, you can lower your LDL cholesterol by somewhere between 10 and 20 percent.”

While cardiologists largely do not recommend taking supplements for cholesterol, many people are still interested in trying them. Here’s what the research says about some of the most popular ones.

  • red yeast rice It has been shown to reduce LDL levels by 15 to 25 percent (though Dr. Nissen’s study showed little benefit). It targets the same pathways in the liver that statins do, but not to the same extent. As a result, experts recommend taking statins instead, especially because the Food and Drug Administration hasn’t evaluated the supplements for safety or stability.

  • fiber supplements It aims to replicate the cardiovascular benefits of a diet high in soluble fiber found in oats, barley, legumes and fruits. But research suggests that soluble fiber — either from diet or supplements — may reduce LDL cholesterol levels by only 5 to 10 percent.

  • phytosterols These are plant-based compounds found naturally in vegetable oils, nuts and seeds, legumes, fruits, and vegetables. Studies have found that phytosterols — again, either from diet or supplements — can lower LDL cholesterol by 6 to 12 percent.

  • Omega-3 Fatty Acid Can lower levels of triglycerides (another type of fat that circulates in the bloodstream), but they are less beneficial for cholesterol. More important, several meta-analyses found no evidence that omega-3 fatty acids reduce the risk of heart disease.

  • Niacin (Vitamin B3) It has also been shown to improve triglyceride and HDL (or “good”) cholesterol levels by 15 to 30 percent, but the benefits for LDL levels are more modest — less than 10 percent. Two large studies found that when taken with statins, niacin did not further reduce people’s risk of heart disease.

The bottom line, Dr. Virani said, is that some supplements “do lower LDL cholesterol, but not enough for me to really recommend them as primary LDL cholesterol-lowering treatments when we have drugs like statins.” It’s been studied for so long, and we know it’s effective and generally safe.” All the experts we spoke to agreed.

“You have to go where the evidence is,” Dr. Virani said, “and the evidence is there with statin therapy, there’s no question about it.”,

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