Can I go off the statins and just take supplements?

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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 more.

“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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