Supplements vs. statins: Which is more effective against cholesterol?

• A new study compares the effectiveness of so-called cholesterol-lowering supplements to a statin, rosuvastatin.
• While the statin lowered participants’ LDL cholesterol over a period of 28 days, the supplements performed no better than a placebo.
• It is important to note that the manufacturer of rosuvastatin, AstraZeneca, funded the study.

To assess a patient’s risk of heart disease and stroke, a yearly physical examination routinely screens for high cholesterol levels in the blood. If cholesterol levels are too high, one’s physician will likely recommend getting them under control to promote continued health.

High cholesterol levels — when total blood cholesterol is equal to or greater than 200 mg/dL — may be addressed in several ways. The goal is to reduce so-called “bad” cholesterol, low-density lipoprotein cholesterol, LDL or LDL-C. LDL comprises most of one’s overall cholesterol.

A doctor is most likely to recommend adopting a heart-healthy diet and may prescribe a statin, an LDL-lowering drug.

Various non-pharmaceutical supplements have also become popular for reducing LDL. However, as cardiologist Dr. Jennifer Wong told Medical News Today, “we see a lot of anecdotal reports about the benefits of supplements and not what it actually does to the LDL.”

Dr. Wong is the medical director of Non-Invasive Cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, California.

A new study funded by AstraZeneca, the manufacturer of Crestor (rosuvastatin), a statin drug, investigates the effects of such supplements on LDL levels.

The supplements tested in the study were fish oil, cinnamon, garlic, turmeric, plant sterols, and red yeast rice. Their effect on LDL was compared to that of rosuvastatin and placebo, in what Dr. Wong — who was not involved in the study — called a “head-to-head statin-drug-against-the-supplements [competition].”

The study found that the tested supplements did no better than placebo at lowering LDL levels. However, rosuvastatin lowered LDL levels by 35.2%, compared with placebo.

The study is published in the Journal of the American College of Cardiology.

Do supplements work for cholesterol?

First author and principal investigator of the study, Dr. Luke Laffin, co-director of the Center for Blood Pressure Disorders at the Cleveland Clinic in Ohio, tells the American Heart Association Newsroom:

“According to a 2020 market research analysis, Americans spend an estimated $50 billion on dietary supplements annually, and many are marketed for ‘heart protection’ or ‘cholesterol management.’ Yet there is minimal-to-no research demonstrating these benefits.”

“Some people also believe supplements are as effective or more effective than cholesterol-lowering statin medications,” says Dr. Laffin.

“Clearly, not everyone needs to take a statin, but those with elevated LDL-C and elevated cardiovascular risk (as were studied in our trial) should at least have a discussion with their physician about the potential benefits of statin therapy in combination with healthy lifestyle choices. I do not see any benefits in taking a supplement for ‘heart health.’”
— Dr. Luke Laffin, speaking to Medical News Today

Michelle Routhenstein, cardiology dietitian at EntirelyNourished.com, who was not involved in the study, told MNT:

“This study hasn’t provided new information, but it reinforces the lack of validity for the unregulated supplement market.”

A daily dose of supplements vs. statins

The study tracked LDL levels in 199 adult participants. Their ages ranged from 40 to 75. Each had no history of cardiovascular disease.

Their LDL levels varied from 70 mg/dL to 189 mg/dL — optimal LDL levels are less than 100, and levels above 160 are considered moderately high. The researchers estimated that their risk of developing atherosclerotic cardiovascular disease in the next 10 years varied from 5% to 20%.

Researchers randomly selected the participants to take either a placebo each day, 5 mg of rosuvastatin each day, or a daily dose of:

• Nature Made® fish oil, 2,400 mg
• Nutriflair™ brand cinnamon, 2,400 mg
• Garlique™ brand garlic with 5,000 mcg of allicin
• BioSchwartz brand turmeric curcumin with bioperine 4,500 mg
• Nature Made® CholestOff Plus™ with 1,600 mg of plant sterols
• Arazo Nutrition brand of red yeast rice, 2,400 mg.

The study lasted for 28 days.

Dr. Laffin said the trial duration was “consistent with widely accepted Cardiovascular Society-endorsed guidelines. The most recent AHA/ACC lipid guidelines state, ‘Assess adherence and percentage response to LDL-C–lowering medications and lifestyle changes with repeat lipid measurement [after] four to twelve weeks’.”

“In some cases, bringing down LDL cholesterol [in a] timely [manner] is imperative, and therefore [the study is] a good preliminary assessment,” Routhenstein noted.

Beyond lowering LDL

The study focused on lowering LDL rather than more generally improving heart health, Dr. Wong pointed out.

“I think for heart endpoints, you would need much longer studies, you know, for whether there’s actual lowering of death and heart attacks and strokes,” she said.

“But one could extrapolate that if you’re not going to lower LDL with the medication, that you may not see as much of those heart endpoints with the supplements as you do with the statins,” she stressed.

“In fact, many drugs that lower LDL have not necessarily been able to show those heart endpoints even after decades, whereas statins have shown that they not just lower LDL but improve the heart endpoints of death and heart attacks and stroke.”
— Dr. Jennifer Wong

As far as supplements go, “There may be some cardiovascular benefits and anecdotal evidence for benefit from the supplements, and certainly reassurance that the supplements don’t hurt you,” Dr. Wong noted.

Effectiveness and safety of statins

Dr. Laffin said that certain statins may have different efficacies with respect to lowering LDL-C, based on their % decrease. “They are generally grouped into low-, moderate-, and high intensity,” he said.

“In general, statins that have the most efficacy, the highest potency, are rosuvastatin, which was used in this study, and atorvastatin,” said Dr. Wong.

Dr. Laffin said that statins were generally very safe. While some people taking statins complain of muscle pain, previous research suggests that this is partly attributable to a “nocebo” effect.

Although nearly 30% of those studied quit their treatment due to muscle pain, researchers found the actual incidence of discomfort to be only about 5% more among patients taking a statin, compared with patients given a placebo.

“The nocebo effect of statins — and the studies that rigorously demonstrate this — actually shows that statin-associated muscle symptoms are quite rare,” Dr. Laffin said.

However, Dr. Wong added that myopathy can be a side effect of statins for some people.

“Some studies show over 25%. In terms of life threatening complications from statins, the incidence is very low,” she said.

Eating for better heart health

When it comes to preserving and promoting heart health, nutrition may be a more effective strategy in the long term, instead of relying on supplements.

“Adopting a truly nutrient-focused heart-healthy diet is a beneficial approach to optimizing heart and blood vessel health. You can be on a statin or a multitude of supplements and still have plaque formation in the arteries if we are not implementing a truly, science-based heart-healthy nutrition and lifestyle,” said Routhenstein.

Dr. Wong said healthy eating was important “whether you’re on a statin or not. Anybody, even if they don’t have a cardiovascular problem yet, should be in a [preventive] mode.“

“[It’s] primary prevention before an event happens and secondary prevention for those who have already had a heart attack and stroke. A heart-healthy diet has been shown in multiple trials to improve outcomes,” she added.

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