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Home » Dietary supplements are not better than statins for heart disease

Dietary supplements are not better than statins for heart disease


As I wrote previously, statins are important in preventing cardiovascular disease and mortality, but people continue to push dietary supplements as a better alternative to statins. Well, a new study blows that claim out of the water — statins are better for your cardiovascular health than dietary supplements.

I keep writing about supplements, and rarely do I find powerful, robust, and repeated evidence that supplements have any positive effect on one’s health. Occasionally, some research might show a small clinical benefit, but mostly, taking supplements means you have very expensive urine since most of it is removed by your kidneys.

As most of you who read this blog know that I love reviewing these articles, so you have the bullet points for the results. Of course, the article is linked, so you can get into the weeds if you want. Here we go.

several cloves of garlic against gray background
Garlic. Photo by Karolina Grabowska on Pexels.com

First, what are statins?

Statins are officially known as HMG-CoA reductase inhibitors, which affect lowering cholesterol levels. HMG-CoA reductase is an enzyme in the pathway for cholesterol synthesis in the liver. By blocking this enzyme, statins effectively reduce cholesterol production. This is important because most blood cholesterol comes from liver production rather than diet. With decreased production of cholesterol, blood levels of cholesterol will fall concomitantly.

Hepatic cholesterol synthesis is mostly at night, so generally, statins should be taken in the evening to maximize their effectiveness. However, some new long-acting statins can be taken at any time, and block cholesterol production throughout the day.

Despite the Nirvana fallacy loved by the anti-medicine world, statins aren’t perfect — they have important side effects, such as muscle problems, increased risk of type 2 diabetes mellitus, and increased liver enzymes as a result of liver damage from the medication. Per 100,000 people treated with statins over five years, there could be 75 cases of diabetes, 7.5 cases of stroke, and 5 cases of muscle damage. I think a lot of those who are opposed to statins focus on these findings of side effects.

However, a recent systematic review (and on the hierarchy of scientific research, systematic reviews are at the top), published in the European Journal of Preventative Cardiology, reported that only a small fraction of side effects reported by patients using statins are attributable to the statin itself. They concluded:

Only a small minority of symptoms reported on statins are genuinely due to the statins: almost all would occur just as frequently on placebo. Only development of new-onset diabetes mellitus was significantly higher on statins than placebo; nevertheless only 1 in 5 of new cases were actually caused by statins. Higher statin doses produce a detectable effect, but even still the proportion attributable to statins is variable: for asymptomatic liver enzyme elevation, the majority are attributable to the higher dose; in contrast for muscle aches, the majority are not.

In other words, the adverse events after using statins may be vastly overstated, to the point where these side effects are tiny compared to the benefits of the drug. Frankly, the risk of death (which we’ll see) from a higher LDL level is so significant, that the relatively rare side effects pale in comparison.

Dietary supplements vs statins study

In a study published in the Journal of the American College of Cardiology, Luke J Laffin, MD, Co-Director, Center for Blood Pressure Disorders at the Cleveland Clinic, and colleagues reviewed data from 190 individuals included in a randomized, single-blind clinical trial that compared the efficacy of a low-dose statin, rosuvastatin, with placebo and six common supplements in impacting lipid and inflammatory biomarkers. The six supplements were fish oil, cinnamon, garlic, turmeric, plant sterols, and red yeast rice.

The primary endpoint for the study was the percent change in LDL cholesterol (often called the “bad” cholesterol) from baseline for rosuvastatin 5 mg daily compared with placebo and each supplement after 28 days.

Here are the key results:

  • People taking rosuvastatin (5 mg per day for 4 weeks) had an average 37.9% reduction in LDL cholesterol, the only group to do better than the placebo arm. I could just stop with this data point.
  • The low-dose statin group had a 24.4% reduction in total cholesterol from baseline compared with the placebo and all supplements.
  • There was no significant change in HDL cholesterol with rosuvastatin.
  • The garlic supplement increased LDL cholesterol by 7.8% over the placebo arm. Garlic is one of the trendy supplements for heart health, but it increased one of the markers for cardiovascular disease.
  • None of the other dietary supplements demonstrated a significant decrease in LDL cholesterol compared with the placebo.
  • None of the supplements lowered LDL cholesterol, inflammatory markers, total cholesterol, or triglycerides compared to the placebo.
  • Adverse event rates were similar across study groups; there were no reports of musculoskeletal or neurological adverse events in the statin arm.
selective focus photography of assorted color stars
Photo by Jess Bailey Designs on Pexels.com

Summary of statins vs. supplements

Let me discuss a couple of issues I have with the study. First, it’s small. I know it’s difficult for researchers to do a massive clinical trial with 3000 participants, but I prefer it. Second, the study endpoint was at 28 days. It would be nice to have a study that compared statins to dietary supplements at one year or later. Third, the study did not provide us with actual clinical outcomes, such as cardiovascular events or death, just a proxy in LDL and HDL cholesterols.

That being said, these numbers were statistically significant. And it showed that statins worked in reducing LDL cholesterol (which is linked to heart disease) whereas the supplements were either equal to or worse than the placebo. I mean garlic is worse than taking nothing in controlling your LDL cholesterol.

So, I give this research study a 4 out of 5 stars. It is a credible study, though I hope that a longer-term and larger study is coming our way.

Citations

Michael Simpson
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