Evaluation of the Antihyperlipidemic Properties of Dietary Supplements

Michael F. Caron, Pharm.D., and C. Michael White, Pharm.D.,

Disclosures

Pharmacotherapy. 2001;21(4) 

In This Article

Abstract and Introduction

We reviewed the published literature regarding the antihyperlipidemic effects of dietary supplements. A search of MEDLINE database, EMBASE Drugs and Pharmacology database, and the Internet was performed, and pertinent studies were identified and evaluated. References from published articles and tertiary references were used to gather additional data. Published trials indicate that red yeast rice, tocotrienols, gugulipid, garlic, and soy protein all have antihypercholesterolemic effects. These supplements, as well as -3 fatty acids, also have antihypertriglyceridemic effects. In clinical trials none of the agents led to a reduction in low-density lipoproteins greater than 25%, suggesting modest efficacy. When recommending these supplements, clinicians should keep in mind that their long-term safety is not established and patients should be monitored closely.

A survey estimated that use of alternative therapy among adults in the United States increased from 33.8% in 1990 to 42.1% in 1997.[1] Consumers showed particular interest in products that may help them reduce the risk of developing heart disease.[2] In a survey of patients with elevated cholesterol levels, 50% indicated that they would like to have an over-the-counter (OTC) antihypercholesterolemic agent available.[2] In patients who are classified as at least somewhat concerned about their cholesterol, more than 60% are interested in taking an OTC 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor. Therefore, it is increasingly likely that clinicians will encounter patients interested in taking dietary supplements with antihypercholesterolemic effects. The following dietary supplements have been said to have lipid-lowering properties[3,4]: acidophilus, artichoke leaf, bilberry leaf, L-carnitine, chondroitin, copper, dietary fiber, flaxseed oil, -oryzanol, genistein, he shou wu, lecithin, maitake, -3 fatty acids, red yeast rice, silicon dioxide, spirulina, aortic glycosaminoglycans, ashwagandha, calcium, ß-carotene, chromium, creatine, fenugreek, fungal polysaccharides, garlic, gugulipid, indole-3-carbinol, lycopene, niacin, pantethine, saponin, ß-sitosterol and sitostanol, soy protein, and tocotrienols. Of these, only seven have objective clinical trial data to support the claim: red yeast rice, tocotrienols, gugulipid, garlic, soy protein, -3 fatty acids, and niacin. The efficacy and safety of niacin has been reviewed extensively and thus is not discussed here.

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