An Update on Statin Alternatives and Adjuncts

Matthew J Sorrentino


Clin Lipidology. 2012;7(6):721-730. 

In This Article


Garlic has been advocated as an agent to lower blood pressure and cholesterol. Garlic contains sulfur-rich derivatives of the amino acid cysteine, including allicin, that are thought to give medicinal benefits. Little or no allicin is present in the intact garlic clove. When garlic is cut or crushed the enzyme allinase interacts with the cysteine compound alliin producing allicin. Allicin gives garlic its typical aroma and taste, but is fairly volatile and usually breaks down in a few hours at room temperature or after 20 min of cooking. Studies in isolated hepatocytes indicate that key enzymes in cholesterol biosynthesis, including HMG-CoA reductase, may be inhibited by the sulfur-containing compounds in garlic.[36] A meta-analysis of five selected trials including a total of 410 individuals indicated a 9% reduction in cholesterol levels in the garlic-treated subjects.[37] Since the publication of the meta-analysis, however, further studies have reported conflicting results. The discrepant results among studies may be explained by manufacturing differences among the garlic preparations. Deodarized garlic powder may not contain the active components thought to inhibit cholesterol synthesis. Fresh garlic may achieve a significant amount of allicin in the diet, but the odor and stomach upset caused by raw garlic make it a difficult agent to use for a cholesterol-lowering agent. Cooked garlic may be better tolerated but prolonged cooking will inactivate the sulfur-containing compounds thought to be beneficial. Garlic as part of a therapeutic lifestyle diet may be an adjunct for cholesterol lowering with standard therapy, but definitive studies have not been carried out.