The Effect of 6 Common Dietary Supplements on LDL-C Concentration

Six common dietary supplements do not decrease LDL-C concentrations in patients with increased risk for atherosclerotic cardiovascular disease.

Rosuvastatin 5-mg daily is associated with a significantly greater decrease in low-density lipoprotein cholesterol (LDL-C) compared with placebo and multiple dietary supplements, including fish oil, cinnamon, and garlic, in patients with an increased 10-year risk for atherosclerotic cardiovascular disease (ASCVD), according to a study published in the Journal of the American College of Cardiology.

The single-center, prospective, randomized, single-blind SPORT (Supplements, Placebo, or Rosuvastatin) study evaluated the efficacy of common dietary supplements compared with a low-dose statin from May 2021 through July 2022.

Eligible participants were aged 40 to 75 years, had an LDL-C concentration of 70 to 189 mg/dL, no personal history of ASCVD, were not taking statins or other prescription lipid-lowering therapy, were not taking any of the dietary supplements included in the trial, and had an increased 10-year risk for ASCVD.

The study regimens included daily doses of rosuvastatin 5 mg, classified as a moderate-intensity statin, placebo, fish oil, cinnamon, garlic, turmeric curcumin with bioperine, plant sterols, or red yeast rice.

The primary endpoint was the percentage change in LDL-C concentration for rosuvastatin 5 mg daily at 28 days compared with the other regimens tested in the following hierarchical order: placebo, fish oil, cinnamon, garlic, turmeric, plant sterols, and red yeast rice.

These findings do not support the ‘cholesterol health’ claims made by supplement manufacturers.

A total of 190 randomized patients completed baseline and follow-up laboratory assessment. All groups had 25 participants, except the fish oil group which had 24. Participants’ overall mean (SD) age was 64.4 (6.4) years, 59% were women, and 89% were Non-Hispanic White patients.

For the patients who received rosuvastatin, the mean percentage decrease in LDL-C concentration was -37.9% (95% CI, -42.1 to -33.6). Rosuvastatin was associated with a significantly greater percentage of LDL-C reduction (P <.001) vs placebo, fish oil, cinnamon, garlic, turmeric, plant sterols, and red yeast rice. The difference for LDL-C reduction with rosuvastatin vs placebo was -35.2% (95% CI, -41.3 to -29.1; P <.001).

The participants who received the low-dose statin had a significant percentage decrease in total cholesterol from baseline (-24.4 %; 95% CI, -27.6 to -21.3) compared with those who received placebo and all supplements (P <.001 for all comparisons). Serum triglyceride levels were significantly lowered for rosuvastatin (-19.3%; 95% CI, -27.6 to -9.9), which was significantly greater vs all comparators (P <.05 for all comparisons).

No difference in high-density lipoprotein cholesterol (HDL-C) was found in a comparison of rosuvastatin with placebo and 6 of the 7 supplements. Plant sterols decreased HDL-C compared with rosuvastatin (-7.5%; 95% CI, -13.3 to -1.6; P =.01).

None of the supplements resulted in a statistically significant decrease in LDL-C vs placebo. However, garlic had a significant increase in LDL-C (7.8%; 95% CI, 1.7-13.8; P =.01). No significant difference in high-sensitivity C-reactive protein, total cholesterol, or serum triglyceride lowering was observed in a comparison of each supplement with placebo.

The plant sterols and red yeast rice groups had the highest rate of adverse events (28%). The placebo group had 1 serious adverse event (deep venous thrombosis), and the fish oil group had 1 serious adverse event (liver adenocarcinoma).

Study limitations include the relatively short study period and the small sample size, which does not allow a meaningful subgroup analysis. Also, 89% of participants were Non-Hispanic White patients.

“These findings do not support the ‘cholesterol health’ claims made by supplement manufacturers,” wrote the researchers. “Patients should be educated about the lack of benefit of these supplements on important cardiovascular risk factors.”

Disclosure: The trial was supported by an unrestricted grant from AstraZeneca. Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

References:

Laffin LJ, Bruemmer D, Garcia M, et al. Comparative effects of low-dose rosuvastatin, placebo and dietary supplements on lipids and inflammatory biomarkers. J Am Coll Cardiol. Published online November 6, 2022. doi: 10.1016/j.jacc.2022.10.013