Dietary supplements not effective in lowering LDL-C, use of low-dose statins encouraged

Rosuvastatin at a low dose outperformed various dietary supplements and placebo in decreasing low-density lipoprotein-cholesterol (LDL-C), total cholesterol and triglycerides. Furthermore, no dietary supplement was superior to placebo in lowering LDL-C.

“We all see patients that have their medication list littered with dietary supplements and, in fact, over 3 quarters of Americans take a dietary supplement, and 18% of those individuals take a supplement to promote heart health,” Dr Luke Laffin (Cleveland Clinic, OH, USA) explained [1]. The presented SPORT trial (NCT04846231) evaluated the effect of low-dose statin treatment of 5 mg rosuvastatin on lipids and inflammatory biomarkers compared with six widely used dietary supplements (fish oil, cinnamon, garlic, turmeric, plant sterols or red yeast rice) and placebo. Within the prospective, randomised, single-blinded trial, 199 participants were equally allocated to 1 of the 8 study arms. Laboratory testing (days 0 and 28) included analysis of a lipid and comprehensive metabolic panel, and highly sensitive (hs)CRP levels. The primary endpoint was the proportion of change in LDL-C.

“Study participants were in their mid-60s, we enrolled 60% women, the median 10-year atherosclerotic cardiovascular disease (ASCVD) risk was 7.9%, mean LDL-C was 128 mg/dL, and most people had relatively normal or low CRP,” Dr Laffin described the SPORT cohort. Analysis of the change in LDL-C showed a -37.86% reduction in LDL-C for rosuvastatin, a significantly greater reduction than was reported for placebo (-2.63%) or any of the supplements (ranging between -6.55 and +5.13; P<0.001 for all comparisons). The results for change in total cholesterol (P<0.001) and triglycerides (P<0.05) were similarly superior in the rosuvastatin arm for all evaluations. HsCRP levels did not differ between the statin arm and the other groups.

“None of the supplements decreased LDL-C compared with placebo and the garlic supplement even increased LDL-C by almost 8% (P=0.01),” Dr Laffin commented on the values for biomarker results of the supplement arms versus the placebo group. Plant sterols significantly decreased HDL-C versus placebo (-7.1%; P=0.02). Additional comparisons did not yield significant results for change in total cholesterol, triglycerides or hsCRP.

“Adverse events were numerically similar across all study groups, and slightly higher with some of the supplements, particularly for plant sterols and red yeast rice,” Dr Laffin indicated, emphasising that no musculoskeletal events were reported in the rosuvastatin arm.

“We should use these results to engage in evidence-based discussions with patients about the benefits of low dose statin and the lack of benefit that we see for these heart health supplements,“ Dr Laffin reviewed the public health importance of the trial.

1. 
   
   1. Laffin L. Effect of low-dose statin compared with placebo and six dietary supplements on lipid and inflammatory biomarkers: The SPORT randomised clinical trial. LBS.05, AHA Scientific Sessions 2022, 05–07 November, Chicago, USA.

 

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Posted on 11 January 202313 June 2024