It is common knowledge that: A high blood cholesterol level is a cardiovascular risk factor; If blood cholesterol is not controlled, it can significantly increase the risk of a cardiovascular event occurring. The first step to reduce and control blood cholesterol levels is simple and everyone can do it: Eat a balanced diet and exercise regularly. A healthy lifestyle can reduce cholesterol values by about 5%-10%; For example, if someone with a cholesterol value of 210 mg/dL starts to be careful with diet and does physical activity, can reduce the values by 10-20 mg/dL. In some people, this absolute reduction in cholesterol may be enough to reach values appropriate to their age and clinical situation. Attention: The adequate level of cholesterol in the blood varies with age and with the presence or not of other cardiovascular risk factors, for example arterial hypertension, tobacco consumption, diabetes, among others. So: Before being sure that your cholesterol has an adequate value, talk to your doctor! Do not evaluate the results of your blood tests by reference values, as these do not take your particularities into account. When lifestyle changes are not enough It sometimes happens that it is not possible to implement the necessary lifestyle changes, or that, even with these, the desired results cannot be achieved. In this case, the doctor may recommend taking medication to control cholesterol . The purpose of this medication goes beyond lowering cholesterol levels. It is essential that cholesterol reduction is accompanied by an effective prevention of cardiac events, such as acute myocardial infarction and stroke . The most commonly used drugs to control cholesterol levels are statins . There are several statins, with different strengths, that can reduce cholesterol between 20%-50%. Statin medication has been shown to consistently reduce the risk of having a cardiac event and developing cardiovascular disease. The fact that cardiovascular diseases are the main cause of death and years of life lost is, therefore, the main reason that justifies the prescription of statins to those who actually need them. But after all, is it possible to replace statins with supplements? Answering this question has been the objective of several studies, one of which was published in 2023. In this study, researchers followed 190 patients with the following characteristics: Age between 40-75 years old, with an average of 64 years old; Women 59%; LDL cholesterol 70-189 mg/dL, with an average of 128 mg/dL; No personal history of cardiovascular disease, but with some degree of cardiovascular risk; None on cholesterol medication. The 190 patients were randomly assigned to one of the following treatment groups: Rosuvastatin (statin) 5 mg/day Natural fish oil (omega-3) 2400 mg/day Cinnamon extract 2400 mg/day Garlic with allicin 5000 µg/day Curcuma 4500 mg/da Plant sterols (phytosterols) 1600 mg/day Red yeast rice 2400mg/day Placebo group, which took a pill with no active ingredient and therefore no effect. All patients received the treatment of the group to which they belonged for one month and the following was evaluated: Reduction of cholesterol levels; Side effects of treatment. The main results and conclusions of the study were as follows: Rosuvastatin, the only statin used in the study, reduced LDL-cholesterol (low-density lipoprotein cholesterol) by 38% and total cholesterol by 24%. All supplements used caused a marginal reduction in cholesterol levels and some of them even increased cholesterol values; Red yeast rice was the best supplement, but it only reduced the cholesterol value by 7%, far below the reduction obtained with rosuvastatin; None of the supplements were better than the placebo, which means that, in the population studied, taking supplements or not taking them at all had the same impact on lowering cholesterol levels; Side effects were the same in all groups, even in patients taking statins, who had no serious side effects. Other than health impacts In addition to the effect that supplements have on lowering cholesterol, the financial factor can be decisive in the right choice . A little research on prices is enough to realize that you will have to pay much more for a supplement than for a statin. Considering all this and the fact that statins have proven their effectiveness in reducing cardiac events, my answer is simple: Choose a statin whenever prescribed by a doctor! Author : José Ferreira Santos Sources Rippe JM. Lifestyle Strategies for risk factor reduction, prevention, and treatment of cardiovascular disease . Am J Lifestyle Med 2018;13:204-212. Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk . Eur Heart J 2020;41:111-188. Laffin LJ, Bruemmer D, Garcia M, Brennan DM, McErlean E, Jacoby DS, et al. Comparative effects of low-dose rosuvastatin, placebo, and dietary supplements on lipids and inflammatory biomarkers . J Am Coll Cardiol 2023;81:1-12. Meet the cardiology clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
