Cholesterol and Supplements

I would recommend that low risk individuals who have high cholesterol levels try taking cholesterol – lowering supplements to lower their bad cholesterol levels. Actually dietary therapy such as vegetables, oats and tofu can lower bad cholesterol levels by at least 10%. By taking supplements, the bad cholesterol level can be lowered by another 10-20%. The rationale for taking cholesterol lowering instead of medications in low risk individuals is that they are not at high risk cardiac events or strokes and can afford to have a less aggressive and slower way of reducing their cholesterol levels.

Supplements have a very low toxicity level and are unlikely to cause harm even if taken at high doses. If the individual already knows that his cholesterol level is high, he may benefit from taking such supplements. If the individual does not know their cholesterol level and is worried, he should go for a check first. By and large, supplements are available over the counter without a need for any prescription. The supplements are unlikely to cause harm and may have some benefit.

There are individuals who refuse to take statins because they are fearful of the possible side effects. I think it boils down to whether the individual is at low or high risk for cardiovascular disease. The evidence is very strong for statins in patients who are in the high risk category. In the low risk category, the guidelines recommend treating the cholesterol level with a statin if the bad cholesterol exceeds 190 mg/dL. In individuals in the low risk category and who have cholesterol levels below 190mg/dL, then they can opt for alternative therapy. Research does support the idea that exercise and dieting helps to lower cholesterol levels through weight loss and a good diet. The cholesterol levels can be reduced by up to 20-30%.

Red yeast rice

Red yeast rice is marketed and found in supplements such as Xuezhikang, cholestin and hypocol. The dose is dependent on the brand of supplement used for example Hypocol dose is up to 2 tablets twice a day.

The active ingredient in red yeast rice is Monacolin K which is also known as lovastatin. Three placebo –controlled studies have shown that red yeast rice can reduce total cholesterol by up to 16% and LDL cholesterol by up to 24%. This degree of reduction is equivalent to lovastatin drug dose of 20-40mg.

Red yeast rice also contains beta-sitosterol and capesterol which inhibits cholesterol absorption of the intestine.

FDA in 2007 warned consumers not to buy certain brands of red yeast rice as they contained lovastatin and banned those products. However, the Hypocol which is available in Singapore has monacolins in the ingredients label and as mentioned above, monacolin K is lovastatin. So I would presume that the red yeast rice sold in Singapore are still effective.

Fish oils contain omega-3 fatty acids which are considered essential. The active components of omega-3 fatty acids are EPA and DHA. They have been shown to have anti-inflammatory and antithrombotic effects. Fish oils are to inhibit the production of triglycerides in the liver.

The main effect of fish oils is that they lower triglyceride levels. However, the lowering of triglyceride levels by drugs or others have not been shown to reduce the risk of cardiac events.

The evidence from clinical trials center mainly on secondary prevention, ie in people who already have heart disease. In two trials of patients who had suffered a previous heart attack, treatment with 850mg of DHA/EPA per day significantly reduced the risk of death by 28%, driven mainly by a 45% risk reduction in sudden cardiac death.

In a trail of patients with heart failure, 850mg pf DHA/EPA reduced the risk of death by 9% and hospitalization for a cardiac cause by 8%.

A very large study from Japan in patients with high cholesterol and a vascular event showed that combined therapy with a statin and 1.8 grams of EPA reduced the combined end-point of death, revascularization, myocardial infarction and unstable angina by 19% compared with statin alone.

There is no toxicity associated with omega-3 fatty acids so there are no real cons except that if you burp after taking one of these capsules, your breathe will smell very fishy.

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