Millions of Americans are prescribed statins to reduce the risk of heart disease, but many prefer to take supplements like fish oil, garlic and flaxseed. Image: Peter Dazeley/Getty Images
If you were prescribed a drug to reduce your risk of heart attack or stroke, would you take it?
Millions of Americans are prescribed statins such as Lipitor, Crestor, or generic formulations to lower their cholesterol. But many people are hesitant to start treatment.
Some people worry about potential side effects such as leg cramps, which may or may not be related to the drug. As an alternative, dietary supplements, often marketed to support heart health, including fish oil and other omega-3 supplements (Omega-3s are essential fatty acids found in fish and flax seeds), are gain popularity.
So which is the most effective? Researchers at the Cleveland Clinic attempted to answer this question by comparing statins to supplements in a clinical trial. They followed the results of 190 adults, aged 40 to 75. Some participants received a daily dose of 5 mg of rosuvastatin, a statin sold under the brand name Crestor for 28 days. Others received supplements including fish oil, cinnamon, garlic, turmeric, plant sterols or red yeast rice during the same period.
Crestor’s manufacturer, Astra Zeneca, sponsored the study, but the researchers worked independently to design the study and perform the statistical analysis.
“What we found was that rosuvastatin reduced LDL cholesterol by almost 38%, which was significantly better than placebo and any of the six supplements studied in the trial,” the author said. of the study. Luke Laffin, MD from the Heart, Vascular & Thoracic Institute at the Cleveland Clinic told NPR. He says this level of reduction is sufficient to reduce the risk of heart attacks and strokes. The conclusions are published in the Journal of the American College of Cardiology.
“Often these supplements are marketed as ‘natural ways’ to lower your cholesterol,” says Laffin. But he says that none of the dietary supplements demonstrated a significant lowering of LDL cholesterol compared to a placebo. LDL cholesterol is considered the “bad cholesterol” because it can contribute to plaque buildup in artery walls, which can narrow arteries and lead to heart attacks and strokes.
“Obviously, statins do what they’re supposed to do,” said the study’s lead author. Steve Nissen, MD, a cardiologist and academic director of the Cleveland Clinic’s Heart, Vascular & Thoracic Institute told NPR. By comparison, he says this research shows that supplements aren’t effective. “They don’t promote heart health. They don’t improve bad cholesterol levels.” Nissen says supplements can be expensive compared to statins. According to insurance, Nissen says people can pay less than $5.00 a month out of pocket for rosuvastatin.
“Statins are the most effective drugs to prevent heart attacks and strokes that we have ever seen,” says Michael Honigberg, MD, a cardiologist and researcher at Massachusetts General Hospital who is not affiliated with the new study. He says the new findings add to an already large body of evidence showing that statins lower LDL cholesterol, and he’s not surprised the supplements weren’t as effective.
However, he says, not everyone with a family history of heart disease or mildly high cholesterol should take a statin. The American College of Cardiology and the American Heart Association have developed prescription instructions. As a general rule, if a person’s LDL cholesterol (bad cholesterol) is 190 or higher, it is often advisable to start a statin. Health professionals use a risk calculator to estimate a person’s risk of having a heart attack or stroke in the next 10 years. If the risk is high enough, based on factors such as age, blood pressure, and smoking status, a statin may be recommended.
Honingberg says that for people who have mildly elevated cholesterol but aren’t at risk enough to be prescribed a statin, he recommends focusing on diet and exercise, rather than buying supplements. “I tell my patients to save their money and spend that money on eating high-quality, heart-healthy foods instead.” He mentions studies that show heart-healthy diets, including Mediterranean diets which emphasize healthy fats, lots of fruits, vegetables and whole grains and the DASH Diet, significantly reduce the risk of heart disease. “I think one formulation that we may not be using enough is that food is medicine and is probably more effective medicine than supplements,” Honingberg says.
The National Center for Complementary and Integrative Health, part of the National Institutes of Health, has also concluded, based on previous research, that omega-3 supplements do not reduce the risk of heart disease, but eating fish – which contains omega-3 fatty acids – is linked to a reduced risk. This suggests that omega-3 fatty acids are most beneficial as part of a healthy diet. And it should be noted that the NIH review concludes that omega-3 supplements may help relieve symptoms of rheumatoid arthritis. Omega 3s are also added to infant formula to support brain development. The NIH review also concludes that omega-3 supplements can lower triglycerides, a type of fat found in the blood. But Dr. Honingberg says it may be recommended for a “small subset of patients” with very high triglyceride levels.
When it comes to people whose risk of heart disease is high enough to warrant a statin prescription, Dr. Honingberg says he spends a lot of time talking about patient concerns.
“We’re talking about the excellent safety profile and the very, very low risk of side effects,” he says. He describes the risk of serious side effects as “infinitely small”.
Sometimes patients stop taking a statin because they think it is causing a certain side effect. But Honingberg points to a double blind Research study which showed that when patients were given a placebo instead of a statin, patients reported experiencing most of the same side effects. “So the conclusion of the trial is that people blame statins for side effects that statins don’t really cause,” he says.
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