Millions of Americans are prescribed statins to reduce their risk of heart disease, but many prefer to take supplements like fish oil, garlic, and flaxseed.
Peter Dazeley / Getty Images
hide captions
switch captions
Peter Dazeley / Getty Images
Millions of Americans are prescribed statins to reduce their risk of heart disease, but many prefer to take supplements like fish oil, garlic, and flaxseed.
Peter Dazeley / Getty Images
If you were prescribed medication to reduce your risk of a heart attack or stroke, would you take it?
Millions of Americans are prescribed statins like Lipitor, Crestor or generic formulations to lower their cholesterol. But a lot of people hesitate to start taking the drug.
Some people worry about potential side effects like leg cramps, which may – or may not – be related to the drug. As an alternative, dietary supplements, often marketed to promote heart health, include fish oil and other supplements. Omega-3 supplements (Omega-3 is an essential fatty acid found in fish and flaxseeds), is popular growth.
So which is the most efficient? Researchers at the Cleveland Clinic set out to answer this question by comparing statins to supplements in a clinical trial. They followed the outcomes of 190 adults, ages 40 to 75. Some of the participants were given 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 time period.
Crestor maker Astra Zeneca funded the study, but the researchers worked independently to design the study and run the statistical analysis.
“What we found was that rosuvastatin lowered LDL cholesterol by almost 38%, and that was far superior to placebo and any of the supplements studied in the trial,” said the study’s authors. Luke Laffin, MD of the Cleveland Clinic’s Heart, Vascular & Thoracic Institute told NPR. This reduction is enough to reduce the risk of heart attack and stroke, he says. The findings are published in Journal of the American College of Cardiology.
“Often these supplements are marketed as ‘natural ways’ to lower your cholesterol,” says Laffin. But he says none of the supplements demonstrated a significant reduction in LDL cholesterol levels compared with a placebo. LDL cholesterol is considered ‘bad cholesterol’ because it can contribute to plaque formation in artery walls – which can narrow arteries and set the stage for heart attacks and strokes.
“Clearly, statins do what they’re intended to do,” study senior author Steve Nissen, MD, a cardiologist and Academic Director of the Heart, Vascular & Thoracic Institute at the Cleveland Clinic told NPR. By comparison, he says the study shows that the supplements aren’t as effective. “They don’t promote heart health. They don’t improve bad cholesterol levels.” Nissen says supplements can be more expensive than statins. Depending on insurance, Nissen says people can pay less than $5 a month out of pocket for rosuvastatin.
“Statins are the most effective heart attack and stroke prevention drugs we’ve actually seen.” Michael HonigbergMD, a researcher and cardiologist at Massachusetts General Hospital who was not affiliated with the new study. He says the new findings add to a growing body of evidence that statins lower LDL cholesterol, and he was not surprised to find that the supplements weren’t effective.
However, he says, not everyone with a family history of heart disease or mildly elevated cholesterol should use a statin. The American College of Cardiology and the American Heart Association have developed a number of prescribing instructions. Usually, if a person’s LDL (bad cholesterol) cholesterol is 190 or higher, they are usually advised to start taking a statin. Healthcare professionals use a risk calculator to estimate a person’s risk of having a heart attack or stroke over the next 10 years. If the risk is high enough, based on factors including age, blood pressure, and smoking status, a statin may be recommended.
For people with mild hypercholesterolemia, but not at high enough risk to be prescribed a statin, he recommends focusing on diet and exercise, rather than buying supplements, says Honingberg. “I tell my patients to save their money and instead spend that money eating high-quality, heart-healthy foods.” He points to studies showing that a diet is good for the heart, including Mediterranean diet which emphasizes healthy fats, lots of fruits, vegetables and whole grains and Diet, significantly reducing the risk of heart disease. “I think one formula that we may not be getting enough of is that food is a drug and perhaps a more effective drug than supplements,” says Honingberg.
The National Center for Complementary and Integrative Health, a division of the National Institutes of Health, has also concluded, based on previous research, that Omega-3 supplements do not reduce heart disease risk, but eating fish – which contain omega-3 fatty acids – may reduce the risk of the disease. This suggests that omega-3 fatty acids are most beneficial as part of a healthy diet. And it’s worth noting that the NIH review concluded that omega-3 supplements can help reduce the symptoms of rheumatoid arthritis. Omega 3 is also added to infant formula to promote brain development. The NIH review also concluded that omega-3 supplements can reduce triglycerides, a type of fat found in the blood. But Dr Honingberg says this may be advisable for a “small group of patients” with very high triglyceride levels.
For people whose risk of heart disease is high enough to warrant a statin prescription, Dr. Honingberg says he spends a fair amount of time talking to patients.
“We talk about excellent safety and a very low risk of side effects,” he said. He describes the risk of serious side effects as “very small.”
Sometimes patients stop taking a statin because they believe it causes certain side effects. But Honingberg points out a double blindness research that showed that when patients were given a placebo instead of a statin, they reported feeling most of the same side effects. “So the bottom line of the trial is that people blame statins for the side effects that statins don’t actually cause,” he said.
