The foundation for the treatment of dyslipidemia is optimal nutrition, diet, and ideal body weight combined with an aerobic and resistance exercise program in all patients. Depending on degree of CV risk, nutritional supplements or drug therapy is the next step. For the low- to moderate-risk patient, nutritional supplements are the second cornerstone of therapy. In the high- and very high-risk patients, pharmacologic agents are needed and should be used in conjunction with diet, nutrition, exercise, weight loss, and scientifically proven nutritional supplements. Clinical studies support the ability to reduce serum cholesterol, LDL, and TGs by 30% to 40% with the combination of diet, lifestyle modifications, and nutritional supplements in most patients. Details of the National Cholesterol Education Program, Portfolio, Dietary Approaches to Stop Hypertension (DASH), and Mediterranean diets are discussed in detail in this article, as well as the type and duration of exercise required to achieve significant and clinically relevant reductions in serum lipids. Nutritional supplements provide additional therapeutic interventions for lipid-lowering. Those supplements that have the best clinical data in humans for improving the lipid profile include niacin, ω-3 FAs, rice bran oil, γ-/δ-tocotrienols, pantethine, red yeast rice, plant sterols, soluble fibers, probiotics, soy, and mixed nuts with MUFA and PUFA such as almonds. Agents that do not appear to have significant effects on lipids based on recent Randomized Control Clinical Trial (RCCT) are guggulipid, policosanol, garlic, IHN, ginseng, fenjuseek, coenzyme Q-10, and chromium. Additional studies are needed to evaluate the role of green tea (EGCG) and curcumin (turmeric) as effective lipid-lowering agents in humans. In addition to cholesterol and LDL reductions, several nutritional supplements have other antiatherogenic effects. Reduced oxidation of LDL-C is documented with niacin, EGCG, pantethine, resveratrol, garlic, policosanol, rice bran oil (RBO), Co-Q-10, γ-/δ-tocotrienols, vitamin E, MUFA, polyphenols, and curcumin. Niacin, ω-3 FAs, plant sterols, and psyllium convert type B dense LDL to the larger type A LDL, which is not atherogenic. Intestinal cholesterol absorption is reduced with plant sterols, soy, EGCG, sesame and fiber. Inhibition of the HMG-CoA reductase is seen in the presence of pantethine, γ-/δ-tocotrienols, red yeast rice, and sesame. Triglycerides are especially lowered with niacin, ω-3 FAs, and pantethine and, to a lesser extent, with red yeast rice and soy. High-density lipoprotein is increased in size from HDL-3 to HDL-2 by niacin, ω-3 FAs, pantethine, and soy. The best clinical data for reduction in CV events with nutritional supplements is with ω-3 FAs, alpha linolenic acid (ALA), and to a lesser extent, with niacin and fiber. This includes CHD, MI, and overall CV events for each of these, as well as reductions in CVA and sudden death for ω-3 FAs and decrease in PAD with fiber.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine