Nutraceuticals for the Control of Dyslipidaemias in Clinical Practice

Abstract

Dyslipidaemias result in the deposition of cholesterol and lipids in the walls of blood vessels, chronic inflammation and the formation of atherosclerotic plaques, which impede blood flow and (when they rupture) result in acute ischaemic episodes. Whilst recent years have seen enormous success in the reduction of cardiovascular risk using conventional pharmaceuticals, there is increasing interest amongst patients and practitioners in the use of nutraceuticals to combat dyslipidaemias and inflammation in cardiovascular disease. Nutraceutical is a portmanteau term: ‘ceutical’ indicate pharmaceutical-grade preparations, and ‘nutra’ indicates that the products contain nutrients from food. Until relatively recently, little high-quality evidence relating to the safety and efficacy of nutraceuticals has been available to prescribers and policymakers. However, as a result of recent randomised-controlled trials, cohort studies and meta-analyses, this situation is changing, and nutraceuticals are now recommended in several mainstream guidelines relating to dyslipidaemias and atherosclerosis. This article will summarise recent clinical-practice guidance relating to the use of nutraceuticals in this context and the evidence which underlies them. Particular attention is given to position papers and recommendations from the International Lipid Expert Panel (ILEP), which has produced several practical and helpful recommendations in this field.

Red yeast rice for dyslipidaemias and cardiovascular risk reduction: A position paper of the International Lipid Expert Panel

“…The unambiguous evidence supporting these therapies supports their continued (and expanding) role in risk reduction. In addition to these 'conventional' therapeutics, growing evidence supports the use of a range of 'nutraceuticals' (constituents of food prepared as pharmaceutical formulations) [11][12][13][14][15][16]. Efficacy claims have been made for a wide range of nutraceuticals in the CVD prevention and management.…”

“…Efficacy claims have been made for a wide range of nutraceuticals in the CVD prevention and management. The evidence has been summarised in position papers of the International Lipid Expert Panel (ILEP) [11,12,14,15,17]. Amongst the many nutraceuticals with potential lipid-lowering effects, red yeast rice (RYR) stands out as having a particularly broad evidence base, and therefore merits further detailed consideration on its role in lipid disorders management.…”

“…In the United Kingdom, the National Institute for Health and Care Excellence recommendations on risk reduction in cardiovascular disease (including lipid modification) are currently in the process of being updated, however the current document makes no recommendation with respect to red yeast rice. ILEP have produced several position papers, relating to the use of nutraceuticals (including red yeast rice) in clinical practice, and particularly in statin-intolerant patients [11,12,14,15,17]. Also other societies and experts' group previously attempted (before and after EFSA decision 2018) to indicate the role of RYR in the therapy of lipid disorders, indicating the groups of patients that might benefit the most from the supplementation and emphasizing the issue of safety (nutrivigilance) and quality of production (lack of contamination) [31,32].…”

“…Furthermore, they strongly indicate the need to improve the adherence to cheap and available therapies like statins, combination therapy of statins and ezetimbe, and support the expansion of criteria for reimbursement, so that these highly effective drugs for the reduction of cardiovascular disease can be made available to all patients for whom evidence suggests are likely to derive a benefit. RYR, and other nutraceuticals [13][14][15][16]33] should be considered as supplementary or supportive agents in the armoury of lipid-modification. They should not routinely replace medicines for which a larger body of long-term efficacy and safety data exist.…”

Beneficial effects of psyllium on the prevention and treatment of cardiometabolic diseases

“…3,77 Research has shown that dyslipidemia leads to the deposition of cholesterol and lipids in blood vessel walls, chronic inflammation, and the formation of atherosclerotic plaques that block blood flow and (when they rupture) lead to acute ischemic attacks. 78 Measures to adjust abnormal lipid metabolism are commonly agreed to prevent the outbreak of CVD. However, many lipid-lowering drugs, such as statins, carry various side effects or contraindications.…”