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Natural sources of antidyslipidaemic agents: is there an evidence-based approach for their prescription?

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Mediterranean Journal of Nutrition and Metabolism

Abstract

Numerous randomized clinical trials, systematic reviews and meta-analyses have confirmed the antidyslipidaemic activity of different dietary supplements, nutraceuticals and herbal remedies. International guidelines for cardiovascular disease prevention have begun to consider dietary supplements as an evidence-based approach to improve patients’ plasma lipid levels. They already suggest to increasing or supplementing the dietary intake of soluble fibre (especially psyllium), soy proteins, plant sterols, niacin, and fish oil. Among the nutraceuticals, mevacoline and policosanol are both able to reduce plasma LDL-C by a mean of 20%. A preliminary clinical study of berberine has shown it to be the most powerful antihyperlipidaemic natural compound, reducing plasma LDL-C by 25% and triglycerides by 35%. Among the herbal remedies, several placebo-controlled randomized clinical trials have confirmed the anti-Numerous randomized clinical trials, systematic reviews and meta-analyses have confirmed the antidyslipidaemic activity of different dietary supplements, nutraceuticals and herbal remedies. International guidelines for cardiovascular disease prevention have begun to consider dietary supplements as an evidence-based approach to improve patients’ plasma lipid levels. They already suggest to increasing or supplementing the dietary intake of soluble fibre (especially psyllium), soy proteins, plant sterols, niacin, and fish oil. Among the nutraceuticals, mevacoline and policosanol are both able to reduce plasma LDL-C by a mean of 20%. A preliminary clinical study of berberine has shown it to be the most powerful antihyperlipidaemic natural compound, reducing plasma LDL-C by 25% and triglycerides by 35%. Among the herbal remedies, several placebo-controlled randomized clinical trials have confirmed the antihypercholesterolaemic, and antihypertriglyceridaemic properties of aged garlic powder, artichoke leaf extracts, guggul, and fenugreek. Single small clinical trials have also suggested that Korean ginseng, green tea, onion, yarrow, holy basil and arjun have an antihypercholesterolaemic effect.

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References

  1. Bean WB (1968) Sir William Osler: Aphorism from his bedside teaching and writing. Thomas, Springfield, IL, p 105

    Google Scholar 

  2. Capasso L (1998) 5300 years ago, the Ice Man used natural laxatives and antibiotics. Lancet 352:1864

    Article  CAS  Google Scholar 

  3. Goldman P (2001) Herbal medicine today and the roots of modern pharmacology. Ann Intern Med 135:594–600

    CAS  Google Scholar 

  4. Rees L, Weil A (2001) Integrated medicine. BMJ 322:119–120

    Article  CAS  Google Scholar 

  5. Astin JA (1998) Why patients use alternative medicine. JAMA 279:1548–1553

    Article  CAS  Google Scholar 

  6. Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (2001) Executive summary of The Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 285:2486–2497

    Article  Google Scholar 

  7. Anderson JW, Allgood LD, Lawrence A et al (2000) Cholesterollowering effects of psyllium intake adjunctive to diet therapy in men and women with hypercholesterolemia: meta-analysis of 8 controlled trials. Am J Clin Nutr 71:472–479

    CAS  Google Scholar 

  8. Sierra M, Garcia JJ, Fernandez N et al (2002) Therapeutic effects of psyllium in type 2 diabetic patients. Eur J Clin Nutr 56:830–842

    Article  CAS  Google Scholar 

  9. Wolever TM, Jenkins DJ, Mueller S et al (1994) Method of administration influences the serum cholesterol-lowering effect of psyllium. Am J Clin Nutr 59:1055–1059

    CAS  Google Scholar 

  10. Petchetti L, Frishman WH, Petrillo R, Raju K (2007) Nutriceuticals in cardiovascular disease: psyllium. Cardiol Rev 15:116–122

    Article  Google Scholar 

  11. Moreyra AE, Wilson AC, Koraym A (2005) Effect of combining psyllium fiber with simvastatin in lowering cholesterol. Arch Intern Med 165:1161–1166

    Article  CAS  Google Scholar 

  12. Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico (1999) Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Lancet 354:447–455

    Article  Google Scholar 

  13. Bucher HC, Hengstler P, Schindler C, Meier G (2002) N-3 polyunsaturated fatty acids in coronary heart disease: a meta-analysis of randomized controlled trials. Am J Med 112:298–304

    Article  CAS  Google Scholar 

  14. Borghi C, Cicero AF (2007) Blood pressure modulating properties of omega-3 polyunsaturated fatty acids (PUFA). Another PUFA heart protective effect? High Blood Pressure Cardiovasc Prevent 14:55–61

    Article  CAS  Google Scholar 

  15. Sirtori CR, Lovati MR (2001) Soy proteins and cardiovascular disease. Curr Atheroscler Rep 3:47–53

    Article  CAS  Google Scholar 

  16. Anderson JW, Johnstone BM, Cook-Newell ME (1995) Meta-analysis of the effects of soy protein intake on serum lipids. N Engl J Med 333:276–282

    Article  CAS  Google Scholar 

  17. Cicero AF, Fiorito A, Panourgia MP et al (2002) Effects of a new soy/beta-sitosterol supplement on plasma lipids in moderately hypercholesterolemic subjects. J Am Diet Assoc 102:1807–1811

    Article  Google Scholar 

  18. Grundy SM (2005) Stanol esters as a component of maximal dietary therapy in the National Cholesterol Education Program Adult Treatment Panel III report. Am J Cardiol 96(1A):47D–50D

    Article  CAS  Google Scholar 

  19. Law M (2000) Plant sterols and stanols margarines and heath. BMJ 320:861–864

    Article  CAS  Google Scholar 

  20. Hallikainen MA, Sarkkinen ES, Gylling H et al (2000) Comparison of the effects of plant sterol ester and plant stanol ester-enriched margarines in lowering serum cholesterol concentrations in hypercholesterolaemic subjects on a low-fat diet. Eur J Clin Nutr 54:715–725

    Article  CAS  Google Scholar 

  21. Patch CS, Tapsell LC, Williams PG, Gordon M (2006) Plant sterols as dietary adjuvants in the reduction of cardiovascular risk: theory and evidence. Vasc Health Risk Manag 2:157–162

    Article  CAS  Google Scholar 

  22. Plat J, Mensink RP (2005) Plant stanol and sterol esters in the control of blood cholesterol levels: mechanism and safety aspects. Am J Cardiol 96(1A):15D–22D

    Article  CAS  Google Scholar 

  23. Earnest CP, Mikus CR, Lemieux I et al (2007) Examination of encapsulated phytosterol ester supplementation on lipid indices associated with cardiovascular disease. Nutrition 23:625–633

    Article  CAS  Google Scholar 

  24. McKenney J (2004) New perspectives on the use of niacin in the treatment of lipid disorders. Arch Intern Med 164:697–705

    Article  CAS  Google Scholar 

  25. Levy DR, Pearson TA (2005) Combination niacin and statin therapy in primary and secondary prevention of cardiovascular disease. Clin Cardiol 28:317–320

    Article  Google Scholar 

  26. McCormack PL, Keating GM (2005) Prolonged-release nicotinic acid: a review of its use in the treatment of dyslipidaemia. Drugs 65:2719–2740

    Article  CAS  Google Scholar 

  27. Xu G, Huang X, Qiu L et al (2007) Mechanism study of chitosan on lipid metabolism in hyperlipidemic rats. Asia Pac J Clin Nutr 16[Suppl 1]:313–317

    CAS  Google Scholar 

  28. Ylitalo R, Lehtinen S, Wuolijoki E et al (2002) Cholesterol-lowering properties and safety of chitosan. Arzneimittelforschung 52:1–7

    CAS  Google Scholar 

  29. Lehtimaki T, Metso S, Ylitalo R et al (2005) Microcrystalline chitosan is ineffective to decrease plasma lipids in both apoprotein E epsilon 4 carriers and non-carriers: a long-term placebo-controlled trial in hypercholesterolemic volunteers. Basic Clin Pharmacol Toxicol 97:98–103

    Article  Google Scholar 

  30. Rabinovitz H, Friedensohn A, Leibovitz A et al (2004) Effect of chromium supplementation on blood glucose and lipid levels in type 2 diabetes mellitus elderly patients. Int J Vitam Nutr Res 74:178–182

    Article  CAS  Google Scholar 

  31. Broadhurst CL, Domenico P (2006) Clinical studies on chromium picolinate supplementation in diabetes mellitus — a review. Diabetes Technol Ther 8:677–687

    Article  CAS  Google Scholar 

  32. Sirtori CR, Calabresi L, Ferrara S et al (2000) L-carnitine reduces plasma lipoprotein(a) levels in patients with hyper Lp(a). Nutr Metab Cardiovasc Dis 10:247–251

    CAS  Google Scholar 

  33. Derosa G, Cicero AF, Gaddi A et al (2003) The effect of L-carnitine on plasma lipoprotein(a) levels in hypercholesterolemic patients with type 2 diabetes mellitus. Clin Ther 25:1429–1439

    Article  CAS  Google Scholar 

  34. Gunes B, Yalcin SS, Kalkanoglu HS et al (2005) The effect of oral carnitine supplementation on the lipid profiles of hyperlipidemic children. Acta Pediatr 9:711–716

    Article  Google Scholar 

  35. Mason P (2002) Dietary supplements. Pharmaceutical Press, London

    Google Scholar 

  36. Cicero AF, Derosa G, Miconi A et al (2005) Treatment of massive hypertriglyceridemia resistant to PUFA and fibrates: a possible role for the coenzyme Q10? Biofactors 23:7–14

    CAS  Google Scholar 

  37. Littarru GP, Langsjoen P (2007) Coenzyme Q and statins: biochemical and clinical implications. Mitochondrion 7:S168–S174

    Article  CAS  Google Scholar 

  38. Cicero AF, Brancaleoni M, Laghi L et al (2005) Antihyperlipidaemic effect of a Monascus purpureus brand dietary supplement on a large sample of subjects at low risk for cardiovascular disease: a pilot study. Complement Ther Med 13:273–278

    Article  Google Scholar 

  39. Keithley JK, Swanson B, Sha BE et al (2002) A pilot study of the safety and efficacy of cholestin in treating HIV-related dyslipidemia. Nutrition 18:201–204

    Article  CAS  Google Scholar 

  40. Gheith O, Sheashaa H, Abdelsalam M et al (2008) Efficacy and safety of Monascus purpureus Went rice in subjects with secondary hyperlipidemia. Clin Exp Nephrol 12:189–194

    Article  Google Scholar 

  41. Chen JT, Wesley R, Shamburek RD et al (2005) Meta-analysis of natural therapies for hyperlipidemia: plant sterols and stanols versus policosanol. Pharmacotherapy 25:171–183

    Article  CAS  Google Scholar 

  42. Berthold HK, Unverdorben S, Degenhardt R et al (2006) Effect of policosanol on lipid levels among patients with hypercholesterolemia or combined hyperlipidemia: a randomized controlled trial. JAMA 295:2262–2269

    Article  CAS  Google Scholar 

  43. Dulin MF, Hatcher LF, Sasser HC, Barringer TA (2006) Policosanol is ineffective in the treatment of hypercholesterolemia: a randomized controlled trial. Am J Clin Nutr 84:1543–1548

    CAS  Google Scholar 

  44. Cicero AF, Derosa G (2005) Rice bran and its main components: potential role in the management of cardiovascular disease risk. Curr Topics Nutraceut Res 3:29–46

    CAS  Google Scholar 

  45. Cicero AF, Martini C, Fiorito A, Gaddi A (2001) Case problem: dietary treatment for children with hyperlipidemia. J Am Diet Assoc 101:693–696

    Article  Google Scholar 

  46. Kong W, Wei J, Abidi P et al (2004) Berberine is a novel cholesterol-lowering drug working through a unique mechanism distinct from statins. Nat Med 10:1344–1351

    Article  CAS  Google Scholar 

  47. Doggrell SA (2005) Berberine — a novel approach to cholesterol lowering. Expert Opin Investig Drugs 14:683–685

    Article  CAS  Google Scholar 

  48. Cicero AF, Rovati L, Setnikar I (2007) Eulipidemic effects of berberine administered alone or in combination with other natural cholesterol-lowering agents in humans. Arzneimittelforschung 57:26–30

    CAS  Google Scholar 

  49. Borek C (2006) Garlic reduces dementia and heart-disease risk. J Nutr 136:810S–812S

    CAS  Google Scholar 

  50. Ackermann RT, Mulrow CD, Ramirez G et al (2001) Garlic shows promise for improving some cardiovascular risk factors. Arch Intern Med 161:813–824

    Article  CAS  Google Scholar 

  51. Gardner CD, Lawson LD, Block E et al (2007) Effect of raw garlic vs commercial garlic supplements on plasma lipid concentrations in adults with moderate hypercholesterolemia: a randomized clinical trial. Arch Intern Med 26:167:346–353

    Google Scholar 

  52. Thompson Coon JS, Ernst E (2003) Herbs for serum cholesterol reduction. A systematic review. J Fam Pract 52:468–478

    Google Scholar 

  53. Tokunaga S, White IR, Frost C et al (2002) Green tea consumption and serum lipids and lipoproteins in a population of healthy workers in Japan. Ann Epidemiol 12:157–165

    Article  Google Scholar 

  54. Ulbricht C, Basch E, Szapary P et al (2005) Guggul for hyperlipidemia: a review by the Natural Standard Research Collaboration. Complement Ther Med 13:279–290

    Article  Google Scholar 

  55. Buettner C, Yeh GY, Phillips RS et al (2006) Systematic review of the effects of ginseng on cardiovascular risk factor. Ann Pharmacother 39:83–95

    Google Scholar 

  56. Cicero AF, Vitale G, Savino G, Arletti R (2003) Notoginsenoides effects on fibrinogen and lipid plasmatic level in rat submitted to a new model of fat diet. Phytother Res 17:174–178

    Article  CAS  Google Scholar 

  57. Adams KE, Cohen MH, Eisenberg D, Jonsen AR (2002) Ethical considerations of complementary and alternative medical therapies in conventional medical settings. Ann Intern Med 137:660–664

    Google Scholar 

  58. Gray CM, Tan AW, Pronk NP, O’Connor PJ (2002) Complementary and alternative medicine use among health plan members. A cross-sectional survey. Eff Clin Pract 5:17–22

    Google Scholar 

  59. Eisenberg DM, Kessler RC, Van Rompay MI et al (2001) Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey. Ann Intern Med 135:344–351

    CAS  Google Scholar 

  60. Owen DK, Lewith G, Stephens CR (2001) Can doctors respond to patients’ increasing interest in complementary and alternative medicine? BMJ 322:154–158

    Article  CAS  Google Scholar 

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Correspondence to Arrigo F. G. Cicero.

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Cicero, A.F.G., Ertek, S. Natural sources of antidyslipidaemic agents: is there an evidence-based approach for their prescription?. Mediterr J Nutr Metab 1, 85–93 (2008). https://doi.org/10.1007/s12349-008-0011-6

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  • DOI: https://doi.org/10.1007/s12349-008-0011-6

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