The Skeptical Cardiologist is moving to Substack

Plus. The time has come to jettison "heart-healthy" OTC nutraceuticals

A few days ago I sent out a newsletter to readers of The Skeptical Cardiologist blog who had indicated an interest in receiving such a thing.

I found the process of creating that newsletter quite tedious using Mailerlite and have decided I will utilize Substack for my newsletters moving forward.

I’ve noticed a lot of the medical writers I most respect have moved here and I’ve been enjoying reading their observations in my email inbox rather than having to go to a website.

I moved my 4914 newsletter subscribers to this site (which I had only rarely been utilizing) and have recreated below the newsletter I recently sent out about the SPORT trial.

If this works well for subscribers I will likely move all my ongoing new content posting to this format.

Exactly how my Substack content and my Blog content will cross-react is unclear to me but sign up and i will keep you posted

(Apologies for the duplicate content to those who read the first newsletter.)

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Low Dose Statin versus Supplements for Lowering LDL-C (Bad) Cholesterol

In 2015 the skeptical cardiologist wrote a post entitled "Red Yeast Rice: Let's Lower Our Cholesterol With Unknown Amounts of a Statin Drug!"

I was prompted to update that piece when I saw the results of a recent trial presented at the American Heart Association which compared the cholesterol-lowering efficacy of a low dose of a statin drug versus 6 widely promoted (allegedly heart-healthy) OTC supplements (including red yeast rice.) 

My red yeast rice article described the history of the discovery and isolation of lovastatin, the first FDA-approved statin, which wonderfully illustrates the process of discovery, isolation, and characterization of a chemical from a natural source and how through animal and human clinical trials a safe and effective treatment that doctors can prescribe was developed.

I hoped that this information would counter the false allure of natural treatments that fuels the multibillion-dollar American nutraceutical industry.

Despite my valiant attempts, alas, many patients continue to fall prey to marketing and misinformation from supplement manufacturers and they keep buying red yeast rice, turmeric, fish oil supplements, and multiple other unproven treatments.

"Almost $50 billion is spent on dietary supplements annually in the United States, and recent data suggest that more than three fourths of the population use them, 18% of those based on specious heart-health claims,"

Luke Laffin, MD, lead author SPORT

Statins versus Supplements: The Trial Results

In the Supplement, Placebo, or Rosuvastatin (SPORT) trial, 199 individuals were randomized to receive 5 mg daily of rosuvastatin, placebo or fish oil, cinnamon, garlic, turmeric, plant sterols, or red yeast rice

These individuals had an increased 10-year risk for atherosclerotic cardiovascular disease (ASCVD) (see how to calculate your risk here) and no history of atherosclerotic cardiovascular disease (ASCVD) and an LDL-C of 70-189 mg/dL.

The researchers were primarily interested in how much lowering of the LDL-C (bad cholesterol) would be achieved after taking the drugs for 28 days.

This is a very reasonable goal as we know that LDL-C (mediated by its closely correlated friend, apo B) is the primary driver of atherosclerosis. When doctors recommend a drug to lower cholesterol the goal is lowering LDL-/apoB which in turn lowers the risk of heart attack and stroke.

The results further confirmed my confidence in 5 mg of rosuvastatin (which I have recommended for patients on the fence about taking a statin drug) , confirming the wonderful efficacy and safety of 5 mg rosuvastatin at lowering LDL-C (lower levels mean less heart attack and stroke.).

LDL-C was lowered by 35% in the group taking rosuvastatin compared to those taking placebo. A drop of this magnitude is known to dramatically reduce heart attack and stroke risk over a 10-year period.

But how did the "natural" and over-the-counter supplements fare?

Natural Supplements had Zero Effect on LDL-C or inflammation

Contrary to the marked efficacy of rosuvastatin (at a very low dosage) none of the dietary supplements lowered LDL-C significantly more than placebo.

In fact, garlic significantly raised LDL-C by 7.8%!

There were no significant abnormalities of liver function tests or glucose during this short study. In addition, no patients complained of any musculoskeletal side effects.

The supplements had no effect on total cholesterol, triglycerides, or C-reactive protein (CRP), which reflects systemic inflammation.

The time has come to jettison heart-health supplements

At the end of my red yeast piece I asked the following question:

One has to ask, given this background, why would a patient choose to take a "natural" OTC supplement containing an unknown amount of both a) effective cholesterol-lowering chemicals and b) potentially toxic extraneous chemicals over the precisely formulated, carefully regulated, fully studied, pure statin drug available by prescription?

It's especially baffling to me when one considers that lovastatin comes from RYR. Thus it would have to be considered "natural."

Akira Endo spent decades carefully identifying the effective and safe chemical portion of RYR. It is now available as a generic costing pennies per pill.

We know exactly how many milligrams you are consuming. We know what benefits to expect and what side effects can occur based on studies on hundreds of thousands of patients who have taken a similar dosage.

If you have been taking any of these supplements please just throw them out now. They have clearly been shown to be useless and with no fewer side effects than a remarkably effective, safe, and inexpensive prescription drug.

Skeptically Yours-

ACP

N.B. The daily supplement dosages were 2400 mg for fish oil (Nature Made); 2400 mg for cinnamon (NutriFlair), 5000 mcg allicin for the garlic (Garlique), 4500 mg for turmeric curcumin (BioSchwartz), 1600 mg plant sterols (CholestOff Plus, Nature Made), and 2400 mg red yeast rice (Arazo Nutrition).

N.B.2 Readers interested in more details can view this good discussion with the lead author here