estatinas versus suplementos valoracion de NEJM

Statins vs. Supplements for Reducing Low-Density Lipoprotein Cholesterol

Fatima Rodriguez, MD, MPH, FACC, FAHA, reviewing Laffin LJ et al. J Am Coll Cardiol 2022 Oct 19

In a randomized, controlled trial, a low dose of rosuvastatin wins by a landslide.

Patients commonly take supplements advertised to improve cardiovascular health, although the evidence to support this practice is limited. In the industry-funded Supplements, Placebo, or Rosuvastatin Study (SPORT) trial, investigators compared the efficacy for lowering low-density lipoprotein cholesterol (LDL-C) of six commonly used dietary supplements — fish oil, cinnamon, garlic, turmeric, plant sterols, and red yeast rice — with a low-dose statin and placebo.

One hundred and ninety-nine patients (mean age, 64 years; 59% women) with elevated LDL-C and increased 10-year risk of atherosclerotic cardiovascular disease identified from a single center were randomized to rosuvastatin (5 mg daily), placebo, or one of the supplements. The primary endpoint was the percent change of LDL-C from baseline after 28 days.

LDL-C percent reductions from baseline were significantly greater with rosuvastatin than with placebo (by an average difference of 35%) or any supplement. Compared with placebo, LDL-C was not significantly reduced with any of the supplements, and garlic was associated with a small but significant increase in LDL-C.

COMMENT

As a preventive cardiologist, I spend as much of my time in clinic convincing patients to take statins as I do telling them to throw away their untested dietary supplements. This highly practical study provides data to support this practice. Patients are better off skipping the supplements and sticking with statins.

Note: Karol E. Watson, MD is an author of this study and a co–Editor-in-Chief of NEJM Journal Watch Cardiology but had no role in selecting or summarizing this study.

At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATIONS

Laffin LJ et al. Comparative effects of low-dose rosuvastatin, placebo and dietary supplements on lipids and inflammatory biomarkers. J Am Coll Cardiol 2022 Oct 19; [e-pub]. (https://doi.org/10.1016/j.jacc.2022.10.013. opens in new tab)