What is the evidence for using supplements in treating hyperlipidemia?

Evidence for Supplements in Treating Hyperlipidemia

There is no clear evidence that dietary supplementation with vitamins, minerals, herbs, or spices can improve outcomes in people with hyperlipidemia who do not have underlying deficiencies, and these supplements are generally not recommended for treating hyperlipidemia. 1

Omega-3 Fatty Acids (Fish Oil)

• Omega-3 fatty acids from fish or fish oil capsules may be considered for cardiovascular disease risk reduction, though they should not be used as primary treatment for hyperlipidemia 1
• For patients with persistently elevated triglycerides despite medication, supplementation with fish oils containing n-3 fatty acids may be recommended, though they may increase LDL cholesterol levels, requiring monitoring 1
• In women with hypercholesterolemia and/or hypertriglyceridemia, consumption of omega-3 fatty acids (EPA 1800 mg/day) may be considered for primary and secondary prevention 1
• For patients who continue to have elevated non-HDL-C while on adequate statin therapy, fish oil may be a reasonable addition to therapy 1

Plant Stanols/Sterols

• Plant stanols/sterols (2 g/day) can enhance LDL cholesterol lowering when added to diet 1
• Clinical trials of plant stanol ester margarine in children showed that LDL cholesterol levels were lowered by a mean of 7.5% 1
• In one study, sitostanol ester dissolved in rapeseed oil margarine reduced LDL cholesterol levels by a mean of 15% 1

Dietary Fiber

• Increasing viscous (soluble) fiber (10-25 g/day) can enhance LDL cholesterol lowering 1
• Clinical trials of psyllium-enriched cereal in hyperlipidemic children have shown mixed results, with one study showing no benefit and another showing a modest 7% LDL cholesterol reduction 1

Soy Protein

• Small studies have shown that substitution with soy-based protein may increase HDL cholesterol and lower VLDL levels and triglycerides, and may lower LDL cholesterol levels 1

Garlic Preparations

• Despite marketing claims, evidence of beneficial effects on lipid profiles from garlic preparations has not been noted in independent clinical trials 1
• A placebo-controlled, double-blind clinical trial of commercially available garlic extract in children with familial hyperlipidemia showed no clinically important effect on the lipid profile 1

Vitamins and Antioxidants

• There may be safety concerns regarding the long-term use of antioxidant supplements such as vitamins E and C and carotene 1
• There is no clear evidence supporting routine use of vitamin supplements for treating hyperlipidemia 1

First-Line Approaches Before Supplements

• Lifestyle modifications remain the foundation of hyperlipidemia treatment before considering supplements:
  • Reducing saturated fat to <7% of energy intake 1
  • Limiting dietary cholesterol to <200 mg/day 1
  • Increasing physical activity 1
  • Achieving modest weight loss 1
  • Consuming a diet rich in fruits, vegetables, whole grains, and low-fat dairy products 1
  • Avoiding trans-fatty acids 1

When Pharmacotherapy is Needed

• Statins remain the first-line drug treatment for hyperlipidemia when lifestyle modifications are insufficient 1, 2, 3
• Ezetimibe is indicated as an adjunct to diet to reduce elevated LDL-C in adults with primary hyperlipidemia, either in combination with a statin or alone when additional LDL-C lowering therapy is not possible 4

Caution and Monitoring

• When using omega-3 supplements, monitor LDL cholesterol levels as they may increase 1
• Fish oil dietary supplements may have widely variable amounts of EPA and DHA (likely the only active ingredients) 1
• Patients should always discuss supplement use with their healthcare provider due to potential interactions with medications and variable product quality 4