Lipid lowering nutraceuticals in clinical practice: position paper from an International Lipid Expert Panel

Abstract

Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide, reaching 31% of deaths in 2012 [1]. In particular, atherosclerosis and ischemic heart disease (IHD) are the main causes of premature death in Europe and are responsible for 42% of deaths in women and 38% in men under 75 years old [2]. The global economic impact of CVD is estimated to have been US $906 billion in 2015 and is expected to rise by 22% by 2030 [3]. Cardiovascular diseases also represent the major cause of disability in developed countries. It has been estimated that their growing burden could lead to a global increase in loss of disability-adjusted life years (DALYs), from a loss of 85 million DALYs in 1990 to a loss of ~150 million DALYs in 2020, becoming a major non-psychological cause of lost productivity [4]. Several risk factors contribute to the etiology and development of CVD; they are divided into those modifiable through lifestyle changes or by taking a pharmacologic treatment (e.g. for hypertension, smoking, diabetes mellitus, hypercholesterolemia) and those that are not modifiable (age, male gender, and family history) [5]. Elevated total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) blood concentrations are the major modifiable risk factors for coronary heart disease (CHD), whereas high concentrations of plasma high-density lipoprotein cholesterol (HDL-C) in certain conditions are considered protective [6]. Moreover, LDL-C remains a fundamental CV risk factor (and a main target of therapy) even when statins are largely used in the general population [7]. An examination of the data of 18 053 participants aged ≥ 20 years who participated in the National Health and Nutrition Examination Surveys (NHANES) from 1999 to 2006 showed that the unadjusted prevalence of hypercholesterolemia ranged from 53.2% to 56.1% in United States adults [8]. Differences related to gender and race or ethnicity were observed; in particular, a lower rate of control was found among women than men and lower rates of having a cholesterol check and being told about hypercholesterolemia were reported by African Americans and Mexican Americans than whites [8]. A recent report from the American Heart Association confirmed that in the US only 75.7% of children and 46.6% of adults present targeted TC levels (TC < 170 mg/dl for children and < 200 mg/dl for adults, in untreated individuals) [9]. The pattern is similar in other Western countries [10, 11]

The role of curcumin in liver diseases

“…Of note, the important role of curcumin in a clinical setting was recently reviewed by an International Lipid Panel expert [98]. In this work, the authors concluded that an evidence-based approach to the use of lipid-lowering nutraceuticals could improve the quality of the treatment, including therapy adherence, and achievement of the LDL-C goal in clinical practice, an important endpoint in cardiovascular disease [99][100][101][102].…”

The short-term supplementation of monacolin K improves the lipid and metabolic patterns of hypertensive and hypercholesterolemic subjects at low cardiovascular risk

“…[29][30][31][32] However, products containing RYR can cause adverse effects, 22 therefore, in order to limit them, before taking any nutraceutical, several factors must be considered, such as the components contained in the blend and their dosage, the dosage of RYR and the amount of MK. MK is the most important molecule among monacolins produced by the fermentation of red rice by the yeast Monacus purpureus; it has a molecular structure similar to lovostatin, 16 the precursor of an entire class of statin drugs considered the elective treatment of dyslipidemia and cholesterol control. The ability of monacolin K to act on cholesterol biosynthesis by reducing the function of HMG-CoA reductase as a competitive inhibitor is now known, and many studies have been conducted on several NCs containing RYR with different dosages of monacolin K to study its efficacy and/or safety in hypercholesterolemic subjects.…”

“…In particular, in recent years, research interest has been focusing on the possible lipid-lowering effects of red yeast rice (RYR) supplements, 5,13,14 so that their use is recommended in the ESC/ EAS guidelines and international documents. 3,15,16 RYR is produced by fermentation of white rice by the mold fungus Monacus purpureus that, by its fermenting activity, enriches the rice of a group of substances called monacolines, which possess a marked and scientifically proven hypocholesterolemic activity. Among them, monacolin K (MK), which has a structure identical to levostatin, 17 inhibits the activity of 3-hydroxy-3-methylglutaryl coenzyme A reductase, a key enzyme in cholesterol biosynthesis.…”

Berberine: A potential adjunct for the treatment of gastrointestinal cancers?

“…[2][3][4][5][6][7][8] Moreover, a growing preclinical literature suggests that BBR has a broad number of antinfective activities, [9][10][11] and it could also exert some protective effects against neurodegenerative processes. [2][3][4][5][6][7][8] Moreover, a growing preclinical literature suggests that BBR has a broad number of antinfective activities, [9][10][11] and it could also exert some protective effects against neurodegenerative processes.…”