Examining cholesterol reducing alternative therapies

This study examined the effectiveness of phytosterols, lifestyle modifications and red yeast rice at lowering cholesterol levels.

High cholesterol levels are a major risk factor for numerous cardiovascular (heart and blood vessel) diseases. Proper management over blood cholesterol is known to reduce the incidence of hypertension (high blood pressure), heart attacks and strokes. A class of drug called statins is often employed in the management of high cholesterol levels. The new American Heart Association state that all high risk adults, including those with known coronary artery disease, should be treated with cholesterol reducing drugs regardless of current cholesterol levels. However, many patients treated with statins do not respond to therapy, while other patients prefer alternative therapies to drug treatment.

Red yeast rice is a natural supplement containing active compounds called monacolins which inhibit cholesterol production in the liver. These compounds are the same active ingredients found in many statin-based drugs, such as simvastatin (Zocor).

Phytosterols are compounds similar to cholesterol which are found in various plants. Phytosterol-enriched foods and dietary supplements have been marketed for decades due to their alleged cholesterol lowering effect. However, no high-grade evidence of any beneficial effect on cardiovascular risk or mortality exists.

This study included a total of 187 participants with high cholesterol levels, including patients also diagnosed with diabetes, hypertension, and coronary artery disease. All participants received red yeast rice supplements twice daily. Participants were also randomized into one of four groups. Each participant received either phytosterol tablets twice daily or a placebo, and in addition patients were randomized to either participate in a 12-week lifestyle change group or receive usual care. Patients in the lifestyle change group attended weekly meetings led by a cardiologist. A dietitian educated the group and encouraged participants to follow a modified Mediterranean diet. An exercise physiologist described the health benefits of exercise, stretching, and light strength training. Each session concluded with exposure to different relaxation techniques, including Tai Chi, meditation, and yoga. Patients in the usual care group met with the study coordinator at the beginning of the study and every 3 months thereafter. Cholesterol levels were measured at the beginning of the study, and after 12, 24, and 52 weeks of treatment.

All participants received red yeast rice and showed significant reductions in total cholesterol, LDL-C (low-density lipoprotein, often referred to as the "bad cholesterol") and triglyceride levels. On average, all participants experienced a cholesterol reduction of 37mg/dL by week 52 of the trial, regardless of further randomization. An increase in HDL-C (high-density lipoprotein, often referred to as the "good cholesterol") was also noted after 52 weeks of treatment.

No significant difference was noted in cholesterol levels between patients receiving phytosterols and those receiving a placebo.

In comparison, participation in the lifestyle change group significantly reduced cholesterol levels. Compared to patients receiving usual care, cholesterol levels were reduced by an average of 9mg/dL by week 12 of the trial. In addition, participation in the lifestyle changes group more than doubled the chance of achieving goal cholesterol levels of under 100mg/dL compared to usual care.

This study concluded that red yeast rice and lifestyle modification are extremely effective at decreasing cholesterol levels. Phytosterols were not found to possess any cholesterol reducing benefits.

Consult with your physician regarding the importance of reducing cholesterol levels and lifestyle and diet modifications which may assist in achieving proper blood cholesterol levels.