A study published in the Journal of the American College of Cardiology (Nov. 6, 2022) concluded that people should not use dietary supplements for heart health. In particular, the researchers were referring to red yeast rice, fish oil, plant sterols, cinnamon, garlic and turmeric. Their precise words: “Patients should be educated about the lack of benefit of these supplements on important cardiovascular risk factors.” What about the things people really care about: heart attacks, strokes, stents or sudden death? To some cardiologists’ dismay, dietary supplements might actually be beneficial.
Digging into the SPORT Data:
This research was dubbed “SPORT.” It stands for: The Supplements, Placebo, or Rosuvastatin Study. The sponsor was AstraZeneca, the maker of Crestor (rosuvastatin). By sponsor, we mean the company paid for this research.
First, let’s look at what the cardiologists at the Cleveland Clinic did in the latest study of supplements for heart health.
The research was designed to compare low-dose rosuvastatin (Crestor) to placebo and a variety of dietary supplements. With eight different groups, there were around two dozen volunteers randomly assigned to each group.
The study lasted just under a month. Researchers did “before” and “after” measurements of the fats in each participant’s blood, including triglycerides as well as HDL, LDL and total cholesterol. Compared to other research, this was a very small study that lasted a very short period of time.
To no one’s surprise, rosuvastatin lowered LDL cholesterol by an average of 38%. None of the dietary supplements reduced LDL significantly in this study.
Misleading Headlines About Supplements for Heart Health:
Here are some of the headlines that summarized the SPORT study:
“Heart Supplements Flunk Lipid Lowering Test” Medscape, Nov. 20, 2022
“Are over-the-counter diet supplements helpful, or harmful? New research that examined six of the most popular over-the-counter dietary supplements found that they’re not effective compared to heart drugs, and may even be harmful.” CBS Philadelphia, Nov. 9, 2022
“Patients may want to think twice before relying on supplements to treat high cholesterol” WISHTV.com Nov. 9, 2022
“6 ‘Heart-Healthy’ Supplements Flop in Cholesterol Study” KOAM NewsNow.com Nov. 17, 2022
“Don’t bother with dietary supplements for heart health, study says” CNN Health, Nov. 6, 2022
Cardiologists Stigmatize Supplements for Heart Health:
By now you get the picture. The message to consumers was that rosuvastatin (Crestor) works and dietary supplements don’t. Of course, everything depends on one’s definition of “works.”
The study was small and only lasted a month. It demonstrated that rosuvastatin (Crestor) was quite good at lowering LDL cholesterol. No surprises there. That’s what statins were designed to do.
The dietary supplements that were tested during that time period did not. The researchers do not appear to have consulted www.ConsumerLab.com to determine the most effective dietary supplements.
Supplement Quality May Be a Problem:
ConsumerLab.com actually tests dietary supplements such as red yeast rice for active ingredients (lovastatin or monacolins K and KA) and contaminants (citrinin). When it comes to red yeast rice (RYR), this testing company recommends HPF Cholestene and notes that it was the only RYR product that it approved for quality.
Apparently the researchers at the Cleveland Clinic did not bother to test the red yeast rice product it used in its SPORT research project (Arazo Nutrition). ConsumerLab noted in its analysis of red yeast rice products that in its test of the Arazo Nutrition brand of red yeast rice that “No lovastatin could be detected.” As a result, ConsumerLab concluded that it was “NOT APPROVED.”
It’s hardly any wonder, then, that the red yeast rice used in this trial did not lower LDL cholesterol, total cholesterol, triglycerides or any other risk factor. It did not contain the active ingredient. In my opinion, that was a BIG ooops!
Other Studies of Supplements for Heart Health:
The SPORT trial results do not mean that dietary supplements it “tested” are worthless. Larger studies that lasted longer have shown different results for some of these natural compounds.
First of all, this study focused primarily on blood lipids, especially LDL cholesterol. It did not attempt to measure any effects on heart health outcomes such as heart attacks or strokes. It was too short and too small to do so.
VITAL:
Other studies have looked at a few of these alternative compounds. A large randomized controlled trial of fish oil and vitamin D, the VITAL trial, followed almost 26,000 Americans over 50 for more than five years (New England Journal of Medicine, Jan. 3, 2019). The investigators concluded that fish oil did not reduce major cardiovascular events.
On the other hand, one meta-analysis of 38 randomized controlled trials of omega-3 fatty acids like those found in fish oil concluded (eClinicalMedicine, Aug.1, 2021):
“Omega-3 FAs reduced cardiovascular mortality and improved cardiovascular outcomes”
We must conclude that fish oil benefits are complicated, but dismissing them completely may be a mistake.
Red Yeast Rice:
What about red yeast rice (RYR)? This medicinal food has been used for centuries in traditional Asian medical systems. The compounds produced by the yeast that makes rice red act on the same pathway as statins like rosuvastatin.
A review of multiple clinical trials found that RYR is safe and effective for people with high cholesterol (Journal of the American College of Cardiology, Feb. 9, 2021). The focus in that review, however, was on blood lipids like LDL cholesterol. Of course, that is just what the more recent SPORT trial studied as well.
The authors concluded:
“RYR could represent a therapeutic tool to support lifestyle improvement in managing mild to moderate hypercholesterolemia in low-risk patients, including those who cannot be treated with statins or other LDL-cholesterol-lowering therapies.”
A meta-analysis of 30 randomized controlled trials concluded that RYR lowers LDL and total cholesterol and reduces insulin resistance. Even more importantly, red yeast rice preparations reduced mortality and major adverse cardiovascular events (Frontiers in Pharmacology, Feb. 21, 2022). Those are things that patients actually care about.
Another meta-analysis included seven studies with more than 10,000 heart attack survivors (Scientific Reports, Feb. 17, 2020). The study showed that in these high-risk individuals, RYR over a period of four weeks to four years lowered the likelihood of another heart attack, stents or sudden death. That’s in addition to helpful effects on blood lipids.
Turmeric (Curcumin):
Asian medical systems also have given the world turmeric. While the Cleveland researchers did not find it useful in lowering cholesterol, other scientists have reviewed the effects of its main ingredient, curcumin. They found that it fights inflammation, reduces oxidation and improves mitochondrial function.
There have actually been studies of curcumin supplements for heart health.
A meta-analysis of studies published in the Archives of Physiology and Biochemistry (Dec. 2022) concluded:
“This study suggests that curcumin may reduce blood lipid levels and can be used as a hypolipidemic agent.”
In other words, the authors report that the active ingredient in turmeric does lower blood lipids. That is in contrast to the results of the SPORT study.
The Bottom Line on Supplements for Heart Health:
Heart disease is complex. There may be many paths to protecting this critical organ. There are also many risk factors beyond LDL cholesterol. If you would like to learn more about them and a variety of ways to improve heart health, please consider our eGuide to Cholesterol Control & Heart Health. It can be found under the Health eGuides tab at this link. There is also more in-depth information about the SPORT trial at this link.
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