CHOLESTEROL JUST SAY NO TO CHOLESTEROL- LOWERING SUPPLEMENTS Elevated LDL cholesterol (bad cholesterol) is considered the most significant risk factor for coronary artery disease. It leads to a buildup of plaque in the heart, in the head, and in the lower extremities leading to heart attacks, strokes and amputations. Diet and exercise are often used to improve cholesterol but unfortunately have limitations. Exercise raises the good cholesterol (HDL) but has little impact on LDL levels. Dietary measures can lower LDL cholesterol between 10-25% but often much more significant LDL lowering is needed. The majority of our cholesterol is actually synthesized in the liver, and we have no direct control over it. Dietary supplements have been used and marketed as helping lower LDL cholesterol. Although millions of dollars are spent on the supplements there has been very little data supporting its use. This year the Cleveland Clinic, often recognized as the leading cardiac Center in the United States published the SPORT study. It compared the By Narendra Singh, MD lowest dose of rosuvastatin (Crestor) 5 mg against six commonly use dietary supplements marketed to improve heart health including fish oil, garlic, cinnamon, turmeric, plant sterols, red yeast rice, and placebo. After one month of treatment the results were unequivocal. Low dose rosuvastatin effectively lowered LDL cholesterol by 38% while placebo dropped LDL cholesterol by 2.8%, fish oil by 3.4%, cinnamon by 0.4%, turmeric by 1.3%, plant sterol by 4.4%, red yeast rice by 6.6% and garlic actually raised LDL cholesterol by 5.1%. Other markers of note were that cinnamon worsened inflammation by 29% while rosuvastatin lowered it by 5.7% and plant sterols lowered it by 13.7%. Cinnamon also worsened the good cholesterol by 2.3% and plant sterols reduced by 4% while rosuvastatin raised good cholesterol by 3.4%. It is clear that supplements do not work to lower bad cholesterol so while they can be used for other reasons the concept that it is promoting heart health needs to be revisited. Fortunately, when it comes to pharmacological options to lower LDL cholesterol more options now exist. Statins remain the first choice to lower LDL cholesterol. They are well proven to reduce the risk of heart attacks, strokes, limb loss and cardiovascular death. They work by shutting off the liver’s production of cholesterol. The main side effect of statins is muscle aches and pains and if a lower dose or an alternative statin is not successful in relieving the symptoms then other options should be considered. Ezetimibe (Zetia) can be used in conjunction with statins to further lower LDL cholesterol by preventing the absorption of dietary cholesterol. Injectables focusing on inhibiting a protein called PCSK9 are very effective at lowering LDL cholesterol. Alirocumab (Praluent) and evolocumab (Repatha) are taken every 2 weeks and inclisarin (Leqvio) only needs to be taken twice a year. These agents are very well tolerated with none of the statin side effects but are more expensive. Most recently, Bempadoic acid (Nexletol) has come on the market. This drug also works by reducing the production of LDL cholesterol by the liver but unlike statins, does not get into muscle tissue and has no muscle related side effects. It does however increase uric acid and should be avoided in individuals with a history of gout. Recently a major study using this compound called CLEAR confirmed that it reduces the risk of cardiovascular death, myocardial infarction, stroke, and the need for coronary revascularization. As always, contact your health care team to determine the best course of treatment for you. NARENDRA SINGH, MD, FRCP(C), FACC, FAHA Preceptor- Mercer University, Atlanta, GA Director, Clinical Research, NSC Research, Atlanta, GA Director, Canadian Collaborative Research Network Affiliated with Piedmont, Northside and Emory Health Systems Recognized expert in South Asian Heart Disease. 1100 Northside <strong>Forsyth</strong> Dr, Suite 345, Cumming, GA, USA, 30041, Phone 678- 845-8960 5400 Laurel <strong>Spring</strong>s Parkway, Suite 1401, Johns Creek, GA, 30024 Phone 678- 208-0165 Email-DrSingh@nscresearch.org or DrSingh@nsccardiology.com www.heartdrsingh.com 34 MYFORSYTHMAG.COM SPRING <strong>2023</strong>
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