Here are three things to consider about cholesterol-lowering supplements, according to Dr Kenneth Ng, consultant cardiologist at Novena Heart Centre, and Dr Rohit Khurana, cardiologist at Gleneagles Hospital.
Q. Should I take them?
Dr Ng: Low-risk individuals with high cholesterol levels can try taking cholesterol-lowering supplements to lower their bad cholesterol levels.
The rationale for taking supplements, instead of medication, is that these low-risk individuals are not at high risk of cardiac events, or strokes, and can afford to have a less aggressive and slower way of reducing their cholesterol levels.
Dietary therapy, such as vegetables, oats and tofu, can also help lower bad cholesterol levels by at least 10 per cent.
By taking supplements, bad cholesterol levels can be lowered by another 10 per cent to 20 per cent.
Dr Khurana: Specific dietary supplements have been recommended to lower cholesterol levels. These include omega-3 fatty acids and fish oils.
Q. Will they cause harm?
Dr Ng: Supplements have a very low toxicity level and are unlikely to cause harm even if taken at high doses.
If the individual already knows his cholesterol level is high, he may benefit from taking such supplements. If the individual does not know his cholesterol level and is worried, he should go for a check first.
By and large, supplements are available over the counter without a need for any prescription.
Dr Khurana: Recent patient trials have questioned the added benefit of fish oil supplements in patients who have already suffered a heart attack and are now taking several other potent prescription medications (statins, blood thinners and anti-hypertensives) to reduce the risk of a recurrent heart attack.
There appear to be no other short- or long-term safety concerns with taking fish oil supplements.
Q. Can they replace statins?
Dr Ng: Some individuals refuse to take statins because they are fearful of the possible side effects.
I think it boils down to whether an individual is at low or high risk for cardiovascular disease.
The evidence for statins is very strong in patients who are in the high-risk category.
Patients in the low-risk category may be given a statin if their bad cholesterol exceeds 190 mg/dL. Those in the low-risk category and whose cholesterol levels are below 190 mg/dL can opt for alternative therapy.
Research does support the idea of lowering cholesterol levels through exercise and diet.
Dr Khurana: I do not advocate their use to replace statins in higher-risk patients when there is a compelling clinical need to lower the patient's low-density lipoprotein cholesterol and total cardiovascular risk.
The cholesterol-lowering effect is not as powerful as conventional statins. There may be a role for red yeast rice extracts for heart disease risk prevention in lower-risk individuals who cannot tolerate a statin due to side effects, such as persistent muscle aches.