Q&A With Heart Experts: In this series, heart specialists answer common questions about statins and heart health.
Can supplements be used instead of statins?
Supplements can have a modest effect on cholesterol levels but are overall less effective. More importantly, supplements have not demonstrated the same ability as statins to reduce heart attacks and strokes. There are even cases of harm from supplements containing red yeast rice because their components are not regulated. Therefore, supplements are not recommended as a substitute for statin therapy, especially in those who have had a heart attack, stroke, obesity, diabetes, metabolic syndrome, or kidney disease.
In a large study at the Cleveland Clinic, rosuvastatin 5 mg lowered low-density lipoprotein cholesterol (LDL-C) significantly more than placebo, fish oil, garlic, turmeric, plant sterols, and red yeast rice. None of the dietary supplements lowered LDL-C significantly more than placebo.
While red yeast rice has been found to reduce cholesterol, it is not regulated by the Food and Drug Administration (FDA). Therefore, the dosing and quality are less predictable and can lead to harm. In Japan, five deaths were linked to contaminated red yeast rice supplements, which caused kidney damage in consumers.
It’s important to remember that prescription drugs and supplements are regulated differently.
Statins have been tested in some of the most rigorous types of medical studies available: large, randomized, placebo-controlled clinical trials. In these studies, thousands of people are randomly assigned to take either the real drug or a sugar pill (placebo), and neither the patients nor the doctors know who is getting which. This design removes bias and provides the strongest evidence about whether a treatment truly works and is safe. As described throughout this document, these trials have consistently shown that statins reduce heart attacks, strokes, and death.
Most supplements have not been tested this way. Their proposed benefits are often based on basic science, meaning an understanding of how a chemical works in a laboratory setting or in the body's chemistry, not on evidence from large trials in real patients. A substance that seems helpful in theory may not actually prevent heart attacks or strokes when tested in people. Without this level of testing, we simply cannot know whether a supplement provides the same protection as a proven medication.
Key Points
- Supplements do not match statins for lowering cholesterol or preventing heart attacks.
- Some supplements can be risky, like red yeast rice.
- Patients at risk of heart disease would benefit from statins, not unregulated substitutes, to reduce heart attacks and strokes safely and effectively.
- Statins are supported by the strongest type of medical evidence: large clinical trials comparing the drug to a placebo. Most supplements have not been tested this way.