compiled by John G. Connor, M.Ac., L.Ac., edited by Barbara Connor, M.Ac., L.Ac.
Herbal Remedies Supply a Novel Prospect for the Treatment of Atherosclerosis: A Review of Current Mechanism Studies – Increasing lines of evidence have questioned the statins-dominated treatment for atherosclerosis, including their dangerous side-effects such as the breakdown of muscle when taken in larger doses. Given the complicated nature of atherosclerosis and the holistic, combinational approach of herbal remedies, we propose that mixed herbal preparations with multiple active ingredients may be preferable for the prevention and treatment of atherosclerosis. (Zeng et al 2011)
Statins work by inhibiting HMG-CoA Reductase which plays a key role in producing cholesterol. Hence they lower cholesterol.
Side Effects of Statins:
- The absolute risk for incident diabetes was about 31 and 34 events per 1000 person years for atorvastatin and rosuvastatin, respectively. There was a slightly lower absolute risk with simvastatin (26 outcomes per 1000 person years) compared with pravastatin (23 outcomes per 1000 person years). Our findings were consistent regardless of whether statins were used for primary or secondary prevention of cardiovascular disease. (Carter et al 2013)
- Recent evidence suggests that, in some patients, statins may adversely influence cognitive function including causing memory impairments. The results of this study suggest that chronic treatment with pravastatin impairs working and recognition memory in rodents. The reversibility of the effects on cessation of treatment is similar to what has been observed in patients, but the lack of effect of atorvostatin suggests that lipophilicity may not be a major factor influencing statin-induced cognitive impairments. (Stuart et al 2013)
- Statin drugs associated with an increase in cataracts. This study matched 6972 pairs of statin users and nonusers and it found that the risk for cataracts was higher among statin users in comparison with nonusers. (Mortensen et al 2013)
- Statin use may be associated with increased musculoskeletal adverse events, especially in physically active individuals. This study found that musculoskeletal conditions, arthropathies, injuries, and pain are more common among statin users than among similar nonusers. (Mansi et al 2013)
- Simvastatin impairs exercise training adaptations. The results of this study found that simvastatin attenuates increases in cardiorespiratory fitness and skeletal muscle mitochondrial content when combined with exercise training in overweight or obese patients at risk of the metabolic syndrome. (Mikus et al 2013)
- If our findings are generalizable, clinical and public health recommendations regarding the ‘dangers’ of cholesterol should be revised. This is especially true for women, for whom moderately elevated cholesterol (by current standards) may prove to be not only harmless but even beneficial. (Petursson et al 2012)
- In view of the mounting evidence of a higher risk of diabetes with statins, specifically from the randomized trials — the FDA recently announced a label change to some statin therapies. Based on current evidence from the literature, a note of ‘an effect of statins on incident diabetes and increases in HbA1c and/or fasting plama glucose’ has been added to the safety labelling of all drugs in the statin class. (Sattar & Taskinen 2012)
- Dr. Shirya Rashid — senior author of the study and assistant professor in the department of medicine at McMaster University — notes that a staggering 40 per cent of people taking statins are resistant to their impact on lowering blood LDL. (From research presented October 28, 2012 at the Canadian Cardiovascular Congress, reported in Science Daily, Oct. 28, 2012)
- We studied 163 consecutive patients with spontaneous intracerebral hemorrhage who underwent magnetic resonance imaging within 30 days of presentation. Sixty-four percent had lobar intracerebral hemorrhage. Overall, 53% had microbleeds and 39% had csMB. Statin users were older, had significantly lower cholesterol and low-density lipoprotein levels, and higher prevalence of hypertension, diabetes, dyslipidemia, and antiplatelet use. Statin use in patients with intracerebral hemorrhage is independently associated with microbleeds, especially cortico-subcortical microbleeds. (Haussen et al 2012)
- Statin medication use in postmenopausal women is associated with an increased risk for diabetes mellitus (DM). This may be a medication class effect. Further study by statin type and dose may reveal varying risk levels for new-onset DM in this population. (Culver et al 2012)
- Statins may alter the concentrations of digoxin leading to alterations in effect. (Williams & Feeley 2002)
- Statin use seems to be associated with an increased risk of developing rheumatoid arthritis. (de John et al 2011)
- Even brief exposure to atorvastatin causes a marked decrease in blood CoQ(10) concentration. Widespread inhibition of CoQ(10) synthesis could explain the most commonly reported adverse effects of statins, especially exercise intolerance, myalgia, and myoglobinuria. (Rundek et al 2004)
- Individuals prescribed statins that have a greater impact on CoQ10, such as atorvastatin, may benefit from higher CoQ10 dosage levels. (Stargrove et al 2008) It appears that levels of coenzyme Q10 are decreased during therapy with HMG-CoA reductase inhibitors, gemfibrozil, Adriamycin, and certain beta blockers. (Sarter B 2002)
Natural Alternatives to Statins:
Omega-3 polyunsaturated fatty acids – are found in fish oil and they have been shown to mitigate the risk of cardiovascular disease. They reduce fatal and nonfatal myocardial infarction, stroke, coronary artery disease, sudden cardiac death, and all-cause mortality. They also have beneficial effects in mortality reduction after a myocardial infarction. Omega-3 fatty acids have also been shown to have beneficial effects on arrhythmias, inflammation, and heart failure. They may also decrease platelet aggregation and induce vasodilation. Omega-3 fatty acids also reduce atherosclerotic plaque formation and stabilize plaques preventing plaque rupture leading to acute coronary syndrome. Moreover, omega-3 fatty acids may have antioxidant properties that improve endothelial function and may contribute to its antiatherosclerotic benefits. (Kar S 2011)
DHA & EPA – The most compelling evidence for the cardiovascular benefit provided by omega-3 fatty acids comes from 3 large controlled trials of 32,000 participants randomized to receive omega-3 fatty acid supplements containing docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) or to act as controls. These trials showed reductions in cardiovascular events of 19% to 45%. These findings suggest that intake of omega-3 fatty acids, whether from dietary sources or fish oil supplements, should be increased, especially in those with or at risk for coronary artery disease. Patients should consume both DHA and EPA. (Lee et al 2008)
Red yeast rice (RYR) – Studies reviewed show that RYR significantly lowered LDL cholesterol and total cholesterol. Effects on triglycerides and HDL cholesterol were also observed in some studies. Compared with statins, RYR was shown to have an equal efficacy to statins when combined with or without other dietary supplements. RYR also appeared to be superior to placebo in preventing nonfatal myocardial infarction, total coronary heart disease events, and total deaths. (Yang & Mousa 2012)
Red yeast rice extract – The tested red yeast rice product demonstrated a significant cholesterol lowering effect compared to placebo, and was well tolerated in this Caucasian population. (Bogsrud et al 2010)
Red yeast rice extract – The treatment with a dietary supplement containing red yeast rice extract and policosanols has been for the first time successfully employed in hypercholesterolemic children. Results indicate this strategy as an effective, safe and well tolerated in a short-term trial. (Guardamagna et al 2011)
Guggulsterone – A recent study demonstrates that guggulsterone upregulates the bile salt export pump (BSEP), an efflux transporter responsible for removal of cholesterol metabolites, bile acids from the liver. Such upregulation of BSEP expression by guggulsterone favors cholesterol metabolism into bile acids, and thus represents another possible mechanism for its hypolipidemic activity. (Deng R 2007)
Artichoke leaf extract – Our results indicate that artichoke leaf extract may be useful for the prevention of hypercholesterolemia-induced pro-oxidant state in LDL+VLDL fraction and the reduction of increased serum cholesterol and triglyceride levels. (Kusku-Kiraz et al 2010)
Curcumin – Long-term curcumin treatment lowers plasma and hepatic cholesterol and suppresses early atherosclerotic lesions comparable to the protective effects of lovastatin. The anti-atherogenic effect of curcumin is mediated via multiple mechanisms including altered lipid, cholesterol and immune gene expression. (Shin et al 2011)
Olive leaf extract – In vitro, oleuropein and its major metabolite, hydroxytyrosol (which are polyphenols contained in olive leaf extract), exhibited a range of pharmacological properties beneficial for the cardiovascular system. These actions included enhanced nitric oxide production by mouse macrophages, antiinflammatory effects, protection against oxidative myocardial injury induced by ischemia and reperfusion , decreased blood pressure, inhibition of platelet aggregation and eicosanoid production, and scavenging of free radicals in addition to inhibition of 5- and 12-lipoxygenases . Oleuropein reduced infarct size, plasma lipid concentrations, and plasma markers of oxidative stress in cholesterol-fed rabbits. In vivo, olive leaf extract lowered blood cholesterol and lipid concentrations in cholesterol-fed rats and lowered blood pressure in nitro-L-arginine methyl ester-induced hypertensive rats as well as in normotensive rats. (Poudyal et al 2010)
Fenugreek seeds – A double blind placebo controlled study concluded that adjunct use of fenugreek seeds improves glycemic control and decreases insulin resistance in mild type-2 diabetic patients. It also found that serum triglycerides decreased and HDL cholesterol increased significantly in the group receiving the fenugreek seed extract. (Gupta et al 2001) Human studies have also confirmed the glucose and lipid-lowering ability of fenugreek. (Sharma et al 1990) Fenugreek was shown to ameliorate dyslipidemia by decreasing the hepatic lipid content in diabetic mice. (Uemura et al 2011)
Pterocarpus marsupium extract – substantially prevented hypertriglyceridaemia and hyperinsulinaemia in this study. (Grover et al 2005) In vivo studies demonstrate that pterostilbene possesses lipid and glucose lowering effects. (Rimando et al 2005)
Cinnamon Bark – The beneficial effects of Cinnamon zeylanicum in animals includes attenuation of diabetes associated weight loss, reduction of fasting blood glucose, LDL and HbA(1c) , increase in HDL cholesterol and increase in circulating insulin levels. (Ranasinghe et al 2012)
Niacin – The use of FDA-approved niacin (nicotinic acid or vitamin B3) formulations at therapeutic doses, alone or in combination with statins or other lipid therapies, is safe, improves multiple lipid parameters, and reduces atherosclerosis progression. Niacin is unique as the most potent available lipid therapy to increase high-density lipoprotein (HDL) cholesterol. (Villines et al 2011)
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