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J Am Coll Cardiol. 2018 Jul 3;72(1):96-118. doi: 10.1016/j.jacc.2018.04.040.

The Role of Nutraceuticals in Statin Intolerant Patients.

Author information

1
Department of Hypertension, Medical University of Lodz, and the Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland. Electronic address: maciejbanach77@gmail.com.
2
Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy.
3
Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.
4
Institute of Genetics and Animal Breeding of the Polish Academy of Sciences, Jastrzebiec, Poland; Department of Pharmacognosy, University of Vienna, Vienna, Austria.
5
Clinic of Cardiology, University Clinical Centre of Kosovo, and the Medical Faculty, University of Prishtina, Prishtina, Kosovo.
6
Institute of Cardiometabolism and Nutrition (ICAN), Endocrinology Department, Hopital Pitié Salpetrière, Paris, France.
7
Department of Internal Medicine, Centres Hospitaliers Jolimont, Haine Saint-Paul, Belgium; Department of Cardiology, Cliniques Universitaires Saint-Luc, Bruxells, Belgium.
8
Institute of Medical Physiology "Richard Burian" Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
9
National Cardiology Research Center, Moscow, Russia.
10
Preventive Cardiology Unit, Department of Vascular Medicine, Division of Internal Medicine, University Medical Centre Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
11
Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.
12
Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece.
13
Department of Laboratory Medicine, AZ Sint-Jan Hospital, Bruges, Belgium.
14
Faculty of Medicine and Institute of Cardiology and Regenerative Medicine, University of Latvia, Riga, Latvia.
15
Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
16
Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London (UCL), London, United Kingdom.
17
Dyslipidaemia Department, Institute of Cardiology AMS of Ukraine, Kiev, Ukraine.
18
Division of Clinical Pharmacology, Division of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas.
19
Department of Epidemiology, University of Alabama Birmingham, Birmingham, Alabama.
20
School of Health Science and Education, Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece.
21
Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
22
First Department of Internal Medicine, Paracelsus Private Medical University, Salzburg, Austria.
23
1st Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Safarik University, Košice, Slovakia.
24
Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece.
25
University Hospital Centre Zagreb, School of Medicine University of Zagreb, Department of Internal Medicine, Zagreb, Croatia.
26
Cardiovascular Clinical Academic Group St. George's Hospitals NHS Trust University of London, London, United Kingdom; IRCCS San Raffaele Roma, Rome, Italy.
27
Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York.
28
Department of Hypertension, Medical University of Lodz, and the Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland.
29
Biotechnology Research Center, Pharmaceutical Technology Institute and Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
30
Department of Functional Sciences, Discipline of Pathophysiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
31
University of Medicine and Pharmacy "Carol Davila," and Department of Cardiology, University and Emergency Hospital, Bucharest, Romania.
32
Third Department of Internal Medicine, First Medical Faculty, Charles University, Prague, Czech Republic.
33
Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, and School of Medicine, University of Western Australia, Perth, Western Australia, Australia.
34
Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, California.

Abstract

Statins are the most common drugs administered for patients with cardiovascular disease. However, due to statin-associated muscle symptoms, adherence to statin therapy is challenging in clinical practice. Certain nutraceuticals, such as red yeast rice, bergamot, berberine, artichoke, soluble fiber, and plant sterols and stanols alone or in combination with each other, as well as with ezetimibe, might be considered as an alternative or add-on therapy to statins, although there is still insufficient evidence available with respect to long-term safety and effectiveness on cardiovascular disease prevention and treatment. These nutraceuticals could exert significant lipid-lowering activity and might present multiple non-lipid-lowering actions, including improvement of endothelial dysfunction and arterial stiffness, as well as anti-inflammatory and antioxidative properties. The aim of this expert opinion paper is to provide the first attempt at recommendation on the management of statin intolerance through the use of nutraceuticals with particular attention on those with effective low-density lipoprotein cholesterol reduction.

KEYWORDS:

cardiovascular risk; dyslipidemia; nutraceuticals; position paper; statin intolerance

PMID:
29957236
DOI:
10.1016/j.jacc.2018.04.040

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