According to the World Health Organization, cardiovascular conditions, such as heart attacks, strokes, coronary heart disease, peripheral arterial disease, and congenital heart disease, are the leading cause of death worldwide. In 2016, an estimated 17.9 million deaths globally were attributed to cardiovascular diseases. (40) One of the risk factors for cardiovascular disease (CVD) is hypercholesterolemia, a condition characterized by elevated levels of cholesterol in the blood. (25) In adults, reducing cholesterol levels by 8% can substantially reduce the risk of coronary events by 38%. (30)
What is cholesterol?
Cholesterol is a small lipid-type molecule in the blood that has important implications for heart health. It plays a part in maintaining cell membrane structure, producing bile acids, and synthesizing steroid hormones. (2) Cholesterol can be obtained through the diet from animal foods but is also produced within the body by the liver. (38)
Types of cholesterol include:
- High-density lipoprotein (HDL) cholesterol – responsible for transporting cholesterol from tissues to the liver to be metabolized; commonly referred to as “good cholesterol”
- Low-density lipoprotein (LDL) cholesterol – responsible for transporting cholesterol from the liver to cells throughout the body; commonly referred to as “bad cholesterol”
- Triglycerides (TG) – contain glycerol and three fatty acids; enable the transfer and storage of fat in adipocytes (fat cells)
- Very low-density lipoprotein (VLDL) cholesterol – function as a carrier molecule of triglycerides (12)
The table below summarizes normal cholesterol levels by gender and age groups.
What causes high cholesterol?
The causes and risk factors for high cholesterol levels include:
- Certain medications, such as diuretics and steroids
- Diabetes
- Heredity (familial hypercholesterolemia)
- High dietary intake of saturated or trans fats
- Overweight or obesity
- Sedentary lifestyle
- Smoking or second-hand smoke exposure (3)(25)
Signs, symptoms, and complications
Hypercholesterolemia doesn’t present with any clinical symptoms. It is commonly diagnosed using a lipid panel to detect elevated levels of cholesterol in the blood.
High blood lipids can lead to atherosclerosis, where plaque deposits form in blood vessels, (21) which may result in serious health complications. The American College of Cardiology has developed a risk estimator for Atherosclerotic Cardiovascular Disease (ASCVD) in primary prevention patients.
Complications of hypercholesterolemia include:
- Coronary heart disease
- Heart attack
- Peripheral vascular disease
- Stroke (21)
Ingredients for cholesterol support
Reducing LDL cholesterol levels reduces the risk of cardiovascular events and cardiovascular disease mortality. This risk reduction was found to be greater in patients with a higher baseline risk for cardiovascular disease. (9)(11) Cholesterol levels can be managed with dietary and lifestyle modification, as well as supplementing with specific natural ingredients. (7)(17)
Red yeast rice (Monascus purpureus)
Red yeast rice is made by fermenting white rice with Monascus purpureus, a type of yeast. (6) It has been used in Chinese culture as a food preservative, flavoring, and coloring agent. It is also used as a dietary supplement to treat hypercholesterolemia. (6)
The active components in red yeast rice are known as monacolins, which have similar lipid-lowering effects to lovastatin and simvastatin, two commonly prescribed statin medications. (6)(22)(27) Red yeast rice has been shown to lower blood pressure, as well as LDL, total cholesterol, and homocysteine levels. (29)(14)(22)(23) Red yeast rice has also been found to induce anti-inflammatory effects. (29)
Note: Listing the dosage of Monacolin K (lovastatin) on the product label is currently not required, so exact dosages may vary.
Coenzyme Q10 (CoQ10)
Coenzyme Q10 is a fat-soluble compound found in the body’s heart, kidneys, liver, and pancreas. (24) CoQ10 reduces lipid oxidation in cells, (26) and acts as a gene modulator (15) and a cofactor in the mitochondrial electron transport system. (41) A meta-analysis found that CoQ10 supplementation lowers levels of the inflammatory mediators C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α). (13) Adding CoQ10 as an adjunct to statin treatment has been shown to improve cardiovascular parameters, such as triglycerides, total cholesterol, LDL, and HDL cholesterol, as well as reduce the intensity of statin-induced side effects. (34)(18)(37)
Omega-3 fatty acids
Demonstrated to provide anti-inflammatory benefits, omega-3 fatty acids, including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are polyunsaturated long-chain fatty acids that form part of cell membranes. (8) High amounts of EPA and DHA are found in fish oil, the primary source of these fats in the diet. (10) Fish oil supplements are commonly manufactured from krill oil, fish oil (e.g. anchovy, sardine, mackerel, etc.), and cod liver oil. Research has demonstrated that omega-3 supplements are effective in the treatment of rheumatoid arthritis (RA), osteoarthritis (OA), depression, and coronary heart disease. (1)(5)(32) Research has shown EPA and DHA to be effective in lowering fasting circulating triglyceride levels by reducing production of VLDL. (28) DHA has been shown to have a greater impact on improving HDL and decreasing triglycerides than EPA. (16)
Garlic (Allium sativa)
Garlic has a long history of culinary and medicinal uses. Garlic is a member of the allium family of plants, which also includes onions, leeks, and chives. (4) It contains sulfur compounds, such as allicin, which provides its antimicrobial, antioxidant, hypoglycemic, and hypolipidemic effects. (20) Garlic supplements have been found to be effective in reducing total cholesterol (TC), LDL, blood pressure in hypertensive patients, and C-reactive protein (CRP), a biomarker of inflammation. (39)(30)(31)(33)(35)(36) Additionally, garlic supplements have been shown to increase HDL levels. (19)
The bottom line
The prevention and management of hypercholesterolemia helps to reduce the risk of cardiovascular disease in patients. A protocol using natural supplements can be used therapeutically on its own or as an adjunct to existing treatment. If you’re a patient, we recommend speaking with your healthcare provider to find out if these supplements are right for your wellness plan.
If you’re a practitioner, view our cholesterol support protocol.
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