A great deal of scientific evidence shows that cholesterol-reducing medications known as statins can help prevent coronary artery disease. Although the safety of these medications has been well documented, as many as 40 percent of patients who receive a prescription for statins take the drug for less than one year. Doctors believe that several factors - including cost, adverse effects, poor understanding of statin benefits and patients’ reluctance to take prescription medications long term - may explain why some patients stop taking these medicines. In the July issue of Mayo Clinic Proceedings, a group of researchers from Pennsylvania examine whether an alternative approach to treating high blood cholesterol may provide an effective treatment option for patients who are unable or unwilling to take statins.

Study design
Researchers followed 74 patients with high blood cholesterol who met standard criteria for using statin therapy. Patients were randomly assigned to either the alternative treatment group or the statin group and followed for three months.

The alternative treatment group participants received daily fish oil and red yeast rice supplements, and they were enrolled in a 12-week multidisciplinary lifestyle program that involved weekly 3.5-hour educational meetings led by a cardiologist, dietitian, exercise physiologist and several alternative or relaxation practitioners. Red yeast rice is the product of yeast grown on rice. A dietary staple in some Asian countries, it contains several compounds known to inhibit cholesterol production.

The statin group participants received 40 milligrams (mg) of Zocor (simvastatin) daily, as well as printed materials about diet and exercise recommendations. At the end of the three-month period, participants from both groups underwent blood cholesterol testing to determine the percentage change in LDL cholesterol.

Results
The researchers noted that there was a reduction in LDL cholesterol levels in both groups. The alternative treatment group experienced a 42.4 percent reduction, and the statin group experienced a 39.6 percent reduction. Members of the alternative therapy group also had a substantial reduction in triglycerides, another form of fat found in the blood, and lost more weight.

“Our study was designed to test a comprehensive and holistic approach to lipid lowering,” notes the study’s lead author, David Becker, M.D., a Chestnut Hill Hospital and University of Pennsylvania Health System cardiologist. “These results are intriguing and show a potential benefit of an alternative, or naturopathic, approach to a common medical condition.”

Dr. Becker acknowledges that a larger, multicenter trial with longer follow-up is necessary to determine long-term compliance with the alternative regimen, because previous studies involving diet and exercise have found a high rate of patients unable or unwilling to follow lifestyle recommendations.

“The excellent adherence in the alternative group was undoubtedly related to the intensive follow-up, education and support provided for this group,” says Dr. Becker.

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Other authors of this article include: Ram Gordon, M.D., Patti Morris, and Jacqueline Yorko, M.Ed., from Chestnut Hill Hospital and the University of Pennsylvania Health System; Y. Jerold Gordon, M.D., from the University of Pittsburgh School of Medicine; Mingyao Li, Ph.D., from the University of Pennsylvania School of Medicine; and Nayyar Iqbal, M.D., from the Philadelphia VA Medical Center/University of Pennsylvania.

A peer-review journal, Mayo Clinic Proceedings publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 80 years and has a circulation of 130,000 nationally and internationally.

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