Abstract
Dyslipidaemias result in the deposition of cholesterol and lipids in the walls of blood vessels, chronic inflammation and the formation of atherosclerotic plaques, which impede blood flow and (when they rupture) result in acute ischaemic episodes. Whilst recent years have seen enormous success in the reduction of cardiovascular risk using conventional pharmaceuticals, there is increasing interest amongst patients and practitioners in the use of nutraceuticals to combat dyslipidaemias and inflammation in cardiovascular disease. Nutraceutical is a portmanteau term: ‘ceutical’ indicate pharmaceutical-grade preparations, and ‘nutra’ indicates that the products contain nutrients from food. Until relatively recently, little high-quality evidence relating to the safety and efficacy of nutraceuticals has been available to prescribers and policymakers. However, as a result of recent randomised-controlled trials, cohort studies and meta-analyses, this situation is changing, and nutraceuticals are now recommended in several mainstream guidelines relating to dyslipidaemias and atherosclerosis. This article will summarise recent clinical-practice guidance relating to the use of nutraceuticals in this context and the evidence which underlies them. Particular attention is given to position papers and recommendations from the International Lipid Expert Panel (ILEP), which has produced several practical and helpful recommendations in this field.
Highlights
Published: 25 August 2021Cardiovascular diseases (CVD) are responsible for an estimated 17.9 million deaths each year and represent the largest overall cause of mortality worldwide [1,2]
International Lipid Expert Panel (ILEP) has produced advice about the use of nutraceuticals in patients at high risk of CVD. They summarise the potential uses of nutraceuticals as follows: (1) managing residual risk associated with lipids other than low-density lipoprotein cholesterol (for example, risk mediated by triglycerides may be ameliorated by Eicosapentaenoic acid (EPA)); (2) managing non-lipid-mediated residual risk; (3)
The development of nutraceuticals from the micronutrient components of food presents an opportunity to target dyslipidaemias and atherosclerosis through direct effects on plasma lipids, and through the modification of pathophysiological processes elicited through atherogenic lipoproteins
Summary
Cardiovascular diseases (CVD) are responsible for an estimated 17.9 million deaths each year and represent the largest overall cause of mortality worldwide [1,2]. In many highly developed countries we may observe a plateau, or even a slight reduction in life expectancy in recent years, which may only be partly attributable to the coronavirus pandemic [4,5]. This article will summarise recent clinical-practice guidance relating to the use of nutraceuticals in this context and the evidence which underlies them. The associations between plasma lipoproteins, atherosclerosis and CVD have been topics of intense research since the observations by Gofman [9] and the results of the Framingham research group [10,11] identified associations between low-density lipoprotein cholesterol (LDL-C) and atherosclerotic events. Inflammation, which occurs when dyslipidaemia results in the deposition of LDL-C in the blood vessel wall is increasingly recognised as a therapeutic target [22,23] in the management of atherosclerosis. A wide range of nutraceuticals have been shown to exert biological actions at targets relevant to these processes, and have the potential to treat dyslipidaemias and ameliorate the severity of their consequences
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