Nutraceuticals with lipid-lowering activity: do they have any effect beyond cholesterol reduction?

A large number of nutraceuticals with lipid-lowering activity are currently available on the market, however, for most of them, it is not known whether the lipid-lowering activity is associated with a concrete reduction in cardiovascular disease risk. The aim of this review is to evaluate whether the most commonly used lipid-lowering nutraceuticals (i.e., soluble fibers, phytosterols, garlic, soy proteins, monacolins, policosanols, berberine and n-3 fatty acids) also have some positive effects on other cardiovascular disease risk factors, on instrumental biomarkers of cardiovascular disease risk or the risk of cardiovascular events. Beyond red yeast rice and n-3 fatty acids, whose use was related to a significant and reliable decrease in cardiovascular disease morbidity and mortality, no evidence is available that demonstrates a preventive effect of lipid-lowering nutraceuticals on hard cardiovascular outcomes. However, for berberine and soluble fibers, the evidence of a positive multimetabolic effect is growing, contributing to a better control of both glucose and lipids values that consequently could be useful in the management of metabolic syndrome.