Cholesterol

Red yeast rice (Monascus purpureus)

1200-2400 mg, once per day, minimum 8 to 12 weeks (10)

• Patients with dyslipidemia who were unable to continue statin use due to myalgia experienced decreased low-density lipoprotein (LDL) cholesterol by 43 mg/dL (1.11 mmol/L)  at 12 weeks, and 0.90 mmol/L at 24 weeks, when taking 1800 mg twice daily, compared to baseline and placebo (1)
• A meta-analysis showed weighted mean difference in total cholesterol levels decreased by 0.91 mmol/L, triglycerides by 0.41 mmol/L, and LDL cholesterol by 0.73 mmol/L as well as increased high-density lipoprotein (HDL) by 0.15 mmol/L (10)
• Monocolin K-rich red yeast rice was found to be more effective in lowering total cholesterol and LDL cholesterol when compared to GABA-rich red yeast rice in patients with hyperlipidemia (24)
• A meta-analysis showed that in a number of small trials, red yeast rice was found to have similar effects to statins in ability to improve cholesterol profile (12)

200 mg, once per day, minimum 3 months (23)

• Systematic review and meta-analysis of seven trials found supplementation effective in reducing triglyceride levels observed with consistent supplementation (20)
• Meta-analysis of eight trials found total cholesterol decrease of 1.07 (standardized mean difference) and HDL increased by 1.30 (standardized mean difference) in patients with coronary artery disease (6)
• Patients with dyslipidemia supplemented with 120 mg of CoQ10 for 24 weeks experienced a decrease in blood pressure, serum triglyceride, and LDL cholesterol; as well as an increase in total antioxidant diastolic blood pressure, and ApoA-I, demonstrating in an overall decrease in cardiovascular disease risk factors, when 120 mg per day (26)
• After supplementing with 200 mg for 1 week, an increase in serum CoQ10 correlated with improved HDL cholesterol as well as inhibition of monocyte-derived macrophage foam cell formation, suggesting overall improvement in cardiovascular health (25)

Omega-3 fatty acids

 2-4 g, total per day, minimum 3 months (Dose varies greatly based on EPA/DHA content) (23)(5)(9)

• By reducing VLDL, both EPA, and DHA when administered independently resulted in reduced fasting circulating triglyceride levels (13)
• Systematic review of six studies found supplementation of EPA or DHA greater than 2 g per day (with greater than or equal to 90% purity) was found to have a triglyceride concentration lowering effect, with DHA having a more significant impact at decreasing triglyceride concentration (5)
• Systematic review and meta-analysis found when given omega-3 fatty acids during statin therapy, an improvement in decreasing total cholesterol was demonstrated (2)
• Fasting serum triglyceride decreased by 25.9%, 25.5%, and 30.9% in groups supplemented with 2, 3, and 4 grams of omega-3 fatty acids respectively in patients with severe hypertriglyceridemia (8)
• When given in addition to rosuvastatin, 4 g per day of omega 3 fatty acids decreased triglyceride levels by 26.3% (11.4% in placebo) and non-HDL-C by 10.7% (2.2% in placebo), with combined supplementation showing the greatest impact in patients with residual hypertriglyceridemia (9)

Garlic (Allium sativum)

400-600 mg, once per day, minimum 12 weeks (22)(19)

• Increase in HDL (high-density lipoprotein) in addition to a decrease in alipoprotein B and an increase in the LDL/alipoprotein B ratio was observed after supplementation with 6 g/day aged black garlic for 12 weeks (7)
• Supplementation decreased total cholesterol by 11.5%, decreased LDL by 13.8% and increased HDL cholesterol by 11.5% in men aged 35-70 with mild hypocholesterolemiam when given 600 mg per day (19)
• Meta-analysis of 14 papers found hyperlipidemia improved as demonstrated by n improvement in total cholesterol (21)
• Inflammation decreased as demonstrated by a decrease in arterial stiffness index, high-sensitivity C-reactive protein, LDL cholesterol, and total antioxidant status in obese patients compared to placebo, when given 400 mg per day (22)
• A meta-analysis showed that, when use of garlic supplementation was continued for at least 2 months, a decrease in total serum cholesterol by 8% and decreased risk of coronary event by 38% was observed in people 50 years of age (17)
• Garlic supplementation in patients with hypertension decreased blood pressure, helped to decrease slightly elevated cholesterol and increase immune function as shown by a decrease in blood pressure, and improvement in blood lipids when treated for a minimum of 2 weeks (16)

L-Carnitine

2 g per day, minimum of 12 weeks (4)(11)

• Patients with hyperlipidemia demonstrated a decrease in lipoprotein (a) by 19.4% compared to 6.7% in placebo group when supplemented with 2 g per day of L-carnitine for 12 weeks; similar decreases in total cholesterol, LDL, apolipoprotein (b), and triacylglycerols (4)
• Decreased oxidation of LDL cholesterol occurred as demonstrated by a decrease in oxidized LDL levels by 15.1 U/L compared to 3.0 U/L in placebo, and LDL cholesterol by 0.45 mmol/L compared to 0.16 mmol/L in placebo in patients with type 2 diabetes when given 2 g per day (11)
• Decreases in plasma lipoprotein (a) were observed in hypercholesterolemic patients newly diagnosed with type 2 diabetes when supplemented with 1g twice per day of L-carnitine compared to placebo (3)
• 77.8% of patients with elevated Lp(a) experienced a reduction in lipoprotein (a) when supplemented compared to 38.9% in placebo; patients with a higher elevation at baseline experienced more significant decreases in Lp(a) with 2 g per day supplementation (18)