The Role of Nutraceuticals in the Optimization of Lipid-Lowering Therapy in High-Risk Patients with Dyslipidaemia
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NONSTATIN DRUGS (M. VRABLIK, SECTION EDITOR)
The Role of Nutraceuticals in the Optimization of Lipid-Lowering Therapy in High-Risk Patients with Dyslipidaemia Peter E. Penson 1,2,3 & Maciej Banach 4,5,6 Accepted: 10 September 2020 # The Author(s) 2020
Abstract Purpose of Review We aimed to summarize recent guidelines, position papers, and high-quality clinical research relating the use of nutraceuticals in the management of individuals at high risk of atherosclerotic cardiovascular disease. Recent Findings It is essential that individuals at high risk of cardiovascular disease receive guideline-directed evidence-based therapies to reduce their risk of morbidity and mortality from cardiovascular events. Compared with conventional therapeutics, nutraceuticals have undergone relatively little investigation in randomized controlled trials. Thus, recommendations for nutraceuticals in international guidelines are rare, and nutraceuticals should not be used preferentially in place of statins. Nevertheless, recent position papers from the International Lipid Expert Panel and clinical evidence from studies of triglyceride reduction by polyunsaturated fatty acid administration demonstrate that nutraceuticals do have an important role in optimizing therapy in individuals at high risk of cardiovascular disease. Roles for nutraceuticals include as follows: (1) managing residual risk associated with lipids other than low-density lipoprotein cholesterol (LDL-C); (2) managing non-lipid-mediated residual risk; (3) optimizing LDL-C treatment in statin intolerance; (4) optimizing LCL-C treatment when add-on therapies for statins are not available; (5) as adjuncts to lifestyle for individuals at high lifetime risk of atherosclerotic cardiovascular disease (ASCVD). The strength of evidence for each of these applications is variable. Summary In addition to guideline-directed therapeutics, nutraceuticals may have roles in optimizing preventative therapy and targeting residual risk in individuals at high risk of ASCVD. Application of Good Manufacturing Practice and randomized controlled trials when producing and evaluating nutraceuticals will expand the armoury of evidence-based agents for the prevention of ASCVD. Keywords Efficacy . Lipid disorders . Nutraceuticals . Safety . Therapy
This article is part of the Topical Collection on Nonstatin Drugs * Maciej Banach [email protected] 1
School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
2
Liverpool Centre For Cardiovascular Science, Liverpool, UK
3
University of Liverpool, Liverpool, UK
4
Department of Hypertension, Medical University of Lodz, Rzgowska 281/289, 93-338 Lodz, Poland
5
Polish Mother’s Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
6
Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
Abbreviations ACC American College of Cardiology AHA American Heart Association ASCVD Atherosclerotic cardiovascular disease DHA Docosahexaenoic acid EPA Eicosapentaenoic acid EAS European At
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