January/February 2023
Statins vs supplements for reducing low-density lipoprotein cholesterol

In a randomised, controlled trial, a low dose of rosuvastatin wins by a landslide.

Patients commonly take supplements advertised to improve cardiovas­cular health, although the evidence to support this practice is limited. In the industry­-funded Supplements, Placebo, or Rosuvastatin Study (SPORT) trial, investigators compared the efficacy for lowering LDL cholesterol of six commonly used dietary supplements – fish oil, cinnamon, garlic, turmeric, plant sterols and red yeast rice – with a low­dose statin and placebo.

A total of 199 patients (mean age, 64 years; 59% women) with elevated LDL cholesterol and increased 10­ year risk of atherosclerotic cardiovascular disease identified from a single centre were randomised to rosuvastatin (5 mg daily), placebo or one of the supplements. The primary endpoint was the percentage change of LDL cholesterol from baseline after 28 days. 

LDL cholesterol percentage reductions from baseline were significantly greater with rosuvastatin than with placebo (by an average difference of 35%) or any supplement. Compared with placebo, LDL cholesterol was not significantly reduced with any of the supplements, and garlic was associated with a small but significant increase in LDL cholesterol.

Comment: As a preventive cardiologist, I spend as much of my time in clinic convincing patients to take statins as I do telling them to throw away their untested dietary supplements. This highly practical study provides data to support this practice. Patients are better off skipping the supplements and sticking with statins. 

Note: Karol E. Watson, MD, is an author of this study and a co–Editor-­in­-Chief of NEJM Journal Watch Cardiology but had no role in selecting or summarising this study. 
At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made. 


Assistant Professor, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, USA.

Laffin LJ, et al. Comparative effects of low-dose rosuvastatin, placebo and dietary supplements on lipids and inflammatory biomarkers. J Am Coll Cardiol 2023; 81: 1-12. 

This summary is taken from the following Journal Watch title: Cardiology

J Am Coll Cardiol