Double the Effectiveness of Your Statin?

Summarized by Robert W. Griffith, MD
August 17, 2005

Introduction

Raised low-density lipoprotein cholesterol (LDL-C) is clearly linked to an increased risk of coronary heart disease (CHD), and lowering the LDL-C level results in reducing the death rare from CHD. Statins are the mainstay of treatment to lower LDL-C, along with improved lifestyle (you know - no smoking, the right diet, and plenty of exercise).

Soluble fiber found in psyllium husk is also capable of lowering LDL-C. Cardiologists from the Robert Wood Johnson Medical School in New Jersey have now studied the cholesterol-lowering effect of adding psyllium to a low dosage of a statin, simvastatin. The findings are reported in the Archives of Internal Medicine, and summarized here.

What was done

Forty men and 28 women, aged 18 to 80, with raised blood lipid levels and who were candidates for drug treatment, were enrolled. They began with a 4-week diet stabilization phase, followed by an 8-week treatment phase.

The treatments, which were allocated at random, were:

• simvastatin 20 mg once daily plus placebo three times daily,
• simvastatin 10 mg once daily plus placebo three times daily,
• simvastatin 10 mg once daily plus 5.8 grams of Metamucil^® three times daily.

The placebo used was Tang^®, which looks and tastes like Metamucil^®, but contains no dietary fiber. Blood lipid determinations were made at baseline, and then after 4 and 8 weeks of treatment.

What was found

The average age of the participants was 64, and the average body mass index (BMI) was 27.5 (i.e. they were mostly overweight, but not obese).

The baseline blood lipids, and the change after 8 weeks of treatment, are given in the table:

*to convert cholesterol values to mmol/L, multiply by 0.0259; for triglycerides, by 0.0113

It can be seen that the average fall in LDL-C for those taking 10 mg simvastatin was 55 mg/dL, compared with 63 mg/dL for those taking either 20 mg simvastatin, or 10 mg of the statin plus 18 gram Metamucil^®. The changes in high-density lipoprotein cholesterol (HDL-C) and triglycerides were not statistically significant - in other words, they could have occurred by chance.

There were no relevant adverse effects reported in any of the treatment groups, except for muscle ache in one patient taking 20 mg simvastatin, and gastrointestinal upset in two patients - 1 in each of the groups taking Tang^®.

What this means

It should be noted that doubling the dose of a statin doesn't result in doubling the reduction in LDL-C. Rather, it reduces it further by about 6%. The same effect was achieved in this study by adding 18 grams of Metamucil^® (about one teaspoonful three times a day). In other words, Metamucil^® produced the same result as doubling the statin dose.

This is not the first study to show the beneficial effects of dietary soluble fiber on cholesterol levels, but it's the first comparison of a statin's effects with and without a supplemental fiber. And it shows fairly conclusively that psyllium supplementation should be considered as a safe and effective alternative to increasing the statin dosage. Its use can reduce the risk of statin side effects, as well as proving less expensive.

Source

• Effect of combining psyllium fiber with simvastatin in lowering cholesterol. AE. Moreyra, AC. Wilson, A. Koraym, Arch Intern Med, 2005, vol. 165, pp. 1161--1166

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