Lifestyle interventions and nutraceuticals: Guideline-based approach to cardiovascular disease prevention

Lowering low-density lipoprotein cholesterol (LDL-C) levels is associated with a well-documented reduction in cardiovascular (CV) disease (CVD) risk. Current guidelines and literature support lifestyle interventions as the primary strategy for reducing CV risk. Association of dietary modifications (such as the Mediterranean diet), physical activity and the cessation of smoking with reduced CV morbidity and mortality has been evidenced. Where lifestyle interventions are not adequate for lowering LDL-C levels and CV risk, pharmacological therapies, most commonly statins, may also be considered. The benefits of lifestyle and pharmacological interventions in the prevention of CVD are widely known, but poor adherence and persistence to these necessitate an approach that aims to improve LDL-C lowering for CVD prevention.

Nutraceuticals (targeted functional foods or dietary supplements of plant or microbial origin) are included in EU guidelines as lifestyle interventions and may provide an additional approach to controlling LDL-C levels when a pharmaceutical intervention is not (yet) indicated. However, among different nutraceuticals, the level of clinical evidence supportive of efficacy for lipid lowering needs to be considered. Meta-analyses of randomised clinical trials have demonstrated that some nutraceuticals (e.g. red yeast rice and berberine) and some nutraceutical combinations improve lipid profiles, including lowering of LDL-C, total cholesterol and triglyceride levels. Therefore, nutraceuticals may be considered in specific patient groups where there is appropriate evidence to support the efficacy and safety.