Nutraceuticals for the treatment of hypercholesterolemia

Hypercholesterolemia is a well-established modifiable cardiovascular risk factor and its treatment is an essential aim in preventing cardiovascular disease. Current guidelines highlight lifestyle intervention as a primary issue in the treatment of the patient with hypercholesterolemia. Therapeutic lifestyle changes are often insufficient to achieve desirable cholesterol levels. This is particularly true for high risk patients; however, also low risk patients, whose cholesterol levels are not necessarily far from recommended targets, have either sub-optimal or even significantly increased lipid levels. Nutraceuticals are borderline devices between nutrients and drugs providing a supplementation of particular nutrients with beneficial effects on health. Several nutraceuticals have been suggested to improve plasma lipid profile. The literature counted over 40 nutraceutical substances with a supposed beneficial effect on lipid metabolism; for some of them a number of clinical trials highlighted a cholesterol lowering effect and a possible positive influence on cardiovascular prognosis. The aim of this article is to review the main evidences supporting or denying the efficacy and safety of some of the most commonly used nutraceuticals with supposed cholesterol lowering activity.