The complex relationship between cardiologists and lipid-lowering dietary supplements: Hate or love?

In August 2025, the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) released an update of the dyslipidaemia management guidelines, including a brief statement on lipid-lowering dietary supplements. The document states that dietary supplements or vitamins lacking documented safety and significant LDL-cholesterol-lowering efficacy are not recommended to reduce ASCVD risk. This sentence has been interpreted by some as a broad discouragement against the use of nutraceuticals; however, the corresponding class of recommendation is "C", indicating reliance on expert opinion and routine practice rather than robust randomized evidence. The negative interpretation is further influenced by the recent EFSA opinion on red yeast rice, which raised safety concerns but does not extend to other nutraceuticals. Concerns regarding efficacy have also been shaped disproportionately by the SPORT trial, a short, single-blinded, underpowered study that compared a low-dose statin with a heterogeneous group of supplements, including some with no proven lipid-lowering effects. Notably, the guideline update does not address several nutraceuticals supported by meta-analyses-such as plant sterols, soluble fibers, berberine, artichoke extract, and bergamot-whose efficacy and safety are well documented. A more constructive reading of the update suggests encouraging clinicians to recommend only evidence-based nutraceuticals and motivating further research. These agents should be considered as adjuncts to lifestyle interventions in low-risk individuals, not as substitutes for pharmacologic therapy when indicated.