The statin drugs, also known as HMG-CoA reductase inhibitors, are the most popular and powerful medications for lowering cholesterol. They work by interfering with HMG-CoA reductase, an enzyme necessary for the body's manufacture of cholesterol. Drugs in this family include:
- atorvastatin calcium (Lipitor)
- fluvastatin (Lescol)
- lovastatin (Mevacor)
- pravastatin (Pravachol)
- simvastatin (Zocor)
- rosuvastatin (Crestor)
- and others
Chaparral, Comfrey, and Coltsfoot
Possible Harmful Interaction
The herb chaparral (Larrea tridentate or L. mexicana ) has been
promoted for use in arthritis, Cancer, and various other conditions, but there is
insufficient evidence supporting its effectiveness. There are, however, concerns
about its apparent liver toxicity.
Several cases of chaparral-induced liver damage have been reported, some of them
severe enough to require liver transplantation. 1-6
Based on these reports, combining chaparral with other agents that are hard on the
liver, such as statin drugs, may amplify the risk of potential liver problems. 7 Other herbs that are toxic to the liver include
comfrey (Symphytum officinale) and coltsfoot (Tussilago farfara).
St. John's Wort
Possible Harmful Interaction
The herb St. John’s wort, used to treat depression, may decrease blood levels of
various drugs in the statin family, including simvastatin, lovastatin, and atorvastatin
(but not pravastatin). 22
Grapefruit Juice
Possible Harmful Interaction
Grapefruit juice impairs the body's normal breakdown of several drugs, including
statins, allowing them to build up to potentially excessive levels in the blood.
8 A recent study indicates that this effect can
last for 3 days or more following the last glass of juice.
9
Because this could increase the risk of serious drug side effects, if you take interacting
statins, the safest approach is to avoid grapefruit juice altogether. Grapefruit
juice may not affect fluvastatin or pravastatin because these drugs are broken down
differently than other statins.10
Vitamin B3
Possible Benefits and Risks
Niacin (nicotinic acid) is vitamin B3. In high doses (often 1500 mg daily or more),
niacin is effective in lowering cholesterol levels. Its other form, niacinamide
(nicotinamide), does not affect cholesterol.
Combining high-dose niacin with statin drugs further improves cholesterol profile
by raising HDL (“good") cholesterol. 23, 24, 25
Unfortunately, there are real concerns that this combination therapy could cause
a potentially fatal condition of muscle breakdown called rhabdomyolysis.
A growing body of evidence, however, suggests that the risk is relatively slight
in individuals with healthy kidneys. Furthermore, even much lower doses of niacin
than the usual dose given to improve cholesterol levels (100 mg versus 1000 mg or
more) may provide a similar benefit. 26 At this
dose, the risk of rhabdomyolysis should be decreased. Nonetheless, it is not safe
to try this combination except under close physician supervision. Rhabdomyolysis
can be fatal.
Pomegranate
Possible Harmful Interaction
One case report suggests that consumption of pomegranate juice might increase the
risk of rhabdomyolosis with rosuvastatin (Crestor). 28
Red Yeast Rice
Possible Harmful Interaction
Red yeast rice is an herbal cholesterol-lowering therapy. It contains a mixture
of statins; its primary statin ingredient is lovastatin, making it most closely
resemble the prescription drug Mevacor.
Based on the similarity of red yeast rice to statin drugs, the two should not be
combined without medical supervision.
CoEnzyme Q-10 (CoQ-10)
Supplementation Probably Helpful
CoEnzyme Q-10 (CoQ-10 ) is a vitamin-like substance that plays a fundamental role
in the body's energy production 13,14 and appears
to be important for normal heart function. 15
Statin drugs inhibit the enzyme necessary for the body's synthesis of both cholesterol
and CoQ-10. Several studies (including two double-blind trials) have found that these
drugs reduce CoQ-10 levels in the body. 16,17,18
Because statin drugs are used to protect the heart by lowering cholesterol levels,
their effect of inhibiting CoQ-10 production might be counterproductive.
Taking CoQ-10 supplements prevents the lowering of CoQ-10 levels caused by statin
drugs, and does so without interfering with their therapeutic effects.
20
One study found that statin-induced lowering of tissue CoQ-10 levels may worsen heart
function in people with Cardiomyopathy, a disease of the heart muscle.
19 Individuals most vulnerable to this effect appear to be those with
low CoQ-10 levels and impaired heart function to begin with. When the study participants
were given oral CoQ-10 supplementation (100 to 200 mg/day), their CoQ-10 blood levels
increased and their deteriorating heart function improved.
Another study in a broader population failed to find any correlation between levels
of CoQ-10 and rate of adverse events. 27 This was
an observational study, however, and therefore not very reliable.
Fish Oil
Supplementation Probably Helpful
Fish oil is thought to help protect against heart disease. A 1-year double-blind,
placebo-controlled trial found that use of fish oil enhanced the benefits of simvastatin,
further reducing triglyceride levels. 21 In another
study, use of DHA (a component of fish oil) significantly enhanced the effectiveness
of statin therapy. 29 A daily dose of eight grams
daily was more effective than four grams daily.