Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy.
CGH Medical Center, Sterling, IL, USA; School of Medicine, University of Illinois, Peoria, IL, USA; Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Curr Pharm Des. 2017;23(17):2496-2503. doi: 10.2174/1381612823666170317145851.
Several risk factors such as abnormality of lipid metabolism (e.g. high levels of low-density lipoprotein cholesterol (LDL-C), elevated triglycerides and low levels of high-density lipoprotein cholesterol (HDL-C)) play a central role in the aetiology of cardiovascular disease (CVD). Nutraceutical combination together with a cholesterol- lowering action, when associated with suitable lifestyle, should furnish an alternative to pharmacotherapy in patients reporting statin-intolerance and in subjects at low cardiovascular risk. The present review is focused on nutraceuticals and their synergetic combinations demonstrating a beneficial effect in the management of dyslipidaemia. Several nutraceuticals have been shown to positively modulate lipid metabolism having different functions. Plant sterols and soluble fibres can, for example, decrease the intestinal assimilation of lipids and increase their elimination. Furthermore, berberine and soybean proteins improve the cholesterol uptake in the liver. Policosanols, monacolins and bergamot inhibit hydroxy-methyl-glutaryl coenzyme A reductase (HMGCoA reductase) enzyme action determining the cholesterol hepatic synthesis. Moreover, pomegranate can decrease LDL oxidation and positively affect subclinical atherosclerosis; red yeast rice and berberine play, instead, an important role on endothelial dysfunction and psyllium, plant sterols and bergamot have positive effects on LDL subclasses. To the best of our knowledge, there are no long-term large-scale studies on the anti-atherogenic effect of the nutraceuticals that are available on the market. Thus, further clinical studies should investigate in order to achieve long term tolerability and safety and to provide a better nutraceutical combination tailored to the patient needs.
多种风险因素，如脂代谢异常（例如，低密度脂蛋白胆固醇（LDL-C）水平升高、甘油三酯升高和高密度脂蛋白胆固醇（HDL-C）水平降低），在心血管疾病（CVD）的发病机制中起核心作用。营养保健品与降低胆固醇作用相结合，当与适当的生活方式相关联时，应该为报告他汀类药物不耐受的患者和心血管风险低的患者提供药物治疗的替代方案。本综述重点介绍了营养保健品及其协同组合，这些组合在血脂异常管理中显示出有益的效果。几种营养保健品已被证明可以通过不同的功能积极调节脂代谢。例如，植物固醇和可溶性纤维可以减少肠道对脂质的吸收并增加其排泄。此外，小檗碱和大豆蛋白可改善肝脏中胆固醇的摄取。多烷醇、洛伐他汀和佛手柑抑制羟甲基戊二酰辅酶 A 还原酶（HMGCoA 还原酶）的酶活性，从而确定肝脏中胆固醇的合成。此外，石榴可以降低 LDL 的氧化并对亚临床动脉粥样硬化产生积极影响；红曲米和小檗碱则对内皮功能障碍发挥重要作用，而车前草、植物固醇和佛手柑对 LDL 亚类有积极影响。据我们所知，目前尚无关于市场上可用的营养保健品的抗动脉粥样硬化作用的长期大规模研究。因此，应该进行进一步的临床研究，以实现长期的耐受性和安全性，并为患者的需求提供更好的营养保健品组合。
