Supplements for Cholesterol and Heart Health
“What can I do to lower my cholesterol naturally?” This question is all too common in my day-to-day practice. Despite the growing availability of safe and effective medications to lower low-density lipoprotein cholesterol (LDL-C) and atherosclerotic heart disease (ASCVD) risk, the use of dietary supplements to promote cholesterol-lowering and heart health is rising. But do these supplements work and are they safe?
Do Supplements Lower Cholesterol?
The most common supplements used to lower LDL-C include:
Red yeast rice (RYR). The typical dose is 1,200-4,800 mg/day, which can reduce LDL-C by ~15%–25%. The primary active compound in RYR is monacolin K, which is chemically identical to lovastatin (a low-intensity statin). There is significant variability in the monacolin K content among different RYR supplements, resulting in an unpredictable and unreliable LDL-C lowering response.[1]
Berberine. The typical dose is 0.5-1.5 g/day, which can reduce LDL-C by ~15%–20%. Berberine may also help to improve blood sugar.
Viscous fiber and plant sterols/stanols (PSS). 5-10 g/day of viscous fiber and 2 g/day of PSS can each reduce LDL-C by ~5-10%. They both work by blocking absorption of cholesterol in the gut. They are also found in food sources such as whole grains, legumes, vegetables, fruits, nuts, and seeds.[1]
Other supplements with small and inconsistent cholesterol benefits include garlic, turmeric, soy protein, green tea, specific probiotic strains, artichoke extracts, and bergamot.
By contrast, statins can lower LDL-C by 30-49% at their moderate doses and by ≥50% at higher doses. A trial called the SPORT trial randomized adults to low-dose rosuvastatin 5mg daily, one of six supplements (RYR, PSS, fish oil, cinnamon, garlic, turmeric), or placebo. Rosuvastatin reduced LDL-C by 37.9%, which was superior to all supplements and placebo. None of the dietary supplements demonstrated a significant decrease in LDL-C compared with placebo.[2]
Do Supplements Reduce the Risk of Heart Disease?
RYR. The only supplement mentioned above with randomized controlled trial data demonstrating cardiovascular benefit, however it was a single study which included only Chinese patients who had a previous heart attack. It is unclear if this benefit translates to other patient groups.[3]
Fish oil. The omega-3 fatty acids EPA and DHA in fish oil supplements can lower triglycerides (TG) but do not lower LDL-C (they may actually increase it). Large randomized studies of EPA/DHA mixtures at doses typically found in supplements (~1 g/day) have not shown significant improvements in cardiovascular outcomes.[4]
Coenzyme Q10 (CoQ10). CoQ10 is mainly used to improve statin-associated muscle symptoms, however the evidence supporting this is conflicting. CoQ10 may have cardiovascular benefits in patients with heart failure, though evidence is limited.[5]
Other supplements including vitamin D, calcium, multivitamins, vitamin C, vitamin E, and selenium have not shown cardiovascular benefits.
Are Supplements Safe?
RYR. Generally well-tolerated, including among patients who have side effects with statins. However, given its active ingredient is identical to lovastatin, there may be a similar risk profile to statins (muscle pain/injury, liver injury). There are several drug interactions to consider, and there are significant product quality concerns. There is wide variability in the monacolin K content between products, and some RYR products have been found to contain citrinin, a toxin which is dangerous to the kidneys.[1]
Berberine. Generally well-tolerated, with the most common side effects being gastrointestinal. However, there are drug interactions with several medications.
Viscous fiber and PSS. Generally well-tolerated with no major safety concerns, though they may interfere with the absorption of medications and vitamins. They should be taken separately from medications and with concomitant high intake of fruits and vegetables. PSS are contraindicated in a condition called sitosterolemia.[1]
Fish oil. Potential adverse effects include an increased risk of atrial fibrillation and bleeding, and an increase in LDL-C.
What The Guidelines Say
The 2026 Dyslipidemia Guidelines (which were endorsed by multiple societies) clearly state the following: “In individuals with dyslipidemia, the use of dietary supplements is not recommended to lower LDL-C or TG based on limited and inconsistent data and/or limited benefits in lipid-lowering and reduction in ASCVD risk.” [6]
What I Tell My Patients
Although there is a perception that dietary supplements are safer than FDA-approved medications, they are poorly regulated and have limited data demonstrating safety and efficacy, particularly when compared with statins. Statins are far more effective than supplements at lowering LDL-C, have clear and consistent cardiovascular benefits, and have decades of safety data. While some patients do experience statin-related side effects, these are typically mild and reversible. In cases where statins are not tolerated, there are several other safe and effective medications which lower LDL-C and cardiovascular risk.
When asked about “natural” ways to lower cholesterol, I highlight lifestyle medications as the most natural approach. I emphasize that supplements are manufactured products just like medications, however they come with safety concerns and questionable efficacy. I then go through the available arsenal of safe and effective lipid-lowering medications, which is extensive and ever-expanding.
References
[1] Kirkpatrick CF, Sikand G, Petersen KS, Anderson CAM, Aspry KE, Bolick JP, Kris-Etherton PM, Maki KC. Nutrition interventions for adults with dyslipidemia: A Clinical Perspective from the National Lipid Association. J Clin Lipidol. 2023 Jul-Aug;17(4):428-451. doi: 10.1016/j.jacl.2023.05.099. Epub 2023 Jun 2.
[2] Laffin LJ, Bruemmer D, Garcia M, et al. Comparative Effects of Low-Dose Rosuvastatin, Placebo, and Dietary Supplements on Lipids and Inflammatory Biomarkers. J Am Coll Cardiol. 2023;81(1):1-12. doi:10.1016/j.jacc.2022.10.013
[3] Cicero AFG, Fogacci F, Zambon A. Red Yeast Rice for Hypercholesterolemia: JACC Focus Seminar. J Am Coll Cardiol. 2021 Feb 9;77(5):620-628. doi: 10.1016/j.jacc.2020.11.056.
[4] Weinberg RL, Brook RD, Rubenfire M, Eagle KA. Cardiovascular Impact of Nutritional Supplementation With Omega-3 Fatty Acids: JACC Focus Seminar. J Am Coll Cardiol. 2021 Feb 9;77(5):593-608. doi: 10.1016/j.jacc.2020.11.060.
[5] Raizner AE, Quiñones MA. Coenzyme Q10 for Patients With Cardiovascular Disease: JACC Focus Seminar. J Am Coll Cardiol. 2021 Feb 9;77(5):609-619. doi: 10.1016/j.jacc.2020.12.009.
[6] Blumenthal RS, Morris PB, Gaudino M, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. Published online March 13, 2026. doi:10.1016/j.jacc.2025.11.016