Many of your patients are taking dietary or health supplements, whether you realize it or not. Marketed as natural health products, vitamins or minerals, these agents are often thought of by the public as important for heart health or for cholesterol lowering. Roughly 50% of Canadians, and up to 80% of Americans, regularly use dietary supplements, usually without physician advice or knowledge. The annual market for such supplements in USA approaches $50 billion per year. Although regulated in Canada by the Natural and Non-Prescription Products Health Directorate, natural health products can make only very limited health claims and do not have to provide much safety information on their labels. They are also not required to confirm efficacy through clinical trials. In some cases, as with fish oil supplements, the medical community has conducted multiple rigorous clinical trials, showing absolutely no cardiovascular or cancer benefit. Canadian lipid guidelines actually have a strong recommendation against the use of fish oil supplements for CV protection. Similarly, past clinical trials have failed to show health benefits of vitamin E or folic acid supplementation. These trials, however, have rarely diminished enthusiasm for supplements and our patients are often on the receiving end of misleading advertising campaigns that infer health benefits that simply do not exist. Most supplements and herbal remedies have not been evaluated at all.

Many dietary supplements are consumed by Canadians who believe they lower cholesterol levels and are thus ‘heart healthy’. Regrettably, many patients abandon their prescribed statins for natural health products, believing they are just as efficacious as statins, yet safer. Given the increasing prevalence of cardiovascular disease and the benefits of cholesterol lowering in preventing CV events, it is important that we understand the role, if any, of natural health products as an adjunct to, or replacement for, effective statin therapy.

What do I tell my patients who claim they can’t take statins due to muscle symptoms?