:
Cardiovascular diseases (CVDs) are the main cause of mortality worldwide. Risk factors of CVD can be classified into modifiable (smoking,
hypertension, diabetes,
hypercholesterolemia) through lifestyle changes or taking
drug therapy and not modifiable (age, ethnicity, sex and family history). Elevated total
cholesterol (TC) and
low-density lipoprotein-cholesterol (
LDL-C) levels have a lead role in the development of
coronary heart disease (CHD), while high levels of
high-density lipoprotein-cholesterol (HDL-C) seem to have a protective role.The current treatment for
dyslipidemia consists of lifestyle modification or
drug therapy even if not pharmacological treatment should be always considered in addition to
lipid-lowering medications.The use of
lipid-lowering nutraceuticals alone or in association with
drug therapy may be considered when the atherogenic
cholesterol goal was not achieved.These substances can be classified according to their mechanisms of action into natural inhibitors of intestinal
cholesterol absorption, inhibitors of hepatic
cholesterol synthesis and enhancers of the excretion of
LDL-C. Nevertheless, many of them are characterized by mixed or unclear mechanisms of action.The use of these nutraceuticals is suggested in individuals with borderline
lipid profile levels or with
drug intolerance, but cannot replace standard
lipid-lowering treatment in patients at high, or very high CVD risk.Nutraceuticals can also have vascular effects, including improvement in endothelial dysfunction and arterial stiffness, as well as antioxidative properties. Moreover, epidemiological and clinical studies reported that in patients intolerant of
statins, many nutraceuticals with demonstrated hypolipidemic effect are well tolerated.