Nutraceuticals are a bridge between non-drug and drug-based approaches to the correction of hypercholesterolemia and the prevention of cardiovascular diseases

Abstract

The burden of lipid metabolism disorders is significant and high. According to the ESSE-RF 3 population-based study conducted in 15 regions of the Russian Federation from 2020 to 2022, which included 28,731 men and women aged 35‒74 years, the prevalence of hypercholesterolemia was 58.8%, and only 7.6% were receiving lipid-lowering therapy. Given the size of the Russian population, there is an urgent need for outpatient cholesterol monitoring. A population-based approach for the primary prevention of atherosclerosis is essential. In addition to promoting and implementing healthy lifestyle initiatives, it is necessary to utilize accessible innovative strategies, such as non-drug dyslipidemia management with nutraceuticals. Monacolin K, derived from red yeast rice (RYR), is a nutraceutical that has a lipid profile-optimizing effect similar to statins by inhibiting HMG-CoA reductase. Current guidelines recommend the use of nutraceuticals with a standardized monacolin K content in patients with low to moderate cardiovascular risk when drug therapy is not indicated. Monacolin K can be used for secondary prevention in cases of statin intolerance or patient reluctance to take statins and other lipid-lowering medications despite indications. Among modern RYR-based nutraceuticals, the most appropriate for the correction of hypercholesterolemia is the combination product Armolipid, which has not only proven cholesterol-lowering efficacy (-15‒25%) but also the ability to reduce the risk of cardiovascular events. Armolipid improves dietary effectiveness, treatment adherence, and a healthy lifestyle. Many clinical studies confirm efficacy and safety of Armolipid. This article examines current recommendations for hypercholesterolemia treatment strategies based on cardiovascular risk and baseline LDL-C levels. The article analyzes the results of key randomized clinical trials, meta-analyses, experimental studies, and clinical trials on the efficacy and safety of monacolin. Particular emphasis is placed on evaluating the results of Armolipid.