title: Simvastatin vs therapeutic lifestyle changes and supplements: randomized primary prevention trial.
abstract: OBJECTIVE
  To compare the lipid-lowering effects of an alternative regimen (lifestyle changes, red yeast rice, and fish oil) with a standard dose of a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin).
  
  
  METHODS
  This randomized trial enrolled 74 patients with hypercholesterolemia who met Adult Treatment Panel III criteria for primary prevention using statin therapy. All participants were randomized to an alternative treatment group (AG) or to receive simvastatin (40 mg/d) in this open-label trial conducted between April 1, 2006, and June 30, 2006. The alternative treatment included therapeutic lifestyle changes, ingestion of red yeast rice, and fish oil supplements for 12 weeks. The simvastatin group received medication and traditional counseling. The primary outcome measure was the percentage change in low-density lipoprotein cholesterol (LDL-C). Secondary measures were changes in other lipoproteins and weight loss.
  
  
  RESULTS
  There was a statistically significant reduction in LDL-C levels in both the AG (-42.4%+/-15%) (P<.001) and the simvastatin group (-39.6%+/-20%) (P<.001). No significant differences were noted between groups. The AG also demonstrated significant reductions in triglycerides (-29% vs -9.3%; 95% confidence interval, -61 to -11.7; P=.003) and weight (-5.5% vs -0.4%; 95% confidence interval, -5.5 to -3.4; P<.001) compared with the simvastatin group.
  
  
  CONCLUSIONS
  Lifestyle changes combined with ingestion of red yeast rice and fish oil reduced LDL-C in proportions similar to standard therapy with simvastatin. Pending confirmation in larger trials, this multifactorial, alternative approach to lipid lowering has promise for a subset of patients unwilling or unable to take statins.
authors.affiliation: Division of Cardiology, Chestnut Hill Hospital, University of Pennsylvania Health System, Philadelphia, PA, USA. dbeckerchcardiology@hotmail.com
authors.forename: David J
authors.initials: DJ
authors.lastname: Becker
authors.forename: Ram Y
authors.initials: RY
authors.lastname: Gordon
authors.forename: Patti B
authors.initials: PB
authors.lastname: Morris
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Yorko
authors.forename: Y Jerold
authors.initials: YJ
authors.lastname: Gordon
authors.forename: Mingyao
authors.initials: M
authors.lastname: Li
authors.forename: Nayyar
authors.initials: N
authors.lastname: Iqbal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D019587:Dietary Supplements; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000097:blood / Q000150:complications / Q000628:therapy*; D008019:Life Style; D008074:Lipoproteins / Q000097:blood; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000379:methods*; D012189:Retrospective Studies; D019821:Simvastatin / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008074:Lipoproteins; D019821:Simvastatin