title: Combinations of phytomedicines with different lipid lowering activity for dyslipidemia management: The available clinical data.
abstract: BACKGROUND
  Cardiovascular diseases are the primary cause of death and the leading cause of disability in industrialized countries. Dyslipidemia is a major independent and reversible risk factor for these diseases: it is estimated that a reduction of 1 mmol/l (38 mg/dl) of LDL cholesterol is associated with a risk of developing a cardiovascular complication reduced by 25%, a reduction potentially achieved by life-style improvement associated to adequate dietary supplementation with bioactive substances.
  
  
  OBJECTIVE
  The aim of this review is to focus on the major phytochemical nutraceuticals combinations supported by clinical trials that have demonstrated positive effects in the treatment of dyslipidemia.
  
  
  METHODS
  There are many nutraceuticals with significant lipid-lowering properties: most of them are used in association with a low dosage, because that permits to reduce the risk of side effects and theoretically to improve efficacy. In fact, natural products with different synergetic lipid-lowering could be combined: they can reduce the absorption of lipids from the bowel and/or increase their excretion (soluble fibers, plant sterols, probiotics), enhance the hepatic uptake of cholesterol (berberine, soybean proteins), inhibit Hydroxy-Methil-Gglutaryl Coenzyme A reductase enzyme and consequently the hepatic synthesis of cholesterol (monacolins, policosanols, allicin, soybean proteins, bergamot); furthermore some products are able to reduce the oxidation of the LDL and increase the thermogenesis and lipid metabolism (chlorogenic acid).
  
  
  CONCLUSIONS
  Rational combinations of nutraceuticals with different lipid-lowering activities, whether associated with an appropriate lifestyle, should provide an alternative to drug treatment in patients in primary cardiovascular disease prevention with mildly added cardiovascular risk and in some statin-intolerant patients.
authors.affiliation: Diseases Research Center, Medicine & Surgery Department, Alma Mater Studiorum Atherosclerosis and Metabolic University of Bologna, Bologna, Italy. Electronic address: arrigo.cicero@unibo.it.
authors.forename: Arrigo F G
authors.initials: AF
authors.lastname: Cicero
authors.affiliation: Diseases Research Center, Medicine & Surgery Department, Alma Mater Studiorum Atherosclerosis and Metabolic University of Bologna, Bologna, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Colletti
mesh_terms: D001599:Berberine / Q000494:pharmacology; D001688:Biological Products / Q000494:pharmacology; D002784:Cholesterol / Q000493:pharmacokinetics; D002986:Clinical Trials as Topic; D019587:Dietary Supplements; D004359:Drug Therapy, Combination; D050171:Dyslipidemias / Q000188:drug therapy* / Q000378:metabolism; D005233:Fatty Alcohols / Q000494:pharmacology; D006801:Humans; D008055:Lipids / Q000097:blood / Q000493:pharmacokinetics; D010840:Phytosterols / Q000494:pharmacology; D008517:Phytotherapy / Q000379:methods*; D010940:Plant Proteins / Q000494:pharmacology; D012838:Silymarin / Q000494:pharmacology
chemical_list: D001688:Biological Products; D005233:Fatty Alcohols; D008055:Lipids; D010840:Phytosterols; D010940:Plant Proteins; D012838:Silymarin; C117343:red yeast rice; D001599:Berberine; C080710:policosanol; D002784:Cholesterol
keywords: Cholesterol; Combination; Dyslipidemia; Hypertriglyceridemia; Nutraceuticals; Phytochemicals