Herbal Products for Cholesterol Lowering: A Narrative Overview

Abstract

Introduction: Hypercholesterolemia is a leading cardiovascular risk factor with a global prevalence of approximately 24%, contributing substantially to atherosclerotic disease. Despite the well-established efficacy of statins and other pharmacological agents, adherence remains a challenge due to adverse effects and patient reluctance toward conventional therapy.

Purpose: This narrative review synthesizes current evidence on the lipid-modulating properties of seven herbal products and nutraceuticals: garlic, green tea, guggul, red yeast rice, fenugreek, artichoke, and berberine. It focuses on their mechanisms of action, clinical efficacy, and safety profiles.

Current knowledge: The reviewed compounds exhibit diverse lipid-lowering mechanisms, including HMG-CoA reductase inhibition, LDL receptor upregulation, reduced intestinal cholesterol absorption, and enhanced bile acid excretion. Red yeast rice, owing to its lovastatin content, holds the strongest clinical evidence, achieving LDL-C reductions of 15-34%. Berberine and artichoke leaf extract also show consistent lipid-lowering effects. Evidence for garlic, green tea, and fenugreek is promising but heterogeneous. Guggul data remain conflicting, with some trials reporting adverse lipid outcomes.

Conclusions: These nutraceuticals may serve as adjunctive interventions alongside lifestyle modification in selected patients but cannot replace established pharmacotherapy. Large-scale, standardized randomized controlled trials are needed to confirm their efficacy and long-term safety.