title: Artichoke leaf extract (Cynara scolymus) reduces plasma cholesterol in otherwise healthy hypercholesterolemic adults: a randomized, double blind placebo controlled trial. High-density lipoprotein cholesterol and cardiovascular disease. Four prospective American studies. Nutritional Intervention Study with Argan Oil in Man: Effects on Lipids and Apolipoproteins Eicosapentaenoic acid is primarily responsible for hypotriglyceridemic effect of fish oil in humans Combined Treatment with Dif1stat® and Diet Reduce Plasma Lipid Indicators of Moderate Hypercholesterolemia More Effectively than Diet Alone: A Randomized Trial in Parallel Groups Moderate fish-oil supplementation reverses low-platelet, long-chain n-3 polyunsaturated fatty acid status and reduces plasma triacylglycerol concentrations in British Indo-Asians. Olive oils high in phenolic compounds modulate oxidative/antioxidative status in men. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Conjugated linoleic acid supplementation for 1 y reduces body fat mass in healthy overweight humans. Corn oil improves the plasma lipoprotein lipid profile compared with extra-virgin olive oil consumption in men and women with elevated cholesterol: results from a randomized controlled feeding trial. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S) Kinetics of HDL cholesterol and paraoxonase activity in moderate alcohol consumers. Effect of phenol-rich extra virgin olive oil on markers of oxidation in healthy volunteers Effect of Xuezhikang, an extract from red yeast Chinese rice, on coronary events in a Chinese population with previous myocardial infarction. Lipid Responses to a Dietary Docosahexaenoic Acid Supplement in Men and Women with Below Average Levels of High Density Lipoprotein Cholesterol Effects of Xuezhikang in patients with dyslipidemia: a multicenter, randomized, placebo-controlled study. Bergamot polyphenolic fraction enhances rosuvastatin-induced effect on LDL-cholesterol, LOX-1 expression and protein kinase B phosphorylation in patients with hyperlipidemia. Relationship between Adiponectin and Leptin, and Blood Lipids in Hyperlipidemia Patients Treated with Red Yeast Rice Efficacy of Artichoke dry extract in patients with hyperlipoproteinemia. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. Tolerability of red yeast rice (2,400 mg twice daily) versus pravastatin (20 mg twice daily) in patients with previous statin intolerance. Effect of lovastatin on cardiovascular resource utilization and costs in the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS). AFCAPS/TexCAPS Research Group. Daily moderate alcohol consumption increases serum paraoxonase activity; a diet-controlled, randomised intervention study in middle-aged men. Effects of differing phenolic content in dietary olive oils on lipids and LDL oxidation Beneficial effects of artichoke leaf extract supplementation on increasing HDL-cholesterol in subjects with primary mild hypercholesterolaemia: a double-blind, randomized, placebo-controlled trial Olive Oil Polyphenols Enhance High-Density Lipoprotein Function in Humans: A Randomized Controlled Trial
abstract: Cardiovascular diseases are the chief causes of death in the UK , and are associated with high circulating levels of total cholesterol in the plasma . Artichoke leaf extracts ( ALEs ) have been reported to reduce plasma lipids levels , including total cholesterol , although high quality data is lacking . The objective of this trial was to assess the effect of ALE on plasma lipid levels and general well-being in otherwise healthy adults with mild to moderate hypercholesterolemia . 131 adults were screened for total plasma cholesterol in the range 6.0 - 8.0 mmol/l , with 75 suitable volunteers r and omised onto the trial . Volunteers consumed 1280 mg of a st and ardised ALE , or matched placebo , daily for 12 weeks . Plasma total cholesterol decreased in the treatment group by an average of 4.2 % ( from 7.16 ( SD 0.62 ) mmol/l to 6.86 ( SD 0.68 ) mmol/l ) and increased in the control group by an average of 1.9 % ( 6.90 ( SD 0.49 ) mmol/l to 7.03 ( 0.61 ) mmol/l ) , the difference between groups being statistically significant ( p=0.025 ) . No significant differences between groups were observed for LDL cholesterol , HDL cholesterol or triglyceride levels . General well-being improved significantly in both the treatment ( 11 % ) and control groups ( 9 % ) with no significant differences between groups . In conclusion , ALE consumption result ed in a modest but favourable statistically significant difference in total cholesterol after 12 weeks . In comparison with a previous trial , it is suggested that the apparent positive health status of the study population may have contributed to the modesty of the observed response The British Regional Heart Study ( BRHS ) reported in 1986 that much of the inverse relation of high-density lipoprotein cholesterol ( HDLC ) and incidence of coronary heart disease was eliminated by covariance adjustment . Using the proportional hazards model and adjusting for age , blood pressure , smoking , body mass index , and low-density lipoprotein cholesterol , we analyzed this relation separately in the Framingham Heart Study ( FHS ) , Lipid Research Clinics Prevalence Mortality Follow-up Study ( LRCF ) and Coronary Primary Prevention Trial ( CPPT ) , and Multiple Risk Factor Intervention Trial ( MRFIT ) . In CPPT and MRFIT ( both r and omized trials in middle-age high-risk men ) , only the control groups were analyzed . A 1-mg/dl ( 0.026 mM ) increment in HDLC was associated with a significant coronary heart disease risk decrement of 2 % in men ( FHS , CPPT , and MRFIT ) and 3 % in women ( FHS ) . In LRCF , where only fatal outcomes were documented , a 1-mg/dl increment in HDLC was associated with significant 3.7 % ( men ) and 4.7 % ( women ) decrements in cardiovascular disease mortality rates . The 95 % confidence intervals for these decrements in coronary heart and cardiovascular disease risk in the four studies overlapped considerably , and all contained the range 1.9 - 2.9 % . HDLC levels were essentially unrelated to non-cardiovascular disease mortality . When differences in analytic methodology were eliminated , a consistent inverse relation of HDLC levels and coronary heart disease event rates was apparent in BRHS as well as in the four American studies Aim : To evaluate whether the consumption of virgin argan oil ( VAO ) is associated with a change in serum lipids and reduces the risk of cardiovascular disease in healthy Moroccans . Methods : Sixty volunteers consumed butter ( 25 g/day ) during 2 weeks ( stabilization period ) and were r and omly divided into two groups : the treatment group received 25 g/day of VAO during 3 weeks ( intervention period ) , and the control group received 25 g/day of extra virgin olive oil ( EVO ) . Throughout the study , weight , blood pressure , and daily food intake were measured . Serum total cholesterol and low- and high-density lipoprotein cholesterol , triglycerides , and apolipoproteins A-I and B were measured at the end of each diet period . Results : Analysis of food intake showed that the daily diet is isocaloric for the butter regimen ( 2,537 ± 244 kcal/day ) as well as for the VAO and EVO regimens ( 2,561± 246 and 2,560 ± 253 kcal/day , respectively ) . Analysis of the lipid intake showed a reduction in saturated fatty acids  with VAO and EVO regimens ( 27 ± 1.4 and 26.4 ± 3.4 % , respectively ) as compared with the stabilization period ( 41.6 ± 2.4 % ) . The analysis of serum lipids showed a significant increase in high-density lipoprotein cholesterol and apolipoprotein A-I in both VAO group ( 8.4 % , p = 0.012 , and 5.2 % , p = 0.027 , respectively ) and EVO group ( 17.3 % , p = 0.001 , and 5.9 % , p = 0.036 , respectively ) . However , low-density lipoprotein cholesterol and apolipoprotein B ( 13.8 % , p = 0.037 , and 7.8 % , p = 0.039 , respectively ) decreased significantly only in EVO group as compared with the stabilization period , while triglycerides decreased significantly by 17.5 % ( p = 0.039 ) only in VAO group . Conclusion : These results confirm the cholesterol-lowering effect of EVO and show for the first time the triglyceride-lowering effect of VAO in men The aim of this study was to determine whether eicosapentaenoic acid ( EPA ) or docosahexaenoic acid ( DHA ) , or both , were responsible for the triglyceride (TG)-lowering effects of fish oil . EPA ( 91 % pure ) and DHA ( 83 % pure ) , a fish oil concentrate ( FOC ; 41 % EPA and 23 % DHA ) and an olive oil ( OO ) placebo ( all ethyl esters ) were tested . A total of 49 normolipidemic subjects participated . Each subject was given placebo for 2–3 wk and one of the n-3 supplements for 3 wk in r and omized , blinded trials . The target n-3 fatty acid ( FA ) intake was 3 g/day in all studies . Blood sample s were drawn twice at the end of each supplementation phase and analyzed for lipids , lipoproteins , and phospholipid FA composition . In all groups , the phospholipid FA composition changed to reflect the n-3 FA given . On DHA supplementation , EPA levels increased to a small but significant extent , suggesting that some retroconversion may have occurred . EPA supplementation did not raise DHA levels , however , FOC and EPA produced significant decreases in both TG and very low density lipoprotein ( VLDL ) cholesterol ( C ) levels ( P<0.01 ) and increases in low density lipoprotein ( LDL ) cholesterol levels ( P<0.05 ) . DHA supplementation did not affect cholesterol , triglyceride , VLDL , LDL , or high density lipoprotein ( HDL ) levels , but it did cause a significant increase in the HDL2/HDL3 cholesterol ratio . We conclude that EPA appears to be primarily responsible for TG-lowering ( and LDL-C raising ) effects of fish oil An open-labeled r and omized trial with parallel groups was carried out to study the effects of Dif1stat ® ( Monascus purpureus – Linear aliphatic alcohols – Niacin ) in the treatment of primary moderate hypercholesterolemia . The trial lasted 8 months . The patients , males and females , were assigned to two groups : A ( # 130 ) , treated  with diet  , and B ( # 110 ) su bmi tted to diet + Dif1stat ® . After 4 months , group A did not show significant changes in Total cholesterol ( TC ) , LDL-cholesterol ( LDLC ) , HDL-cholesterol ( HDLC ) or non-HDL-cholesterol ( non-HDLC ) . The same group , showed a reduction in TC ( –22 % ) , LDLC ( –30 % ) and non-HDLC ( –27 % ) after 8 months ( P ≤ 0.001 ) . After 4 months , TC ( –21.3 % ) , LDLC ( –29 % ) , and non-HDLC ( –26 % ) were significantly lowered in group B ( P ≤ 0.001 ) . In group B , TC , LDLC and non-HDLC showed a further reduction after 8 months : –29.4 , –38 and –37 % , respectively ( P ≤ 0.001 ) . Even triglycerides ( TG ) decreased significantly ( –33 % ) ( P ≤ 0.001 ) . After 8 months , group B showed a significant reduction of TG ( –33 % ) ( P ≤ 0.001 ) , when compared to group A. Some safety parameters were significantly reduced in both groups : AST and γ-GT in group A after 4 and 8 months , as well as ALT , AST and γ-GT in group B after 8 months ( P ≤ 0.001 ) . Dif1stat ® , given with a suitable diet , was well tolerated in the long-term and induced an anti-atherogenic plasma lipid and lipoprotein profile , in patients with moderate hypercholesterolemia BACKGROUND The mechanisms involved in the increased mortality from coronary artery disease in British Indo-Asians are not well understood . OBJECTIVES This study aim ed to investigate whether British Indo-Asian Sikhs have higher plasma triacylglycerol concentrations , lower platelet phospholipid levels , and lower dietary intakes of long-chain n-3 polyunsaturated fatty acids ( PUFAs ) than do age- and weight-matched Europeans and whether moderate dietary fish-oil intake can reverse these differences . DESIGN A r and omized , double-blind , placebo-controlled , parallel , fish-oil intervention study was performed . After a 2-wk run-in period , 44 Europeans and 40 Indo-Asian Sikhs were r and omly assigned to receive either 4.0 g fish oil [ 1.5 g eicosapentaenoic acid ( EPA ) and 1.0 g docosahexaenoic acid ( DHA ) ] or 4.0 g olive oil ( control ) daily for 12 wk . RESULTS At baseline , the Indo-Asians had significantly higher plasma triacylglycerol , small dense LDL , apolipoprotein B , and dietary and platelet phospholipid n-6 PUFA values and significantly lower long-chain n-3 PUFAs ( EPA and DHA ) than did the Europeans . A significant decrease in plasma triacylglycerol , plasma apolipoprotein B-48 , and platelet phospholipid arachidonic acid concentrations and a significant increase in plasma HDL concentrations and platelet phospholipid EPA and DHA levels were observed after fish-oil supplementation . No significant effect of ethnicity on the responses to fish-oil supplementation was observed . CONCLUSIONS Moderate fish-oil supplementation contributes to a reversal of lipid abnormalities and low n-3 PUFA levels in Indo-Asians and should be considered as an important , yet simple , dietary manipulation to reduce CAD risk in Indo-Asians with an atherogenic lipoprotein phenotype The aim of the present study was to evaluate whether olive oils high in phenolic compounds influence the oxidative/antioxidative status in humans . Healthy men ( n = 12 ) participated in a double-blind , r and omized , crossover study in which 3 olive oils with low ( LPC ) , moderate ( MPC ) , and high ( HPC ) phenolic content were given as raw doses ( 25 mL/d ) for 4 consecutive days preceded by 10-d washout periods . Volunteers followed a strict very low-antioxidant diet the 3 d before and during the intervention periods . Short-term consumption of olive oils decreased plasma oxidized LDL ( oxLDL ) , 8-oxo-dG in mitochondrial DNA and urine , malondialdehyde in urine ( P < 0.05 for linear trend ) , and increased HDL cholesterol and glutathione peroxidase activity ( P < 0.05 for linear trend ) , in a dose-dependent manner with the phenolic content of the olive oil administered . At d 4 , oxLDL after MPC and HPC , and 8-oxo-dG after HPC administration ( 25 mL , respectively ) , were reduced when the men were in the postpr and ial state ( P < 0.05 ) . Phenolic compounds in plasma increased dose dependently during this stage with the phenolic content of the olive oils at 1 , 2 , 4 , and 6 h , respectively ( P < 0.01 ) . Their concentrations increased in plasma and urine sample s in a dose-dependent manner after short-term consumption of the olive oils ( P < 0.01 ) . In conclusion , the olive oil phenolic content modulated the oxidative/antioxidative status of healthy men who consumed a very low-antioxidant diet BACKGROUND We examined the cholesterol-lowering effects of a proprietary Chinese red-yeast-rice supplement in an American population consuming a diet similar to the American Heart Association Step I diet using a double-blind , placebo-controlled , prospect ively r and omized 12-wk controlled trial at a university research center . OBJECTIVE We evaluated the lipid-lowering effects of this red-yeast-rice dietary supplement in US adults separate from effects of diet alone . DESIGN Eighty-three healthy subjects ( 46 men and 37 women aged 34 - 78 y ) with hyperlipidemia [ total cholesterol , 5.28 - 8.74 mmol/L ( 204 - 338 mg/dL ) ; LDL cholesterol , 3.31 - 7.16 mmol/L ( 128 - 277 mg/dL ) ; triacylglycerol , 0.62 - 2.78 mmol/L ( 55 - 246 mg/dL ) ; and HDL cholesterol 0.78 - 2.46 mmol/L ( 30 - 95 mg/dL ) ] who were not being treated with lipid-lowering drugs participated . Subjects were treated with red yeast rice ( 2.4 g/d ) or placebo and instructed to consume a diet providing 30 % of energy from fat , < 10 % from saturated fat , and < 300 mg cholesterol daily . Main outcome measures were total cholesterol , total triacylglycerol , and HDL and LDL cholesterol measured at weeks 8 , 9 , 11 , and 12 . RESULTS Total cholesterol concentrations decreased significantly between baseline and 8 wk in the red-yeast-rice-treated group compared with the placebo-treated group [ ( x+/-SD ) 6.57+/-0.93 mmol/L ( 254+/-36 mg/dL ) to 5.38+/-0.80 mmol/L ( 208+/-31 mg/dL ) ; P < 0.001 ] . LDL cholesterol and total triacylglycerol were also reduced with the supplement . HDL cholesterol did not change significantly . CONCLUSIONS Red yeast rice significantly reduces total cholesterol , LDL cholesterol , and total triacylglycerol concentrations compared with placebo and provides a new , novel , food-based approach to lowering cholesterol in the general population BACKGROUND Short-term trials showed that conjugated linoleic acid ( CLA ) may reduce body fat mass ( BFM ) and increase lean body mass ( LBM ) , but the long-term effect of CLA was not examined . OBJECTIVE The objective of the study was to ascertain the 1-y effect of CLA on body composition and safety in healthy overweight adults consuming an ad libitum diet . DESIGN Male and female volunteers ( n = 180 ) with body mass indexes ( in kg/m(2 ) ) of 25 - 30 were included in a double-blind , placebo-controlled study . Subjects were r and omly assigned to 3 groups : CLA-free fatty acid ( FFA ) , CLA-triacylglycerol , or placebo ( olive oil ) .  Change in BFM , as measured by dual-energy X-ray absorptiometry , was the primary outcome . Secondary outcomes included the effects of CLA on LBM , adverse events , and safety variables . RESULTS Mean ( + /- SD ) BFM in the CLA-triacylglycerol and CLA-FFA groups was 8.7 + /- 9.1 % and 6.9 + /- 9.1 % , respectively , lower than that in the placebo group ( P < 0.001 ) . Subjects receiving CLA-FFA had 1.8 + /- 4.3 % greater LBM than did subjects receiving placebo ( P = 0.002 ) . These changes were not associated with diet or exercise . LDL increased in the CLA-FFA group ( P = 0.008 ) , HDL decreased in the CLA-triacylglycerol group ( P = 0.003 ) , and lipoprotein(a ) increased in both CLA groups ( P < 0.001 ) compared with month 0 . Fasting blood glucose concentrations remained unchanged in all 3 groups . Glycated hemoglobin rose in all groups from month 0 concentrations , but there was no significant difference between groups . Adverse events did not differ significantly between groups . CONCLUSION Long-term supplementation with CLA-FFA or CLA-triacylglycerol reduces BFM in healthy overweight adults BACKGROUND Restricted intakes of saturated and trans-fatty acids is emphasized in heart-healthy diets , and replacement with poly- and monounsaturated fatty acids is encouraged . OBJECTIVE To compare the effects of polyunsaturated fatty acid-rich corn oil ( CO ) and monounsaturated fatty acid-rich extra-virgin olive oil ( EVOO ) on plasma lipids in men and women ( N = 54 ) with fasting low-density lipoprotein cholesterol ( LDL-C ) ≥130 mg/dL and < 200 mg/dL and triglycerides ( TG ) ≤350 mg/dL. METHODS In a double-blind , r and omized , crossover design ( 21-day treatments , 21-day washout between ) , 4 tablespoons/day CO or EVOO were provided in 3 servings study product/day ( muffin , roll , yogurt ) as part of a weight-maintenance diet ( ∼35 % fat , < 10 % saturated fat , < 300 mg cholesterol ) . Subjects ate breakfast at the clinic every weekday throughout the study . Lunches , dinners , and snacks ( and breakfasts on weekends ) were provided for consumption away from the clinic . RESULTS Baseline mean ( st and ard error ) lipids in mg/dL were : LDL-C 153.3 ( 3.5 ) , total cholesterol ( total-C ) 225.7 ( 3.9 ) , non-high-density lipoprotein (non-HDL)-C 178.3 ( 3.7 ) , HDL-C 47.4 ( 1.7 ) , total-C/HDL-C 5.0 ( 0.2 ) , and TG 124.8 ( 7.2 ) . CO result ed in significantly larger least-squares mean % changes ( all P < .001 vs EVOO ) from baseline in LDL-C -10.9 vs -3.5 , total-C -8.2 vs -1.8 , non-HDL-C -9.3 vs -1.6 , and total-C/HDL-C -4.4 vs 0.5 . TG rose a smaller amount with CO , 3.5 vs 13.0 % with EVOO ( P = .007 ) . HDL-C responses were not significantly different between conditions ( -3.4 vs -1.7 % ) . CONCLUSION Consumption of CO in a weight-maintenance , low saturated fat and cholesterol diet result ed in more favorable changes in LDL-C and other atherogenic lipids vs EVOO Drug therapy for hypercholesterolaemia has remained controversial mainly because of insufficient clinical trial evidence for improved survival . The present trial was design ed to evaluate the effect of cholesterol lowering with simvastatin on mortality and morbidity in patients with coronary heart disease ( CHD ) . 4444 patients with angina pectoris or previous myocardial infa rct ion and serum cholesterol 5.5 - 8.0 mmol/L on a lipid-lowering diet were r and omised to double-blind treatment with simvastatin or placebo . Over the 5.4 years median follow-up period , simvastatin produced mean changes in total cholesterol , low-density-lipoprotein cholesterol , and high-density-lipoprotein cholesterol of -25 % , -35 % , and + 8 % , respectively , with few adverse effects . 256 patients ( 12 % ) in the placebo group died , compared with 182 ( 8 % ) in the simvastatin group . The relative risk of death in the simvastatin group was 0.70 ( 95 % CI 0.58 - 0.85 , p = 0.0003 ) . The 6-year probabilities of survival in the placebo and simvastatin groups were 87.6 % and 91.3 % , respectively . There were 189 coronary deaths in the placebo group and 111 in the simvastatin group ( relative risk 0.58 , 95 % CI 0.46 - 0.73 ) , while noncardiovascular causes accounted for 49 and 46 deaths , respectively . 622 patients ( 28 % ) in the placebo group and 431 ( 19 % ) in the simvastatin group had one or more major coronary events . The relative risk was 0.66 ( 95 % CI 0.59 - 0.75 , p < 0.00001 ) , and the respective probabilities of escaping such events were 70.5 % and 79.6 % . This risk was also significantly reduced in subgroups consisting of women and patients of both sexes aged 60 or more . Other benefits of treatment included a 37 % reduction ( p < 0.00001 ) in the risk of undergoing myocardial revascularisation procedures . This study shows that long-term treatment with simvastatin is safe and improves survival in CHD patients BACKGROUND The inverse association between moderate drinking and coronary heart disease mortality is well established . This study was performed to investigate the kinetics of the alcohol-induced increases in apo A-1 , HDL cholesterol , and paraoxonase ( PON ) activity , as well as to study whether the alcohol-induced increases in PON activity differ within different PON polymorphisms , and to investigate whether moderate alcohol consumption has similar effects on the outcome measures in postmenopausal women as in middle-aged men . METHODS In a r and omized , diet-controlled , crossover study , 10 middle-aged men and 9 postmenopausal women , all apparently healthy , nonsmoking , and moderate alcohol drinkers , consumed beer or no-alcohol beer ( control ) with evening dinner during two successive periods of 3 weeks . During the beer period , alcohol intake equaled 40 and 30 g/day for men and women , respectively . The total diet was supplied to the subjects and had essentially the same composition during these 6 weeks . Before each treatment was a 1-week washout period , in which the subjects were not allowed to drink alcoholic beverages . RESULTS Moderate alcohol consumption significantly increased serum apo A-I level after 5 days ( 3.7 % , p < 0.05 ) ; after 10 days , serum HDL cholesterol level was increased ( 6.8 % , p < 0.001 ) , and after 15 days serum PON activity was increased ( 3.7 % , p < 0.05 ) , all compared with no alcohol consumption . Gene polymorphisms did not modulate the alcohol effect on PON . CONCLUSIONS Serum apo A-I , HDL cholesterol , and PON activity were significantly increased during 3 weeks of moderate alcohol consumption as compared with no alcohol consumption . Moreover , the results suggest that there is a sequence in induction of these parameters . After an increase in apo A-I , HDL cholesterol is increased followed by an increase in PON activity . Increased serum HDL cholesterol level and PON activity may be a mechanism of action not only in healthy middle-aged men but also in postmenopausal women , underlying the reduced coronary heart disease risk in moderate drinkers Objective : We studied whether consumption of phenol-rich extra virgin olive oil affects the susceptibility of low density lipoproteins ( LDL )  to  oxidation  and other markers of oxidation in humans . Design : R and omized cross-over intervention trial , stratified according to sex , age and energy intake . Setting : Division of Human Nutrition and Epidemiology , Wageningen University , The Netherl and s . Subjects : Forty-six healthy men and women completed the study .Intervention : Subjects consumed two diets supplying 69 g per day of extra virgin olive oil either rich or poor in phenols for 3 weeks each . The mean difference in phenol intake between the treatments was 18 mg per day .  Vitamin E intake was low during the whole study . Fasting blood sample s were taken twice at the end of each period . Results : Resistance of LDL and high density lipoprotein ( HDL ) to oxidation was not affected by treatment . The mean lag time of copper-induced formation of conjugated dienes was 1.6 min shorter in LDL and 0.4 min longer in HDL after the high phenol diet . Other markers of antioxidant capacity in plasma were also not affected : mean lipid hydroperoxides were 0.07 µmol/l higher , mean malondialdehydes were 0.001 µmol/l higher , mean protein carbonyls were 0.001 nmol/mg protein lower , and the mean ferric reducing ability of plasma ( FRAP ) was 0.006 mmol/l higher after the high phenol diet . All 95 % confidence intervals enclosed zero . Serum cholesterol concentrations were not affected by the treatment . Conclusion : Consumption of 18 mg per day of phenols from extra virgin olive oil for 3 weeks did not affect LDL or HDL oxidation or other markers of antioxidant capacity in fasting plasma sample s . Sponsorship : Supported by the International Olive Oil Council and the Foundation for Nutrition and Health Research .European Journal of Clinical Nutrition ( 2001 ) 55 , Results of well-controlled prospect i ve clinical trials showed the efficacy of lipid-lowering therapies in the reduction of cardiovascular ( CV ) events in western population s , but they were not reported with a Chinese population . This multicenter study was conducted to determine the effects of Xuezhikang ( XZK ) , a partially purified extract of red yeast rice , on lipoprotein and CV end points in Chinese patients who experienced a previous myocardial infa rct ion . Nearly 5,000 of these patients with average low-density lipoprotein cholesterol levels at baseline were r and omly assigned either to placebo or to XZK daily for an average of 4.5 years . The primary end point was a major coronary event that included nonfatal myocardial infa rct ion and death from coronary heart disease . Frequencies of the primary end point were 10.4 % in the placebo group and 5.7 % in the XZK-treated group , with absolute and relative decreases of 4.7 % and 45 % , respectively . Treatment with XZK also significantly decreased CV and total mortality by 30 % and 33 % , the need for coronary revascularization by 1/3 , and lowered total and low-density lipoprotein cholesterol and triglycerides , but raised high-density lipoprotein cholesterol levels . In conclusion , long-term therapy with XZK significantly decreased the recurrence of coronary events and the occurrence of new CV events and deaths , improved lipoprotein regulation , and was safe and well tolerated Objective : To assess fasting lipid responses to a docosahexaenoic acid ( DHA ) supplement in men and women with below-average levels of high-density lipoprotein ( HDL ) cholesterol . Methods : This r and omized , double-blind , controlled clinical trial included 57 subjects , 21–80 years of age , with fasting HDL cholesterol concentrations ≤44 mg/dL ( men ) and ≤54 mg/dL ( women ) , but ≥35 mg/dL. Subjects were r and omly assigned to receive either 1.52 g/day DHA from capsules containing DHA-rich algal triglycerides or olive oil ( control ) for six weeks . Results : There were no significant differences between groups in baseline lipid values . The DHA supplemented group showed significant changes [ −43 ( DHA ) vs. −14 ( controls ) mg/dL , p = 0.015 ] and percent changes [ −21 % ( DHA ) vs. −7 % ( controls ) , p = 0.009 ] in triglycerides , total ( 12 vs. 3 mg/dL ; p = 0.021 and 6 % vs. 2 % ; p = 0.018 ) and low-density lipoprotein ( 17 vs. 3 mg/dL ; p = 0.001 and 12 % vs. 3 % ; p = 0.001 ) cholesterol concentrations , and in the triglyceride to HDL cholesterol ratio ( −1.33 vs. −0.50 , p = 0.010 ) , compared with controls . In addition , there was a significant reduction in the percentage of LDL cholesterol carried by small , dense particles in the DHA supplemented group ( changes = −10 % vs. −3 % , p = 0.025 ) . Conclusions : Supplementation with 1.52 g/d of  DHA in men and women with below-average HDL cholesterol concentrations  raised the LDL cholesterol level , but had favorable effects on triglycerides , the triglyceride/HDL cholesterol ratio and the fraction of LDL cholesterol carried by small , dense particles . Further research is warranted to evaluate the net impact of these alterations on cardiovascular risk BACKGROUND Xuezhikang ( XZK ) is an extract of fermented red yeast rice that has lipid-lowering properties . OBJECTIVE To evaluate the effects of XZK on lipids in subjects with dyslipidemia but no coronary heart disease . METHODS A total of 116 adults with baseline non-high-density lipoprotein cholesterol ( non-HDL-C ) levels of approximately 208 mg/dL and low-density lipoprotein cholesterol ( LDL-C ) levels of approximately 175 mg/dL were r and omized to either placebo or XZK 1200 or 2400 mg daily and treated for 12 weeks . RESULTS A majority of the patients were white ( 53.4 % ) or Asian ( 37.1 % ) .  Daily XZK 1200 mg and 2400 mg for 4 to 12 weeks result ed in statistically significant ( P < .001 ) and clinical ly meaningful decreases in non-HDL-C ( ∼24 % reduction ) and LDL-C ( ∼27 % reduction ) compared with placebo . XZK treatment at either dose enabled approximately 50 % of subjects to reduce their LDL-C levels by ≥ 30 % . Doubling the XZK daily dose from 1200 to 2400 mg at treatment week 8 caused an additional 4.6 % reduction in LDL-C. Significant benefits were also observed across secondary efficacy variables , including total cholesterol ( TC ) , apolipoprotein B ( Apo B ) , triglycerides , HDL-C , the TC/HDL-C ratio , and the Apo B/Apo A-I ratio , at treatment week 8 or 12 . XZK was safe and well tolerated . Safety and tolerability profiles were similar across treatment groups . Most adverse events were gastrointestinal . No subject experienced myopathy or markedly elevated liver transaminases or creatine kinase . CONCLUSION Xuezhikang significantly reduced non-HDL-C and LDL-C , and was well tolerated . Further , longer-term studies in more diverse patient population s are needed to corroborate these findings BACKGROUND Statins are the most commonly prescribed drugs to reduce cardiometabolic risk . Besides the well-known efficacy of such compounds in both preventing and treating cardiometabolic disorders , some patients experience statin-induced side effects . We hypothesize that the use of natural bergamot-derived polyphenols may allow patients undergoing statin treatment to reduce effective doses while achieving target lipid values . The aim of the present study is to investigate the occurrence of an enhanced effect of bergamot-derived polyphenolic fraction ( BPF ) on rosuvastatin-induced hypolipidemic and vasoprotective response in patients with mixed hyperlipidemia . METHODS A prospect i ve , open-label , parallel group , placebo-controlled study on 77 patients with elevated serum LDL-C and triglycerides was design ed . Patients were r and omly assigned to a control group receiving placebo ( n=15 ) , two groups receiving orally administered rosuvastatin ( 10 and 20mg/daily for 30 days ; n=16 for each group ) , a group receiving BPF alone orally ( 1000 mg/daily for 30 days ; n=15 ) and a group receiving BPF ( 1000 mg/daily given orally ) plus rosuvastatin ( 10mg/daily for 30 days ; n=15 ) . RESULTS Both doses of rosuvastatin and BPF reduced total cholesterol , LDL-C , the LDL-C/HDL-C ratio and urinary mevalonate in hyperlipidemic patients , compared to control group . The cholesterol lowering effect was accompanied by reductions of malondialdehyde , oxyLDL receptor LOX-1 and phosphoPKB , which are all biomarkers of oxidative vascular damage , in peripheral polymorphonuclear cells . CONCLUSIONS Addition of BPF to rosuvastatin significantly enhanced rosuvastatin-induced effect on serum lipemic profile compared to rosuvastatin alone . This lipid-lowering effect was associated with significant reductions of biomarkers used for detecting oxidative vascular damage , suggesting a multi-action enhanced potential for BPF in patients on statin therapy Background : This study aim ed to investigate the possible relationships between adiponectin and leptin , blood lipids such as total cholesterol , high-density lipoprotein cholesterol ( HDL-C ) , low-density lipoprotein cholesterol ( LDL-C ) , and triglycerides ( TG ) as well as other clinical biomarkers in hyperlipidemia patients treated with red yeast rice .  Methods : 30 patients with primary hyperlipidemia were recruited , treated with red rice yeast capsules 600 mg twice a day for 8 weeks , and followed up for 4 weeks . The primary endpoint was the mean difference in LDL-C from baseline to week 8 , while the secondary endpoints were the mean percentage changes from baseline of total cholesterol , TG , HDL-C , adiponectin , and leptin . Results : At week 8 , the decrease in LDL-C and total cholesterol was -38.11 ± 30.90 mg/dl ( p < 0.0001 ) and -44.54 ± 27.46 mg/dl ( p < 0.0001 ) , respectively , and the increase in adiponectin was 35.83 ± 67.85 μg/ml ( p = 0.017 ) as compared to baseline . Adiponectin also correlated positively with HDL-C ( r2 = 0.39 ; p = 0.001 ) . Serum leptin correlated negatively with TG ( r2 = 0.19 ; p = 0.035 ) , and there was a trend of correlation between leptin and HDL-C , but this was not statistically significant ( r2 = 0.16 ; p = 0.052 ) . Conclusion : Red yeast rice can significantly increase adiponectin and can significantly lower LDL-C and total cholesterol levels . Adiponectin correlates positively with HDL-C while serum leptin correlates negatively with TG  . Red yeast rice has a potentially protective effect in obesity-related and cardiovascular diseases Efficacy and tolerability of artichoke dry extract ( drug/extract ratio 25 - 35:1 , aquous extract , CY450 ) as coated tablets containing 450 mg extract ( tradename : Valverde Artischocke bei Verdauungsbeschwerden ) was investigated in the treatment of hyperlipoproteinemia and compared with placebo .  143 adult patients with initial total cholesterol of > 7.3 mmol/l ( > 280 mg/dl ) were included in a double blind , r and omized , placebo controlled , multi-center clinical trial . Patients received 1,800 mg artichoke dry extract per day or placebo over 6 weeks . Changes of total cholesterol and LDL-cholesterol from baseline to the end of treatment showed a statistically significant superiority ( p = 0.0001 ) of artichoke dry extract over placebo . The decrease of total cholesterol in the CY450 group was 18.5 % compared to 8.6 % in the placebo group . LDL-cholesterol decrease in the CY450 group was 22.9 % and 6.3 % for placebo . LDL/HDL ratio showed a decrease of 20.2 % in the CY450 group and 7.2 % in the placebo group . There were no drug related adverse events during this study indicating an excellent tolerability of artichoke dry extract . This prospect i ve study could contribute clear evidence to recommend artichoke dry extract CY450 for treating hyperlipoproteinemia and , thus , prevention of atherosclerosis and coronary heart disease BACKGROUND In patients with high cholesterol levels , lowering the cholesterol level reduces the risk of coronary events , but the effect of lowering cholesterol levels in the majority of patients with coronary disease , who have average levels , is less clear . METHODS In a double-blind trial lasting five years we administered either 40 mg of pravastatin per day or placebo to 4159 patients ( 3583 men and 576 women ) with myocardial infa rct ion who had plasma total cholesterol levels below 240 mg per deciliter ( mean , 209 ) and low-density lipoprotein ( LDL ) cholesterol levels of 115 to 174 mg per deciliter ( mean , 139 ) . The primary end point was a fatal coronary event or a nonfatal myocardial infa rct ion . RESULTS The frequency of the primary end point was 10.2 percent in the pravastatin group and 13.2 percent in the placebo group , an absolute difference of 3 percentage points and a 24 percent reduction in risk ( 95 percent confidence interval , 9 to 36 percent ; P = 0.003 ) . Coronary bypass surgery was needed in 7.5 percent of the patients in the pravastatin group and 10 percent of those in the placebo group , a 26 percent reduction ( P=0.005 ) , and coronary angioplasty was needed in 8.3 percent of the pravastatin group and 10.5 percent of the placebo group , a 23 percent reduction ( P=0.01 ) . The frequency of stroke was reduced by 31 percent ( P=0.03 ) . There were no significant differences in overall mortality or mortality from noncardiovascular causes . Pravastatin lowered the rate of coronary events more among women than among men . The reduction in coronary events was also greater in patients with higher pretreatment levels of LDL cholesterol . CONCLUSIONS These results demonstrate that the benefit of cholesterol-lowering therapy extends to the majority of patients with coronary disease who have average cholesterol levels Currently , no consensus has been reached regarding the management of hyperlipidemia in patients who develop statin-associated myalgia ( SAM ) . Many statin-intolerant patients use alternative lipid-lowering therapies , including red yeast rice . The present trial evaluated the tolerability of red yeast rice versus pravastatin in patients unable to tolerate other statins because of myalgia . The study was conducted in a community-based setting in Philadelphia , Pennsylvania . A total of 43 adults with dyslipidemia and a history of statin discontinuation because of myalgia were r and omly assigned to red yeast rice 2,400 mg twice daily or pravastatin 20 mg twice daily for 12 weeks . All subjects were concomitantly enrolled in a 12-week therapeutic lifestyle change program . The primary outcomes included the incidence of treatment discontinuation because of myalgia and a daily pain severity score . The secondary outcomes were muscle strength and plasma lipids . The incidence of withdrawal from medication owing to myalgia was 5 % ( 1 of 21 ) in the red yeast rice group and 9 % ( 2 of 22 ) in the pravastatin group ( p = 0.99 ) . The mean pain severity did not differ significantly between the 2 groups . No difference was found in muscle strength between the 2 groups at week 4 ( p = 0.61 ) , week 8 ( p = 0.81 ) , or week 12 ( p = 0.82 ) . The low-density lipoprotein cholesterol level decreased 30 % in the red yeast rice group and 27 % in the pravastatin group . In conclusion , red yeast rice was tolerated as well as pravastatin and achieved a comparable reduction of low-density lipoprotein cholesterol in a population previously intolerant to statins This cost-consequences analysis of the Air Force/Texas Coronary Atherosclerosis Prevention Study compares the costs of lovastatin treatment with the costs of cardiovascular hospitalizations and procedures . The cost of lovastatin treatment was defined as the average retail price and the cost of drug safety monitoring and adverse experiences . Costs were determined by actual rates of hospitalizations and procedures . Within a trial , lovastatin treatment cost approximately $ 4,654/patient . Lovastatin treatment significantly reduced the cumulative rate of cardiovascular hospitalizations and procedures ( p = 0.002 ) . Over the duration of the study , the cumulative number of cardiovascular hospitalizations and related therapeutic procedures was significantly reduced by 29 % . The time to first cardiovascular-related hospitalization or procedure was significantly extended by lovastatin ( p = 0.002 ) . Lovastatin reduced the frequency of cardiovascular hospitalization ( 28 % ) , and cardiovascular therapeutic ( 32 % ) and diagnostic procedures ( 23 % ) . Among therapeutic procedures , treatment reduced coronary artery bypass graft surgery by 19 % and percutaneous transluminal coronary angioplasty by 37 % . Total cardiovascular-related hospital days were reduced by 26 % ( p = 0.025 ) . The between-group offset in direct medical costs was $ 524 , which result ed in a 11 % cost offset of lovastatin therapy over the mean study duration of 5.2 years . Lovastatin provides meaningful reductions in cardiovascular-related re source utilization and reductions in direct cardiovascular-related costs associated with the onset of coronary disease Moderate alcohol consumption is associated with a reduced risk of  coronary heart disease .  Part of this inverse association may be explained by its effects on HDL . Paraoxonase , an HDL-associated enzyme , has been suggested to protect against LDL oxidation . We examined the effects of moderate consumption of red wine , beer and spirits in comparison with mineral water on paraoxonase activity in serum . In this diet-controlled , r and omised , cross-over study 11 healthy middle-aged men consumed each of the beverages with evening dinner for 3 weeks . At the end of each 3 week period , blood sample s were collected pre- and postpr and ially and after an overnight fast . Fasting paraoxonase activity was higher after intake of wine ( P<0 . 001 ) , beer ( P<0.001 ) , and spirits ( P<0.001 ) than after water consumption ( 149.4+/-111.1 , 152.6+/-113.1 , 152.8+/-116.5 and 143 . 1+/-107.9 U/l serum ) , but did not differ significantly between the 3 alcoholic beverages . Similar effects were observed pre- and postpr and ially . The increases in paraoxonase activity were strongly correlated with coincident increases in concentrations of HDL-C and apo A-I ( r=0.60 , P<0.05 and r=0.70 , P<0.05 ) . These data suggest that increased serum paraoxonase may be one of the biological mechanisms underlying the reduced coronary heart disease risk in moderate alcohol Summary . Background : Evidence from in vitro studies suggests that antioxidant olive oil phenolic compounds can prevent LDL oxidation . However , in vivo evidence in support of this hypothesis is sparse . Aim of the study : to establish the antioxidant effect of olive oils with differences in their phenolic compounds content in humans Methods : A controlled , double blind , cross-over , r and omized , clinical trial using three similar olive oils with increasing phenolic concentration ( from 0 to 150 mg/Kg ) was conducted in 30 healthy volunteers .  Olive oils were administered over three periods of 3 weeks preceded by two-week washout periods . Results : Urinary tyrosol and hydroxytyrosol increased ( p < 0.020 ) , in vivo plasma oxidized LDL decreased ( p = 0.006 ) , and ex vivo resistance of LDL to oxidation increased ( p = 0.012 ) with the phenolic content of the olive oil administered . After virgin olive oil administration , an increase ( p = 0.029 ) was observed in HDL cholesterol levels . Conclusions : Sustained consumption of virgin olive oil with the high phenolic content was more effective in protecting LDL from oxidation and in rising HDL cholesterol levels than that of other type of olive oils . Dose-dependent changes in oxidative stress markers , and phenolic compounds in urine , were observed with the phenolic content of the olive oil administered . Our results support the hypothesis that virgin olive oil consumption could provide benefits in the prevention of oxidative processes The aim of this study was to evaluate the effects of artichoke leaf extract ( ALE ) supplementation ( 250 mg , 2 b.i.d . ) on the lipid pattern . A r and omized , double-blind , placebo-controlled clinical trial was performed on 92 overweight subjects with primary mild hypercholesterolaemia for 8 weeks . Forty-six subjects were r and omized to supplementation ( age : 54.2 ± 6.6 years , body mass index ( BMI ): 25.8 ± 3.9 kg/m2 , male/female : 20/26 ) and 46 subjects to placebo ( age : 53.8 ± 9.0 years , BMI : 24.8 ± 1.6 kg/m2 , male/female : 21/25 ) . Verum supplementation was associated with a significant increase in mean high-density lipoprotein (HDL)-cholesterol ( p < 0.001 ) and in mean change in HDL-cholesterol ( HDL-C ) ( p = 0.004 ) . A significantly decreased difference was also found for the mean change in total cholesterol ( p = 0.033 ) , low-density lipoprotein (LDL)-cholesterol ( p < 0.001 ) , total cholesterol/HDL ratio ( p < 0.001 ) and LDL/HDL ratio ( p < 0.001 ) , when verum and placebo treatment were compared . These results indicate that ALE could play a relevant role in the management of mild hypercholesterolaemia , favouring in particular the increase in HDL-C , besides decreasing total cholesterol and LDL-cholesterol Objective — Olive oil polyphenols have shown beneficial properties against cardiovascular risk factors . Their consumption has been associated with higher cholesterol content in high-density lipoproteins ( HDL ) . However , data on polyphenol effects on HDL quality are scarce . We , therefore , assessed whether polyphenol-rich olive oil consumption could enhance the HDL main function , its cholesterol efflux capacity , and some of its quality -related properties , such HDL polyphenol content , size , and composition . Approach and Results — A r and omized , crossover , controlled trial with 47 healthy European male volunteers was performed . Participants ingested 25 mL/d of polyphenol-poor ( 2.7 mg/kg ) or polyphenol-rich ( 366 mg/kg ) raw olive oil in 3-week intervention periods , preceded by 2-week washout periods . HDL cholesterol efflux capacity significantly improved after polyphenol-rich intervention versus the polyphenol-poor one ( + 3.05 % and −2.34 % , respectively ; P=0.042 ) . Incorporation of olive oil polyphenol biological metabolites to HDL , as well as large HDL ( HDL2 ) levels , was higher after the polyphenol-rich olive oil intervention , compared with the polyphenol-poor one . Small HDL ( HDL3 ) levels decreased , the HDL core became triglyceride-poor , and HDL fluidity increased after the polyphenol-rich intervention . Conclusions — Olive oil polyphenols promote the main HDL antiatherogenic function , its cholesterol efflux capacity . These polyphenols increased HDL size , promoted a greater HDL stability reflected as a triglyceride-poor core , and enhanced the HDL oxidative status , through an increase in the olive oil polyphenol metabolites content in the lipoprotein . Our results provide for the first time a first-level evidence of an enhancement in HDL function by polyphenol-rich olive oil
target: The results of this systematic review indicate that the dietary supplementation with red yeast rice , bergamot , artichoke , and virgin olive oil has promising effects on the increase of HDL-C serum levels .
  The artichoke leaf extract and virgin olive oil appear to be particularly interesting , while bergamot extract needs further research and the effect of red yeast rice seems to be limited to patients with previous myocardial infa rct ion .
  Various MediterrAsian diet products or natural extracts may represent a potential intervention treatment to raise HDL-C in dyslipidemic subjects
background: Background .
  High HDL-cholesterol ( HDL-C ) values are negatively correlated with cardiovascular diseases .
  This review analyses the effect of the supplementation with various Mediterranean diet products ( artichoke , bergamot , and olive oil ) and Asian diet products ( red yeast rice ) on the  HDL-C value in dyslipidemic subjects .