Effects of Armolipid Plus® on small dense LDL particles

Gentile et al. assessed the effect of Armolipid Plus® (Rottapharm SpA, Monza, Italy) on low density lipoprotein (LDL) particle size.[1] Patients (n = 30) with familial combined hyperlipidaemia (FCHL) were randomly assigned either to placebo or Armolipid Plus® (nutraceutical combination of red yeast rice extract, berberine, policosanols, folic acid, coenzyme Q10 and astaxanthin) for eight weeks. A decrease in body mass index and LDL score (proportion of small dense LDL (sdLDL) to the whole LDL) and an increase of LDL particle size was recorded in the treatment group.[1] sdLDL is an emerging cardiovascular (CV) risk factor,[2] included in the “atherogenic lipoprotein phenotype”, along with decreased high density lipoprotein (HDL) and elevated triglycerides (TG).[2,3] Beneficial effects of different nutraceuticals on these atherogenic particles have been reported,[4,5] including improvement in other CV risk markers such as carotid intima-media-thickness and oxidative stress.[4,6]

It is important to consider that the patients included in the study had FCHL, a genetic disorder and a nutraceutical approach may have different outcomes, possibly dependent on interindividual genetic variability,[7] but also could allow starting primary prevention sooner, to postpone initiating statin treatment or to be used during pregnancy after their safety is ensured.[8] FCHL patients often have high TG levels and in such condition, aggressive lifestyle modification (including nutritional supplementation) is recommended in addition to pharmacological intervention.[9]

Benefits of lifestyle interventions on LDL subclass distribution are documented.[2] Armolipid Plus® was given in addition to standard diet [1] and the results obtained might be a consequence of nutraceutical combination only, or a synergistic effect of both nutraceutical combination + hypolipidemic diet or even diet alone could have some effects. A significant difference in anthropometric parameters and diastolic blood pressure were reported only in Armolipid Plus group, attributing such effects to berberine.[1] However, there were no details about physical activity. Atherogenic lipoproteins can be decreased by physical activity and diet, while composition and antioxidant function of small dense HDL3c improved in subjects with the metabolic syndrome.[10] An intensive lifestyle intervention including nutraceuticals might prevent and/or reduce overall cardiometabolic risk that could be of particular importance in cases of FCHL. However, caution is recommended because of possible interactions with other medications. Some nutraceuticals, including Armolipid Plus, may have lipid-lowering effects similar to statins, but some supplements seem to have advantages compared with statins [11]; in any case, statin-related side effects are usually avoided. Future use of these natural supplements, alone or as a part of multifactorial treatment approach,[12] remains to be assessed.

Disclosure statement

The authors declare no conflicts of interest.

Antonio Magán-Fernández
Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
Periodontology Department, School of Dentistry, University of Granada, Granada, Spain
Giuseppa Castellino and Dragana Nikolic
Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
Euro-Mediterranean Institute of Science and Technology, Palermo, Italy
Manfredi Rizzo
Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
[email protected]