{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:48:09Z","timestamp":1787755689342,"version":"build-2784847793"},"reference-count":113,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T00:00:00Z","timestamp":1631059200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health","award":["Ricerca Corrente"],"award-info":[{"award-number":["Ricerca Corrente"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>There is an increasing number of nutraceutical combinations (NCs) on the market for hypercholesterolemia, although clinical trials to verify their safety and efficacy are scarce. We selected fourteen randomized, placebo-controlled clinical trials (RCTs) on different lipid-lowering NCs in hypercholesterolemic subjects. We described each compound\u2032s mechanism of action and efficacy in the mixtures and summarized the clinical trials settings and NCs safety and efficacy results. Almost all NCs resulted efficient against hypercholesterolemia; only one reported no changes. Interestingly, red yeast rice (RYR) was present in eleven mixtures. It is not clear whether the lipid-lowering efficacy of these combinations derives mainly from the RYR component monacolin K \u201cnatural statin\u201d single effect. Up to now, few RCTs have verified the efficacy of every single compound vs. NCs to evaluate possible additive or synergistic effects, probably due to the complexity and the high resources request. In conclusion, to manage the arising nutraceutical tide against hypercholesterolemia, it could be helpful to increase the number and robustness of clinical studies to verify the efficacy and safety of the new NCs.<\/jats:p>","DOI":"10.3390\/nu13093128","type":"journal-article","created":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T10:12:03Z","timestamp":1631095923000},"page":"3128","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Nutraceutical Combinations in Hypercholesterolemia: Evidence from Randomized, Placebo-Controlled Clinical Trials"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1936-6139","authenticated-orcid":false,"given":"Olga","family":"Protic","sequence":"first","affiliation":[{"name":"Cardiology Unit, IRCCS INRCA, 60129 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9619-0181","authenticated-orcid":false,"given":"Anna Rita","family":"Bonfigli","sequence":"additional","affiliation":[{"name":"Scientific Direction, IRCCS INRCA, 60129 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Antonicelli","sequence":"additional","affiliation":[{"name":"Cardiology Unit, IRCCS INRCA, 60129 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,8]]},"reference":[{"key":"ref_1","first-page":"e29","article-title":"Heart disease and stroke statistics--2015 update: A report from the American Heart Association","volume":"131","author":"Mozaffarian","year":"2015","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1161\/ATVBAHA.115.306964","article-title":"Mitochondrial Reactive Oxygen Species Mediate Lysophosphatidylcholine-Induced Endothelial Cell Activation","volume":"36","author":"Li","year":"2016","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1161\/CIRCRESAHA.118.313816","article-title":"Atherosclerosis","volume":"123","author":"Kobiyama","year":"2018","journal-title":"Circ. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2999","DOI":"10.1093\/eurheartj\/ehw272","article-title":"2016 ESC\/EAS Guidelines for the Management of Dyslipidaemias","volume":"37","author":"Catapano","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_5","first-page":"927","article-title":"Atherosclerosis: Process, indicators, risk factors and new hopes","volume":"5","author":"Setorki","year":"2014","journal-title":"Int. J. Prev. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"965","DOI":"10.5114\/aoms.2017.69326","article-title":"Lipid lowering nutraceuticals in clinical practice: Position paper from an International Lipid Expert Panel","volume":"75","author":"Cicero","year":"2017","journal-title":"Arch. Med. Sci."},{"key":"ref_7","unstructured":"Task Force Members, ESC Committee for Practice Guidelines (CPG), and ESC National Cardiac Societies (2019). 2019 ESC\/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. Atherosclerosis, 290, 140\u2013205."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1111\/bph.13636","article-title":"Nutraceuticals in hypercholesterolaemia: An overview","volume":"174","author":"Santini","year":"2017","journal-title":"Br. J. Pharmacol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.numecd.2016.11.122","article-title":"Joint position statement on \u201cNutraceuticals for the treatment of hypercholesterolemia\u201d of the Italian Society of Diabetology (SID) and of the Italian Society for the Study of Arteriosclerosis (SISA)","volume":"27","author":"Pirro","year":"2017","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s12937-019-0438-2","article-title":"Nutraceutical approach for the management of cardiovascular risk\u2014A combination containing the probiotic Bifidobacterium longum BB536 and red yeast rice extract: Results from a randomized, double-blind, placebo-controlled study","volume":"18","author":"Ruscica","year":"2019","journal-title":"Nutr. J."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Domenech, M., Casas, R., Ruiz-Le\u00f3n, A.M., Sobrino, J., Ros, E., and Estruch, R. (2019). Effects of a Novel Nutraceutical Combination (Aquilea Colesterol\u00ae) on the Lipid Profile and Inflammatory Biomarkers: A Randomized Control Trial. Nutrients, 11.","DOI":"10.3390\/nu11050949"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/s40292-016-0163-2","article-title":"Effects of a Combined Nutraceutical on Lipid Pattern, Glucose Metabolism and Inflammatory Parameters in Moderately Hypercholesterolemic Subjects: A Double-blind, Cross-over, Randomized Clinical Trial","volume":"24","author":"Cicero","year":"2017","journal-title":"High Blood Press. Cardiovasc. Prev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1966","DOI":"10.1007\/s12325-017-0580-1","article-title":"Short-Term Effects of a Combined Nutraceutical on Lipid Level, Fatty Liver Biomarkers, Hemodynamic Parameters, and Estimated Cardiovascular Disease Risk: A Double-Blind, Placebo-Controlled Randomized Clinical Trial","volume":"34","author":"Cicero","year":"2017","journal-title":"Adv. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1159\/000445359","article-title":"Middle-Term Dietary Supplementation with Red Yeast Rice Plus Coenzyme Q10 Improves Lipid Pattern, Endothelial Reactivity and Arterial Stiffness in Moderately Hypercholesterolemic Subjects","volume":"68","author":"Cicero","year":"2016","journal-title":"Ann. Nutr. Metab."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1016\/j.numecd.2009.05.017","article-title":"Effects of a nutraceutical combination (berberine, red yeast rice and policosanols) on lipid levels and endothelial function randomized, double-blind, placebo-controlled study","volume":"20","author":"Affuso","year":"2010","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.metabol.2017.12.009","article-title":"Curcumin potentiates cholesterol-lowering effects of phytosterols in hypercholesterolaemic individuals. A randomised controlled trial","volume":"82","author":"Ferguson","year":"2018","journal-title":"Metabolism"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Sol\u00e0, R., Valls, R.M., Puzo, J., Calabuig, J.R., Brea, A., Pedret, A., Mori\u00f1a, D., Villar, J., Mill\u00e1n, J., and Anguera, A. (2014). Effects of poly-bioactive compounds on lipid profile and body weight in a moderately hypercholesterolemic population with low cardiovascular disease risk: A multicenter randomized trial. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0101978"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1007\/s00394-012-0357-x","article-title":"LDL-cholesterol-lowering effect of a dietary supplement with plant extracts in subjects with moderate hypercholesterolemia","volume":"52","author":"Ogier","year":"2013","journal-title":"Eur. J. Nutr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/s00394-009-0045-7","article-title":"Purified black tea theaflavins and theaflavins\/catechin supplements did not affect serum lipids in healthy individuals with mildly to moderately elevated cholesterol concentrations","volume":"49","author":"Trautwein","year":"2010","journal-title":"Eur. J. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.2147\/DDDT.S128623","article-title":"Effect of a food supplement containing berberine, monacolin K, hydroxytyrosol and coenzyme Q10 on lipid levels: A randomized, double-blind, placebo controlled study","volume":"11","author":"Scandiani","year":"2017","journal-title":"Drug Des. Dev. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Cicero, A.F.G., D\u2032Addato, S., and Borghi, C. (2020). A Randomized, Double-Blinded, Placebo-Controlled, Clinical Study of the Effects of a Nutraceutical Combination (LEVELIP DUO\u00ae) on LDL Cholesterol Levels and Lipid Pattern in Subjects with Sub-Optimal Blood Cholesterol Levels (NATCOL Study). Nutrients, 12.","DOI":"10.3390\/nu12103127"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"102282","DOI":"10.1016\/j.ctim.2019.102282","article-title":"Efficacy and tolerability of a nutraceutical combination of red yeast rice, guggulipid, and chromium picolinate evaluated in a randomized, placebo-controlled, double-blind study","volume":"48","author":"Iskandar","year":"2020","journal-title":"Complement. Ther. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1016\/j.amjcard.2018.11.018","article-title":"Short-Term Effects of Dry Extracts of Artichokeand Berberis in Hypercholesterolemic Patients Without Cardiovascular Disease","volume":"123","author":"Cicero","year":"2019","journal-title":"Am. J. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"192","DOI":"10.14797\/mdcj-15-3-192","article-title":"Red Yeast Rice for Hypercholesterolemia","volume":"15","author":"Cicero","year":"2019","journal-title":"Methodist DeBakey Cardiovasc. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"5220","DOI":"10.1021\/jf000338c","article-title":"Constituents of red yeast rice, a traditional Chinese food and medicine","volume":"48","author":"Ma","year":"2000","journal-title":"J. Agric. Food Chem."},{"key":"ref_26","first-page":"e05368","article-title":"Scientific opinion on the safety of monacolins in red yeast rice","volume":"16","author":"Younes","year":"2018","journal-title":"EFSA J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.atherosclerosis.2015.04.004","article-title":"Traditional Chinese lipid-lowering agent red yeast rice results in significant LDL reduction but safety is uncertain\u2014A systematic review and meta-analysis","volume":"240","author":"Gerards","year":"2015","journal-title":"Atherosclerosis"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1093\/eurheartj\/ehn515","article-title":"Homocysteine and coronary atherosclerosis: From folate fortification to the recent clinical trials","volume":"30","author":"Antoniades","year":"2009","journal-title":"Eur. Heart J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.atherosclerosis.2005.12.018","article-title":"Mild folate deficiency induces a proatherosclerotic phenotype in endothelial cells","volume":"189","author":"Brown","year":"2006","journal-title":"Atherosclerosis"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s13148-015-0046-8","article-title":"Vitamin B12 insufficiency induces cholesterol biosynthesis by limiting s-adenosylmethionine and modulating the methylation of SREBF1 and LDLR genes","volume":"7","author":"Adaikalakoteswari","year":"2015","journal-title":"Clin. Epigenet."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"20B","DOI":"10.1016\/j.amjcard.2008.02.029","article-title":"Mechanism of action of niacin","volume":"101","author":"Kamanna","year":"2008","journal-title":"Am. J. Cardiol."},{"key":"ref_32","first-page":"213","article-title":"Genomics and Enzymology of NAD Biosynthesis","volume":"7","author":"Sorci","year":"2010","journal-title":"Compr. Nat. Prod. II Chem. Biol."},{"key":"ref_33","first-page":"1259","article-title":"Effect of Nicotinic Acid (Vitamin B3 or Niacin) on the lipid profile of diabetic and non\u2013diabetic rats","volume":"29","author":"Ali","year":"2013","journal-title":"Pak. J. Med. Sci."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.jnutbio.2019.04.011","article-title":"Riboflavin deficiency affects lipid metabolism partly by reducing apolipoprotein B100 synthesis in rats","volume":"70","author":"Bian","year":"2019","journal-title":"J. Nutr. Biochem."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1024\/0300-9831\/a000015","article-title":"Effects of vitamin E on plasma lipid status and oxidative stress in Chinese women with metabolic syndrome","volume":"80","author":"Wang","year":"2010","journal-title":"Int. J. Vitam. Nutr. Res."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Ziegler, M., Wallert, M., Lorkowski, S., and Peter, K. (2020). Cardiovascular and Metabolic Protection by Vitamin E: A Matter of Treatment Strategy?. Antioxidants, 9.","DOI":"10.3390\/antiox9100935"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"102526","DOI":"10.1016\/j.ctim.2020.102526","article-title":"Folic acid and vitamin B12 supplementation in subjects with type 2 diabetes mellitus: A multi-arm randomized controlled clinical trial","volume":"53","author":"Satapathy","year":"2020","journal-title":"Complement. Ther. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1007\/s00467-015-3208-1","article-title":"Efficacy and safety of nicotinamide in the management of hyperphosphatemia in pediatric patients on regular hemodialysis","volume":"31","author":"Sabri","year":"2016","journal-title":"Pediatr. Nephrol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"30","DOI":"10.4103\/1117-1936.177167","article-title":"Comparative study of the effect of tocotrienols and -tocopherol on fasting serum lipid profiles in patients with mild hypercholesterolaemia: A preliminary report","volume":"14","author":"Ajuluchukwu","year":"2007","journal-title":"Niger. Postgrad. Med. J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.1007\/s12272-001-1291-5","article-title":"Arterial compliance and vitamin E blood levels with a self emulsifying preparation of tocotrienol rich vitamin E","volume":"31","author":"Rasool","year":"2008","journal-title":"Arch. Pharm. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1007\/s11883-017-0678-6","article-title":"Oxidative Stress in Atherosclerosis","volume":"19","author":"Kattoor","year":"2017","journal-title":"Curr. Atheroscler. Rep."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"619","DOI":"10.2741\/4231","article-title":"Clinical applications of coenzyme Q10","volume":"19","author":"Cordero","year":"2014","journal-title":"Front. Biosci. (Landmark Ed.)"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.pharmthera.2009.07.003","article-title":"Role of coenzyme Q10 (CoQ10) in cardiac disease, hypertension and Meniere-like syndrome","volume":"124","author":"Kumar","year":"2009","journal-title":"Pharmacol. Ther."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Sabbatinelli, J., Orlando, P., Galeazzi, R., Silvestri, S., Cirilli, I., Marcheggiani, F., Dludla, P.V., Giuliani, A., Bonfigli, A.R., and Mazzanti, L. (2020). Ubiquinol Ameliorates Endothelial Dysfunction in Subjects with Mild-to-Moderate Dyslipidemia: A Randomized Clinical Trial. Nutrients, 12.","DOI":"10.3390\/nu12041098"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1186\/s12944-018-0876-4","article-title":"The effects of coenzyme Q10 supplementation on lipid profiles among patients with coronary artery disease: A systematic review and meta-analysis of randomized controlled trials","volume":"17","author":"Jorat","year":"2018","journal-title":"Lipids Health Dis."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1194\/jlr.M600020-JLR200","article-title":"Inhibition of lipid synthesis through activation of AMP kinase: An additional mechanism for the hypolipidemic effects of berberine","volume":"47","author":"Brusq","year":"2006","journal-title":"J. Lipid Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1016\/j.bbrc.2007.08.060","article-title":"Berberine-induced LDLR up-regulation involves JNK pathway","volume":"362","author":"Lee","year":"2007","journal-title":"Biochem. Biophys. Res. Commun."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.atherosclerosis.2008.02.004","article-title":"Berberine decreases PCSK9 expression in HepG2 cells","volume":"201","author":"Cameron","year":"2008","journal-title":"Atherosclerosis"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1055\/s-0032-1328321","article-title":"The effects of berberine on blood lipids: A systemic review and meta-analysis of randomized controlled trials","volume":"79","author":"Dong","year":"2013","journal-title":"Planta Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1124\/jpet.106.107144","article-title":"Policosanol inhibits cholesterol synthesis in hepatoma cells by activation of AMP-kinase","volume":"318","author":"Singh","year":"2006","journal-title":"J. Pharmacol. Exp. Ther."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/S0188-4409(00)00265-4","article-title":"Policosanol modulates HMG-CoA reductase activity in cultured fibroblasts","volume":"32","author":"Amor","year":"2001","journal-title":"Arch. Med. Res."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2262","DOI":"10.1001\/jama.295.19.2262","article-title":"Effect of policosanol on lipid levels among patients with hypercholesterolemia or combined hyperlipidemia: A randomized controlled trial","volume":"295","author":"Berthold","year":"2006","journal-title":"JAMA"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1007\/s11745-011-3591-8","article-title":"Modified-policosanol does not reduce plasma lipoproteins in hyperlipidemic patients when used alone or in combination with statin therapy","volume":"46","author":"Backes","year":"2011","journal-title":"Lipids"},{"key":"ref_54","first-page":"331","article-title":"Effects of policosanol in the functional recovery of non-cardioembolic ischemic stroke hypertensive patients","volume":"67","year":"2018","journal-title":"Rev. Neurol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"312","DOI":"10.11613\/BM.2011.042","article-title":"Serum calcium, magnesium, phosphorous and lipid profile in healthy Iranian premenopausal women","volume":"21","author":"Farhangi","year":"2011","journal-title":"Biochem. Med. (Zagreb)"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.1002\/mnfr.201100722","article-title":"Effects of plant sterols and stanols on intestinal cholesterol metabolism: Suggested mechanisms from past to present","volume":"56","author":"Mensink","year":"2012","journal-title":"Mol. Nutr. Food Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1885","DOI":"10.1194\/jlr.R017855","article-title":"Mechanisms and genetic determinants regulating sterol absorption, circulating LDL levels, and sterol elimination: Implications for classification and disease risk","volume":"52","author":"Calandra","year":"2011","journal-title":"J. Lipid Res."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/j.jada.2010.02.011","article-title":"The comparative efficacy of plant sterols and stanols on serum lipids: A systematic review and meta-analysis","volume":"110","author":"Talati","year":"2010","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1017\/S0007114514000750","article-title":"LDL-cholesterol-lowering effect of plant sterols and stanols across different dose ranges: A meta-analysis of randomised controlled studies","volume":"112","author":"Ras","year":"2014","journal-title":"Br. J. Nutr."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Karkovi\u0107 Markovi\u0107, A., Tori\u0107, J., Barbari\u0107, M., and Jakobu\u0161i\u0107 Brala, C. (2019). Hydroxytyrosol, Tyrosol and Derivatives and Their Potential Effects on Human Health. Molecules, 24.","DOI":"10.3390\/molecules24102001"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"7609","DOI":"10.1021\/jf0706934","article-title":"New insights into controversies on the antioxidant potential of the olive oil antioxidant hydroxytyrosol","volume":"55","author":"Rietjens","year":"2007","journal-title":"J. Agric. Food Chem."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1002\/med.1028","article-title":"Antioxidant and other biological activities of phenols from olives and olive oil","volume":"22","author":"Visioli","year":"2002","journal-title":"Med. Res. Rev."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1007\/s00394-016-1188-y","article-title":"Impact of phenolic-rich olive leaf extract on blood pressure, plasma lipids and inflammatory markers: A randomised controlled trial","volume":"56","author":"Lockyer","year":"2017","journal-title":"Eur. J. Nutr."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.phrs.2018.10.007","article-title":"The effect of artichoke on lipid profile: A review of possible mechanisms of action","volume":"137","author":"Santos","year":"2018","journal-title":"Pharmacol. Res."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"24021","DOI":"10.1074\/jbc.M115.645200","article-title":"Identification of the Flavonoid Luteolin as a Repressor of the Transcription Factor Hepatocyte Nuclear Factor 4\u03b1","volume":"290","author":"Li","year":"2015","journal-title":"J. Biol. Chem."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"634","DOI":"10.2174\/156800908786241050","article-title":"Luteolin, a flavonoid with potential for cancer prevention and therapy","volume":"8","author":"Lin","year":"2008","journal-title":"Curr. Cancer Drug Targets"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Wong, T.Y., Lin, S.M., and Leung, L.K. (2015). The Flavone Luteolin Suppresses SREBP-2 Expression and Post-Translational Activation in Hepatic Cells. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0135637"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"2215","DOI":"10.1007\/s00394-017-1379-1","article-title":"The potential effects of chlorogenic acid, the main phenolic components in coffee, on health: A comprehensive review of the literature","volume":"56","author":"Tajik","year":"2017","journal-title":"Eur. J. Nutr."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"2549","DOI":"10.1080\/10408398.2017.1332572","article-title":"Lipid-lowering activity of artichoke extracts: A systematic review and meta-analysis","volume":"58","author":"Sahebkar","year":"2018","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1093\/jn\/132.6.1129","article-title":"S-alk(en)yl cysteines of garlic inhibit cholesterol synthesis by deactivating HMG-CoA reductase in cultured rat hepatocytes","volume":"132","author":"Liu","year":"2002","journal-title":"J. Nutr."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.lfs.2009.05.020","article-title":"Inhibitory effect of novel diallyldisulfide analogs on HMG-CoA reductase expression in hypercholesterolemic rats: CREB as a potential upstream target","volume":"85","author":"Rai","year":"2009","journal-title":"Life Sci."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"334","DOI":"10.5551\/jat.E550","article-title":"Lipid-lowering effects of time-released garlic powder tablets in double-blinded placebo-controlled randomized study","volume":"15","author":"Sobenin","year":"2008","journal-title":"J. Atheroscler. Thromb."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1111\/nure.12012","article-title":"Effect of garlic on serum lipids: An updated meta-analysis","volume":"71","author":"Ried","year":"2013","journal-title":"Nutr. Rev."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1007\/s11130-011-0258-9","article-title":"Positive effects of astaxanthin on lipid profiles and oxidative stress in overweight subjects","volume":"66","author":"Choi","year":"2011","journal-title":"Plant Foods Hum. Nutr."},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Kishimoto, Y., Yoshida, H., and Kondo, K. (2016). Potential Anti-Atherosclerotic Properties of Astaxanthin. Mar. Drugs, 14.","DOI":"10.3390\/md14020035"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"253","DOI":"10.5114\/aoms.2015.50960","article-title":"Lipid profile and glucose changes after supplementation with astaxanthin: A systematic review and meta-analysis of randomized controlled trials","volume":"11","author":"Ursoniu","year":"2015","journal-title":"Arch. Med. Sci."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1093\/ecam\/nem013","article-title":"Antidiabetes and Anti-obesity Activity of Lagerstroemia speciosa","volume":"4","author":"Klein","year":"2007","journal-title":"Evid.-Based Complement. Altern. Med."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1002\/ptr.3664","article-title":"A review of the efficacy and safety of banaba (Lagerstroemia speciosa L.) and corosolic acid","volume":"26","author":"Stohs","year":"2012","journal-title":"Phytother. Res."},{"key":"ref_79","first-page":"125","article-title":"Antioxidant effect of Lagerstroemia speciosa Pers (banaba) leaf extract in streptozotocin-induced diabetic mice","volume":"49","author":"Saumya","year":"2011","journal-title":"Indian J. Exp. Biol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.diabres.2006.01.010","article-title":"Effect of corosolic acid on postchallenge plasma glucose levels","volume":"73","author":"Fukushima","year":"2006","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.1002\/mnfr.201100440","article-title":"Long-term curcumin administration protects against atherosclerosis via hepatic regulation of lipoprotein cholesterol metabolism","volume":"55","author":"Shin","year":"2011","journal-title":"Mol. Nutr. Food Res."},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Shao, W., Yu, Z., Chiang, Y., Yang, Y., Chai, T., Foltz, W., Lu, H., Fantus, I.G., and Jin, T. (2012). Curcumin prevents high fat diet induced insulin resistance and obesity via attenuating lipogenesis in liver and inflammatory pathway in adipocytes. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0028784"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"191","DOI":"10.4162\/nrp.2010.4.3.191","article-title":"Hypocholesterolemic effects of curcumin via up-regulation of cholesterol 7a-hydroxylase in rats fed a high fat diet","volume":"4","author":"Kim","year":"2010","journal-title":"Nutr. Res. Pract."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"919","DOI":"10.3945\/jn.108.100966","article-title":"Curcumin inhibits adipogenesis in 3T3-L1 adipocytes and angiogenesis and obesity in C57\/BL mice","volume":"139","author":"Ejaz","year":"2009","journal-title":"J. Nutr."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1002\/jsfa.4597","article-title":"Fat digestion and absorption in spice-pretreated rats","volume":"92","author":"Prakash","year":"2012","journal-title":"J. Sci. Food Agric."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.clnu.2013.09.012","article-title":"A systematic review and meta-analysis of randomized controlled trials investigating the effects of curcumin on blood lipid levels","volume":"33","author":"Sahebkar","year":"2014","journal-title":"Clin. Nutr."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1770","DOI":"10.1002\/ptr.5197","article-title":"Lipid-lowering effects of curcumin in patients with metabolic syndrome: A randomized, double-blind, placebo-controlled trial","volume":"28","author":"Yang","year":"2014","journal-title":"Phytother. Res."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"10214","DOI":"10.1074\/jbc.M209323200","article-title":"Guggulsterone is a farnesoid X receptor antagonist in coactivator association assays but acts to enhance transcription of bile salt export pump","volume":"278","author":"Cui","year":"2003","journal-title":"J. Biol. Chem."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1001\/jama.290.6.765","article-title":"Guggulipid for the treatment of hypercholesterolemia: A randomized controlled trial","volume":"290","author":"Szapary","year":"2003","journal-title":"JAMA"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.ctim.2008.07.001","article-title":"Resin from the mukul myrrh tree, guggul, can it be used for treating hypercholesterolemia? A randomized, controlled study","volume":"17","author":"Nohr","year":"2009","journal-title":"Complement. Ther. Med."},{"key":"ref_91","doi-asserted-by":"crossref","unstructured":"Shimizu, M., Hashiguchi, M., Shiga, T., Tamura, H.O., and Mochizuki, M. (2015). Meta-Analysis: Effects of Probiotic Supplementation on Lipid Profiles in Normal to Mildly Hypercholesterolemic Individuals. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0139795"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"1729","DOI":"10.1128\/AEM.72.3.1729-1738.2006","article-title":"Bile salt hydrolase activity in probiotics","volume":"72","author":"Begley","year":"2006","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1017\/S0022029909990173","article-title":"Effect of fermented milk containing Lactobacillus acidophilus and Bifidobacterium longum on plasma lipids of women with normal or moderately elevated cholesterol","volume":"76","author":"Andrade","year":"2009","journal-title":"J. Dairy Res."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1128\/MMBR.00004-10","article-title":"Genomic insights into bifidobacteria","volume":"74","author":"Lee","year":"2010","journal-title":"Microbiol. Mol. Biol. Rev."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"902917","DOI":"10.1155\/2012\/902917","article-title":"Cholesterol-lowering probiotics as potential biotherapeutics for metabolic diseases","volume":"2012","author":"Kumar","year":"2012","journal-title":"Exp. Diabetes Res."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"430","DOI":"10.3109\/07853890.2015.1071872","article-title":"Effects of probiotics consumption on lowering lipids and CVD risk factors: A systematic review and meta-analysis of randomized controlled trials","volume":"47","author":"Sun","year":"2015","journal-title":"Ann. Med."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"6141","DOI":"10.2174\/1381612811319340008","article-title":"Tea and health: Studies in humans","volume":"19","author":"Khan","year":"2013","journal-title":"Curr. Pharm. Des."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"12031","DOI":"10.1021\/jf8022035","article-title":"Theaflavins from black tea, especially theaflavin-3-gallate, reduce the incorporation of cholesterol into mixed micelles","volume":"56","author":"Vermeer","year":"2008","journal-title":"J. Agric. Food Chem."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.jnutbio.2004.11.006","article-title":"Effectiveness of moderate green tea consumption on antioxidative status and plasma lipid profile in humans","volume":"16","author":"Erba","year":"2005","journal-title":"J. Nutr. Biochem."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"1448","DOI":"10.1001\/archinte.163.12.1448","article-title":"Cholesterol-lowering effect of a theaflavin-enriched green tea extract: A randomized controlled trial","volume":"163","author":"Maron","year":"2003","journal-title":"Arch. Intern. Med."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.3945\/ajcn.116.137075","article-title":"Effects of green tea catechin extract on serum lipids in postmenopausal women: A randomized, placebo-controlled clinical trial","volume":"104","author":"Samavat","year":"2016","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1007\/s11745-006-0982-3","article-title":"Supplementation with a pine bark extract rich in polyphenols increases plasma antioxidant capacity and alters the plasma lipoprotein profile","volume":"37","author":"Devaraj","year":"2002","journal-title":"Lipids"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1016\/j.phymed.2016.08.007","article-title":"Effects of low molecular weight procyanidin rich extract from french maritime pine bark on cardiovascular disease risk factors in stage-1 hypertensive subjects: Randomized, double-blind, crossover, placebo-controlled intervention trial","volume":"23","author":"Valls","year":"2016","journal-title":"Phytomedicine"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1186\/s13063-020-04551-4","article-title":"Effects of a novel nutraceutical combination (BruMeChol\u2122) in subjects with mild hypercholesterolemia: Study protocol of a randomized, double-blind, controlled trial","volume":"21","author":"Bonfigli","year":"2020","journal-title":"Trials"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"193","DOI":"10.4103\/idoj.IDOJ_475_18","article-title":"Clinical Trial Designs","volume":"10","author":"Nair","year":"2019","journal-title":"Indian Dermatol. Online J."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.tifs.2019.03.026","article-title":"A practical guide for designing effective nutraceutical combinations in the form of foods, beverages, and dietary supplements against chronic degenerative diseases","volume":"88","year":"2019","journal-title":"Trends Food Sci. Technol."},{"key":"ref_107","first-page":"1487","article-title":"New concepts in nutraceuticals as alternative for pharmaceuticals","volume":"5","author":"Nasri","year":"2014","journal-title":"Int. J. Prev. Med."},{"key":"ref_108","doi-asserted-by":"crossref","unstructured":"Song, J., Luo, J., Ma, Z., Sun, Q., Wu, C., and Li, X. (2019). Quality and Authenticity Control of Functional Red Yeast Rice\u2014A Review. Molecules, 24.","DOI":"10.3390\/molecules24101944"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1016\/j.nutres.2016.07.005","article-title":"Low daily dose of 3 mg monacolin K from RYR reduces the concentration of LDL-C in a randomized, placebo-controlled intervention","volume":"36","author":"Heinz","year":"2016","journal-title":"Nutr. Res."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1530\/eje.1.02012","article-title":"Efficacy and safety of Monascus purpureus Went rice in subjects with hyperlipidemia","volume":"153","author":"Lin","year":"2005","journal-title":"Eur. J. Endocrinol."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"167","DOI":"10.2147\/IJGM.S202446","article-title":"Mini-review: Medication safety of red yeast rice products","volume":"12","author":"Farkouh","year":"2019","journal-title":"Int. J. Gen. Med."},{"key":"ref_112","unstructured":"Philibert, C., Bres, V., Jean-Pastor, M.J., Guy, C., Lebrun-Vignes, B., Robin, P., Pinzani, V., and Hillaire-Buys, D. (2016). Red yeast-rice-induced muscular injuries: Analysis of French pharmacovigilance database and literature review. Therapie."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1111\/jcpt.12374","article-title":"Systematic review of red yeast rice compared with simvastatin in dyslipidaemia","volume":"41","author":"Ong","year":"2016","journal-title":"J. Clin. Pharm. Ther."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/9\/3128\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:58:34Z","timestamp":1760165914000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/9\/3128"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,8]]},"references-count":113,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["nu13093128"],"URL":"https:\/\/doi.org\/10.3390\/nu13093128","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,8]]}}}