Statins are usually well-tolerated drugs with a clear dose-dependent efficacy. However, manifestation of statin's side effects also bears a direct relation to higher doses necessary to achieve high impact cholesterol-lowering effects. Nevertheless, the reliance on statin efficacy alone has often left dietary intervention underutilized even though studies have shown a reduction in serum cholesterol levels when dietary fiber intake is increased. In this meta-analysis, we investigated whether the concomitant use of psyllium, a gel-forming viscous soluble fiber, would cause further overall cholesterol lowering in subjects already receiving statins. A systematic review of the medical literature was performed and identified three randomized, controlled clinical studies that evaluated the cholesterol lowering efficacy of statins when given concomitantly with psyllium as a fiber supplement. The duration of the studies ranged from 4 weeks to 12 weeks. The objective of the meta-analysis was to estimate the overall effect of psyllium plus statin versus statin alone. The results of the meta-analysis showed a clinically and statistically significant (p?=?0.001) cholesterol lowering advantage for psyllium plus statin combination treatment over a statin alone. Adding psyllium fiber resulted in reductions in low-density lipoprotein-cholesterol equivalent to doubling the statin dose. In conclusion, the data support that psyllium fiber takenbefore meals adds to the efficacy of statins, providing an easy to implement dietary intervention for those who cannot tolerate side effects associated with higher-dose statins.
This SR suggests quite a large effect on using psyllium fibre before meals on further reducing serum lipids additional to a statin. I will offer this to patients.
No hard cardiovascular endpoints and only short-term follow-up with cholesterol numbers, so not sure this is useful.
This study written by the makers of Metamucil suggests that adding fiber to statins helps lower cholesterol. However, the meta-analysis included only 3 trials of short duration (4-12 weeks). Although cholesterol was lowered, there are no data on whether this actually reduced CV events.
Finally an article that is relevant to primary care!
Small meta-analysis but with 3 good studies with consistent results, this is likely to reflect the truth. A question for experts in the area will be about the clinical relevance of the effect of fiber added to statin therapy.
As stated in the article, the limitations of this meta-analysis include the small number of studies available for inclusion, the relatively short-term follow-up in the studies and lack of hard cardiovascular outcomes as end points.