Prolonged exposure to lower low-density lipoprotein cholesterol (LDL-C) is perhaps the most effective modifiable risk factor in reduction of cardiovascular (CV) events.

Although statins are highly effective, their usage remains poor, especially in low- to low-middle-income countries.

Nutritional supplements, being culturally more acceptable, are a potential solution but have not been systematically tested.

Our study, ESSENS, was the first randomized study evaluating efficacy and safety of a lipid-lowering nutritional supplement in India.

191 statin-free subjects with newly-diagnosed hyperlipidemia and no evidence of CV disease were randomized to one capsule of a proprietary nutritional supplement containing red yeast rice, grape-seed, niacinamide, and folic acid or matched placebo twice daily.

12 wk treatment with the supplement resulted in ∼30% reduction in LDL-C with no apparent safety issues.