Statines versus supplementen: laat u niet bedotten

Bovenstaande bevindingen over statines versus supplementen komen voort uit een door de fabrikant betaalde studie met Rosuvastatine (5 mg) die ruim door de media (1-5) is opgepikt. De 190 proefpersonen hadden geen hart en vaatziekten maar wel een verhoogd risico hierop (5). Statines zijn remmers van de cholesterolaanmaak. Ze laten het LDLC dalen en het hart-vaatziekterisico verminderen (6-10). Ruim 2 miljoen Nederlanders (14 procent van de volwassenen!) slikken ze (10a).

‘Het publiek zou van mening zijn dat de onderzochte supplementen het LDLC laten dalen en het hart-vaatziekterisico verminderen’ (1,5). Het klinkt nobel, maar de onderzoekers zetten argeloze medewetenschappers, consumenten en journalisten moedwillig op het verkeerde been. Ten eerste was al lang bekend dat de onderzochte voedingssupplementen het LDLC niet doen dalen. De uitkomst stond dus tevoren vast. Ten tweede wordt ten onrechte de suggestie gewekt dat de supplementen daardoor geen bijdrage leveren aan een goede conditie van hart en vaten. Het LDLC daalde immers niet, dus ‘die dure supplementen kunnen we ons besparen’ (1,5). Sterker nog: visolie doet het LDLC eerder stijgen dan dalen (11-14). Jammer voor de onderzoekers dat die stijging er bij hen niet uit kwam: dat had hun verhaal nog spannender gemaakt.

Dat knoflook en visolie het LDL-gehalte niet doen dalen, was al lang bekend

Supplementen werken anders. Visolie stopt op actieve wijze een ontstekingsproces (14-17) en laat het vetgehalte in het bloed (de triglyceriden) dalen (11-14). Dat atherosclerose (‘aderverkalking’) door een ontstekingsproces ontstaat, weten we al sinds 1859. Het is stevig vastgelegd in een legendarisch artikel uit 1999 (18). Tenminste één van de medeauteurs van de huidige studie was daarvan op de hoogte. In het verleden liet hij nota bene zelf zien dat door onderdrukking van ontsteking het hart-vaatziekterisico daalt (26-30). De andere onderzochte supplementen komen uit planten en schimmels en vier ervan danken hun werking aan de ‘nrf2 agonisten’ die ze bevatten. Die veroorzaken een lichte oxidatieve stress, waardoor het lichaam zich beter beschermt (19-25b).

LDLC is geen ‘synoniem voor een hartinfarct’. En een daling van LDLC leidt niet automatisch tot een verminderd hart-vaatziekterisico (14,31). Ook al wordt dat door autoriteiten, zoals de Amerikaanse (32) en Nederlandse (33) hartstichtingen en ook de Nederlandse Gezondheidsraad (34,35), nog steeds met droge ogen beweerd (14,31). Sommige geneesmiddelen, waaronder plaspillen (40,41) en de SGLT2-remmers tegen diabetes type 2 en hartfalen (36-39), doen het LDLC stijgen, maar het hart-vaatziekterisico dalen. Postmenopauzale hormoonvervanging doet het LDLC dalen maar het hart-vaatziekterisico (vooral beroerte) stijgt (42-43d).

Door hun suggestieve conclusies brengen de auteurs van deze studie de geloofwaardigheid van de medische wetenschap in diskrediet. Niet-ingewijde medewetenschappers worden bedot en de media doen de rest. Supplementen zijn, in tegenstelling tot geneesmiddelen, niet te patenteren en worden daarom nauwelijks onderzocht. De Europese Unie stelde onlangs dat de hoeveelheid lovostatine in supplementen met rode gistrijst minder dan 3 mg moet zijn. Lovostatine is de natuurlijke statine, waarvan alle synthetische (gepatenteerde) statines zijn afgeleid. Bij patiënten met een verhoogd LDLC verlaagt 10 mg lovostatine het LDLC met 1 mmol/L (44,45). De reden van de EU-verordening ligt vooral in de spierklachten die statines als bijwerking hebben (46-48). Spierpijn en -kramp tot zeldzamere spierafbraak en spierscheuring zijn gerapporteerd (49,50). Het zou de fabrikant gesierd hebben als het onderzoek daarop was gericht.

NB. Dr. Muskiet heeft geen belangen, noch in geneesmiddelen, noch in supplementen.

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