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Herbal Extract, Guggulipid, Does Not Effectively Treat Hypercholesterolaemia Among Western Population

Guggulipid, an herbal extract commonly used in Asia as a cholesterol-lowering agent, did not lower serum cholesterol levels after 8 weeks of treatment in a group of individuals with moderate hypercholesterolaemia eating a Western diet.

This finding is despite recent research that indicates that guggulsterones, the purported bioactive compounds of the extract guggul from the resin of the mukul myrrh tree (Commiphora mukul), are antagonists of hormone receptors involved in bile acid regulation and cholesterol metabolism.

Guggulipid has been approved for use as a lipid-lowering drug in India since 1987. It is available in the United States as a dietary supplement and has been approved by the US Food and Drug Administration as an investigational drug for the treatment of hypercholesterolaemia.

Philippe O. Szapary, MD, of the University of Pennsylvania, Philadelphia, United States and colleagues studied the short-term safety and efficacy of guggul extract in 103 otherwise healthy adults with primary hypercholesterolaemia. Participants had levels of low- density lipoprotein cholesterol (LDL-C) between 130 to 200 mg/dL and fasting levels of triglycerides less than 400 mg/dL.

Eighty percent of the study participants were white and 51% were male. The participants mean age was 51.5 years and mean body-mass index was 26.0. Investigators randomised 33 individuals to receive standard dose (1000 mg) and 34 individuals to receive high-dose (2000 mg) guggulipid, while 36 individuals received placebo. The medications were taken orally, 3 times per day.

Over 8 weeks of treatment, LDL-C levels decreased by 5% over baseline among the placebo group. Conversely, participants in the standard dose group had a 9% increase and those in the high dose group had a 10% increase in LDL- C levels over baseline. There were no significant changes in the levels of total cholesterol, high-density lipoprotein cholesterol (HDL-C0, triglycerides, or very-low- density lipoprotein cholesterol (VLDL-C) over baseline in the guggulipid groups.

Among the 83 individuals who completed the study, the high- dose guggulipid group did show a 29% reduction in median levels of high-sensitivity C-reactive protein compared with a 25% increase in the placebo group while the standard-dose guggulipid group showed no change from baseline. The investigators note that these effects warrant further investigation.

"Our goal was to evaluate the real-world effect of guggulipid as it might be used in the general population of patients with hypercholesterolaemia who purchase this dietary supplement," Dr. Szapary and colleagues write. They conclude, "in a typical American population of adults with hypercholesterolaemia and eating a typical Western diet, using this standardised guggulipid product did not reduce and actually raised levels of LDL-C compared with placebo."
JAMA 2003;290:765-772.

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