Red Yeast Rice for the Improvement of Lipid Profiles in Mild-to-Moderate Hypercholesterolemia: A Narrative Review

Abstract

Reducing low-density lipoprotein cholesterol (LDL-C) levels is a key target for lowering cardiovascular risk and preventing atherosclerotic cardiovascular disease (ASCVD). Red yeast rice (RYR) is a nutraceutical widely used as a lipid-lowering dietary supplement. The main cholesterol-lowering components of RYR are monacolins, particularly monacolin K, which is structurally identical to lovastatin and targets the same key enzyme of cholesterol biosynthesis. RYR supplementation reduces LDL-C levels by approximately 15–34% versus placebo, with a similar effect to low-dose, first-generation statins in subjects with mild-to-moderate dyslipidemia. RYR has also demonstrated beneficial reductions of up to 45% versus placebo in the risk of ASCVD events in secondary prevention studies. RYR at a dose that provides about 3 mg/d of monacolin K is well tolerated, with an adverse event profile similar to that of low-dose statins. RYR is therefore a treatment option for lowering LDL-C levels and ASCVD risk for people with mild-to-moderate hypercholesterolemia who are ineligible for statin therapy, particularly those who are unable to implement lifestyle modifications, and also for people who are eligible for statin therapy but who are unwilling to take a pharmacologic therapy.

The antihyperlipidemic effect of a combined supplement of standardized dry extracts of amla (Emblica officinalis), walnut (Juglans regia), olive (Olea europaea) and red yeast rice (Monascus purpureus) powder: Reduction in circulatory low-density lipoprotein-cholesterol (LDL-C) and remnant cholesterol (RC) levels in patients with hypercholesterolemia

“…RYR has a comparable lipid-lowering activity to statins and lowers the cardiovascular disease risk in patients with statin intolerance or those who do not meet their goals after a single course of treatment with statins or ezetimibe. RYR has been suggested as a treatment option for lowering LDL-C levels and ASCVD risk for people with mild-to-moderate hypercholesterolemia who are ineligible for statin therapy, particularly those who are unable to implement lifestyle modifications, and also for those who are otherwise eligible for statin therapy but unwilling to take a pharmacologic therapy ( Cicero et al, 2023 ). The antihyperlipidemic therapeutic effect of RYR is believed to be due to its principal active constituent monacolins, more specifically monacolin K (2.9 mg from Cholesfytol NG® supplementation).…”

Effect of dietary supplementation with a new nutraceutical formulation on cardiometabolic risk factors: a double-blind, placebo-controlled, randomized clinical study

“…However, the tested combined nutraceutical has been shown to improve a relatively large number of cardiometabolic risk factors, in agreement with what is expected for a well-designed combined nutraceutical [ 20 ]. Considering the recent European Commission concerns about the use of red yeast rice products containing high dosages of monacolin K [ 21 , 22 ], the current development of new combined nutraceuticals is needed to balance the strong reduction in the daily dose of monacolins required by the new EU rules.…”

Cholesterol-Lowering Bioactive Foods and Nutraceuticals in Pediatrics: Clinical Evidence of Efficacy and Safety

“…Red yeast rice is a widely used and clinically tested cholesterol-lowering nutraceutical derived from the fermentation of standard rice by specific mycelia (usually Monascus pur-pureus Went) with the production of a pigment (making the rice red) and some bioactive compounds, among which monacolins are reversible inhibitors of 3-hydroxy-3-methylglutaril Coenzyme A reductase (Figure 2) [107]. The most bioactive compound was monacolin K, which is chemically analogous to lovastatin.…”