Low daily dose of 3 mg monacolin K from RYR reduces the concentration of LDL-C in a randomized, placebo-controlled intervention.
Reviewer: Dr. Alan Gaby, MD
Author: Heinz T, et al
Reference: Low daily dose of 3 mg monacolin K from RYR reduces the concentration of LDL-C in a randomized, placebo-controlled intervention. Nutr Res 2016;36:1162-1170.
Design: Randomized, double-blind, placebo-controlled trial.
Participants: One hundred forty-two patients (mean age, 57.3 years) with hypercholesterolemia who were not receiving statin drugs.
Study Medication and Dosage: Red yeast rice at a dose that provided 3 mg per day of monacolin K (lovastatin).
Primary Outcome Measures: Changes in total-cholesterol and LDL-cholesterol levels.
Mon: In the red yeast rice group, the mean total-cholesterol level fell by 11.2% and the mean LDL-cholesterol level fell by 14.8% (p < 0.001 compared with the changes in the placebo group). Fifty-one percent of the participants treated with red yeast rice achieved the target LDL-cholesterol level of < 4.14 mmol/L.
Practice Implications: Red yeast rice is fermented rice produced by growing red yeast (Monascus purpureus) on white rice. It has been used in China for more than 1,000 years and is a dietary staple in China and Japan. Some strains of red yeast rice (but not those sold as food in China and Japan), when fermented under controlled conditions, produce compounds called monacolins, which are structurally very similar to statin drugs such as pravastatin, simvastatin, and lovastatin. Indeed, lovastatin has been identified as the most predominant monacolin in red yeast rice, although up to 10 distinct monacolins have been found in some products. Like statin drugs, monacolins inhibit cholesterol synthesis by inhibiting HMG-CoA reductase, and also decrease C-reactive protein levels.
In numerous clinical trials, administration of red yeast rice significantly decreased serum total- and LDL-cholesterol levels. The effects were similar to those of commonly used statin drugs, even though red yeast rice contains substantially lower amounts of lovastatin and other monacolins than the dosages of most statin drugs used to treat hypercholesterolemia. It is possible that the various monacolins in red yeast act synergistically, or that they act additively or synergistically with other substances in red yeast rice. Most of the previous clinical trials administered red yeast rice at dosages that provided 5-10 mg per day of monacolin K, as compared with 3 mg per day in the present study. While red yeast rice is considerably less likely than statin drugs to cause myalgia and other side effects, it is not risk-free. Therefore, when using red yeast rice to treat hypercholesterolemia, the lowest effective dose should be given. Patients taking statin drugs should in most cases not receive red yeast, since the combination may increase the risk of adverse effects.