Red Yeast Rice revisited for lowering cholesterol.

Red Yeast Rice

Red yeast rice is an increasingly popular dietary supplement which is used by people who have elevated cholesterol levels.  In fact, in 2006, American consmers spent $17 million dollars on this dietary supplement.  It has been used as an herbal medication in China for centuries.

Statins or HMG-CoA reducatase inhibitors are currently the most effective lipid-lowering medications for the prevention of coronary artery disease.  Though they are generally well-tolerated, they can be associated with side effects including:  elevated hepatic or liver enzyme levels, gastrointestinal symptoms, and statin-associated myalgias which include both muscle pain and weakness.  Myositis which includes elevated creatine phosphokinase levels (CPK) and rhabdomyolysis (rapid break down of skeletal muscle tissue) are more rare, but are serious complictions of therapy. Statin-associated myalgias are dose related and typically do occur without myosistis.

As no definitive treatment for statin-associated myalgia (SAM)currently exists, many patients adopt alterative strategies including red yeast rice.  Though now more controversial, some patients with SAM have benefited from supplementing with coenzyme Q10.  Like statin type medication, red yeast rice contains lovastatin (monocolin k) that may inhibit HMG-CoA reducatase and lower cholesterol levels.

A recent study (Becker et al, 2009) evaluated the effectiveness and tolerability of red yeast rice to treat dyslipidemia in patients who cannot tolerate statins.

Intervention:

Patients were assigned by random allocation software to receive red yeast rice, 1800 mg (31 patients), or placebo (31patients) twice daily for 24 weeks. All patients were concomitantly enrolled in a 12-week therapeutic lifestyle change program.

Results:

• LDL cholesterol reduction of 1.11 mmol/l (43 mg/dl) at week 12.
• Levels of HDL choleterol (good cholesterol), liver enzymes, CPK, and pain severity did not differ between the red yeast rice group and placebo at weeks 12 or 24.

Conclusions:

Red yeast rice and therapeutic lifestyle change decrease LDL cholesterol level without increasing CPK or pain levels and may be a treatment option for dyslipidemic patients who cannot tolerate statin therapy.

Side effects:

Two (7%) of 29 patients in the red yeast rice group developed persistent intolerable myalgias and discontinued treatment. Their CPK levels were within normal limits.  Two other patients discontinued red yeast rice, 1 because of dizziness and 1 because of loose stools. All 4 patients remained in the study and completed the study protocol.  One of 30 patients in the placebo group developed persistent intolerable myalgias and discontinued treatment but completed the study protocol.

ATP III Classification of LDL, Total, and HDL Cholesterol (mg/dL)

LDL Cholesterol – Primary Target of Therapy

• <100 Optimal
• 100-129 Near optimal/above optimal
• 130-159 Borderline high
• 160-189 High
• >190 Very high

Total Cholesterol

• <200 Desirable
• 200-239 Borderline high
• >240 High

HDL Cholesterol (good cholesterol)

• <40 Low
• >60 High

Reference:

Becker DJ, Gordon RY, Halbert SC, French B, Morris PB, Rader DJ.  Red yeast rice for dyslipidemia in statin-intolerant patients: a randomized trial.  Ann Intern Med. 2009 Jun 16;150(12):830-9, W147-9.