From the Guidelines
Red yeast rice is not recommended as a primary treatment for managing hypercholesterolemia due to the lack of standardized regulation and potential side effects, and instead, statins should be considered as the first-line treatment for lowering cholesterol levels. According to the 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults 1, statins are the primary recommended treatment for managing hypercholesterolemia. The guideline does not provide recommendations for the use of red yeast rice due to the lack of available evidence in the United States at the time of the review.
The use of statins is further supported by the 2020 European Society of Cardiology position paper on lipid management in rheumatoid arthritis, which recommends statins as the primary pharmacological treatment for hypercholesterolemia 1. Additionally, the 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease also recommends statins as the primary treatment for lowering LDL cholesterol levels 1.
While red yeast rice may contain monacolin K, which is chemically identical to the prescription medication lovastatin, the lack of standardization in red yeast rice supplements and potential side effects, such as muscle pain and liver damage, make it a less desirable option compared to prescription statins. Therefore, statins should be considered as the first-line treatment for managing hypercholesterolemia, and red yeast rice should only be considered under the guidance of a healthcare provider and with careful monitoring of liver function and potential side effects.
From the Research
Effectiveness of Red Yeast Rice in Managing Hypercholesterolemia
- Red yeast rice has been shown to be effective in reducing serum cholesterol levels, with a daily consumption of monacolin K (up to 10 mg/day) reducing low-density lipoprotein (LDL) cholesterol plasma levels by 15% to 25% within 6 to 8 weeks 2, 3.
- The lipid-regulating potency of red yeast rice in commercial preparations can vary greatly due to differences in monacolin K content, making it challenging to predict dose-related efficacy and side-effect risks 4.
- Studies have reported significant reductions in total cholesterol and LDL cholesterol levels with the use of red yeast rice, with some trials suggesting improvements in endothelial function and arterial stiffness 2, 5, 3.
Safety and Side Effects
- While red yeast rice has a mechanism of action similar to statins, the risk associated with daily consumption of 3 to 10 mg monacolin K is considered minimal, with mild myalgias reported in some cases, particularly in patients who are severely statin-intolerant 2, 3.
- The US Food and Drug Administration has issued warnings against taking red yeast rice products due to concerns about efficacy, safety, and lack of standardized preparation methods 4.
- Primary care physicians should be aware of the potential side effects of taking red yeast rice, including muscle pains and abnormal liver function tests, although these have not been commonly reported in studies 4, 6.
Clinical Use
- Red yeast rice may be considered a therapeutic tool to support lifestyle improvement in managing mild to moderate hypercholesterolemia in low-risk patients, including those who cannot be treated with statins or other LDL-cholesterol-lowering therapies 2.
- Red yeast rice may be a useful alternative treatment for primary hyperlipidemia in patients with low cardiac risk who refuse to take lipid-lowering prescription medication or are statin-intolerant 6.