From the Guidelines
Red yeast rice is not recommended as a primary treatment for managing hypercholesterolemia due to the lack of standardized regulation and inconsistent active ingredient content, as well as the availability of more effective and safer alternatives such as statins. The 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults 1 does not provide recommendations for the use of red yeast rice, and instead emphasizes the importance of statin therapy in managing hypercholesterolemia. While red yeast rice may contain monacolin K, which is chemically identical to the prescription medication lovastatin, the variability in active ingredient content and potential for side effects make it a less desirable option.
The most recent and highest quality study, a 2020 position paper on lipid management in rheumatoid arthritis by the European Society of Cardiology 1, recommends pharmacological treatment of hypercholesterolemia primarily with statins, and suggests that other lipid-modifying therapies such as PCSK9 inhibitors, ezetimibe, and fibrates may be considered if goal LDL-C cannot be reached through lifestyle and statin therapy. This guideline does not mention red yeast rice as a recommended treatment option.
In terms of managing hypercholesterolemia, 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 1 recommends treatment with a statin medication to reduce low-density lipoprotein (LDL) cholesterol below 100 mg/dL, and suggests that intensifying LDL-lowering drug therapy with an additional drug may be effective if goal LDL-C cannot be reached through lifestyle and statin therapy. Again, red yeast rice is not mentioned as a recommended treatment option.
Overall, while red yeast rice may have some potential benefits in lowering cholesterol levels, the lack of standardized regulation, inconsistent active ingredient content, and potential for side effects make it a less desirable option compared to more effective and safer alternatives such as statins. Therefore, statin therapy is recommended as the primary treatment for managing hypercholesterolemia, and red yeast rice should not be used as a substitute for evidence-based treatments.
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.