Preventive cardiology
Lipid-Lowering Efficacy of Red Yeast Rice in a Population Intolerant to Statins

https://doi.org/10.1016/j.amjcard.2009.10.045Get rights and content

Chinese red yeast rice is a dietary supplement containing monacolins, unsaturated fatty acids, and phytosterols capable of lowering low-density lipoprotein (LDL) cholesterol. Few studies have reported on its use in clinical practice or in statin-intolerant patients. We reviewed approximately 1,400 clinical charts and identified 25 patients treated with red yeast rice for ≥4 weeks. The patients were included if they had pre- and post-treatment lipid levels without simultaneous changes in other lipid-lowering medications. These patients had experienced myalgias (68%), gastrointestinal intolerance (16%), and/or elevated alanine aminotransferase levels (8%) with previous use of other lipid-lowering agents. The total cholesterol decreased 15% (−37 ± 26 mg/dl, p <0.001) and LDL cholesterol decreased 21% (−35 ± 25 mg/dl, p <0.001) during 74 ± 39 days of treatment. Most (92%) patients tolerated the treatment, and many (56%) achieved their LDL cholesterol goal. In patients unable to tolerate daily statin use, the total cholesterol level decreased 13% (−33 ± 10 mg/dl, p <0.001) and LDL cholesterol decreased 19% (−31 ± 4 mg/dl, p <0.001). In conclusion, red yeast rice modestly decreased total and LDL cholesterol, was well-tolerated, and was an acceptable alternative in patients intolerant of other lipid-lowering medications.

Section snippets

Methods

We reviewed the clinical charts of approximately 1,400 patients referred to the Hartford Hospital Cholesterol Management Center and identified 25 patients treated with red yeast rice for ≥4 weeks. The patients were included if they had pre- and post-treatment lipid level measurements that were ≥4 weeks apart without simultaneous changes in other lipid-lowering medications. In addition to lipid levels, alanine aminotransferase (ALT) and creatine phosphokinase (CPK) were measured in clinical

Results

Total cholesterol decreased 15% (−37 ± 26 mg/dl, p <0.001) and LDL cholesterol decreased 21% (−35 ± 25 mg/dl, p <0.001) during 74 ± 39 days of treatment. Triglycerides and high-density lipoprotein cholesterol decreased 6% (p = 0.06) and 0.5% (p = 0.48), respectively (Table 1). Patients with initial LDL cholesterol levels in the highest tertile (mean LDL cholesterol 198 ± 27 mg/dl) experienced an 18% LDL cholesterol reduction (−36 ± 3 mg/dl, p = 0.006), those in the second tertile (mean 168 ± 18

Discussion

This retrospective observational study of a clinical population demonstrated significant LDL cholesterol reductions with red yeast rice therapy in a population highly intolerant to daily statin use. The LDL cholesterol lowering effect of red yeast rice is in part due to the presence of monacolin-K, which is identical to lovastatin.6 However, the documented LDL cholesterol-lowering effect of red yeast rice exceeds that expected for the lovastatin concentration of the red yeast rice preparation.

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Dr. Wortham is on the Speaker's Bureau of Novartis (East Hanover, New Jersey), Sanofi Aventis (Bridgewater, New Jersey); Dr. Thompson has received grant/research support from Merck (West Point, Pennsylvania), Pfizer (New York, New York), Astra Zeneca (Wilmington, Delaware), B. Braun (Bethlehem, Pennsylvania), GlaxoSmithKline (Research Triangle Pk, North Carolina), Roche (Nutley, New Jersey), and Genomas (Hartford, Connecticut); has been a Consultant to Astra Zeneca, Merck, Schering-Plough (Liberty Corner, New Jersey), Takeda (Deerfield, Illinois), Roche, Genomas, and Abbott (North Chicago, Illinois); has been on the Speaker's Bureau for Merck, Pfizer, Abbott, Astra Zeneca, Schering-Plough, Stock; and has been a shareholder in Zoll (Chelmsford, Massachusetts), General Electric (Fairfield, Connecticut), JA Wiley Publishing (StreetHoboken, New Jersey), Zimmer (West Center Street Warsaw, Indiana), Medtronic (Minneapolis, Minnesota), and Merck. Work performed at the Cholesterol Management Center, Henry Low Heart Center, Hartford Hospital, Hartford, Connecticut.

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