Hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors – better known as statins – have proven themselves effective for lowering cholesterol levels and reducing the risk for cardiovascular disease. (Downs J, et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA. 1998;279:1615-22; and Bots M, et al. METEOR Study Group. Intensive lipid lowering may reduce progression of carotid atherosclerosis within 12 months of the treatment: the METEOR study. J Intern Med. 2009;265:698-707)
Unfortunately, statin drugs are associated with significant side effects, and many carry a high price tag. A one-month supply of a prescription statin can cost anywhere from $30 for generic medications to well over $100 for brand-name drugs. For people without insurance prescription coverage – or for those whose physicians prescribe brands that aren’t on an insurance company’s formulary – the cost of controlling one’s cholesterol can quickly mount.
Red Yeast Rice May Be an Alternative to Prescription Statin Drugs
Red yeast rice is the fermented product of a yeast species, Monascus purpureus, grown on rice. It has been used in China for medicinal and non-medicinal purposes for over a millennium.
Red yeast rice contains at least eight statin-like compounds – called monacolins – which inhibit HMG-CoA reductase, the liver enzyme that manufactures cholesterol in humans. One of the monacolins in red yeast rice (monacolin K) is chemically identical to lovastatin, a potent HMG-CoA reductase inhibitor that is commonly prescribed for patients with high cholesterol levels.
Ten years ago, red yeast rice (also known as “cholestin”) was relatively unknown in the United States. American scientists were just beginning to duplicate research that had already been completed in China – research which demonstrated that red yeast rice reduced total serum cholesterol levels between 11 and 32 percent. (Morelli V, Zoorob R. Alternative therapies: part II. Congestive heart failure and hypercholesterolemia. Am Fam Phys. 2000;62[6]:1325-30)
A 1999 trial in the U.S. involving 83 hyperlipidemic patients showed that red yeast rice lowered total cholesterol levels approximately 15%, and LDL levels decreased about 22%. These results were similar to those conferred by prescription statin agents available at that time. (Heber D, et al. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr 1999;69:231-6)
Red Yeast Rice Compares Favorably with Statin Drugs in Efficacy and Side Effects
The true incidence of adverse events caused by statin drugs is a matter of debate: Many patients who develop one of the most common side effects, muscle pain (myopathy), may not report it to their doctors, or physicians may attribute their patients’ complaints to other causes.
Some studies show the incidence of statin-related myopathy to be around 10%, but it is interesting to note that, in a survey of patients for whom the cost of medications was not an issue, 40% of prescriptions for lipid-lowering drugs weren’t filled, leading some experts to believe that the rate of side effects is much higher and that it influences patients’ adherence to treatment. (Avorn J, et al. Persistence of use of lipid-lowering medications: a cross-national study. JAMA. 1998;279:1458-1462)
Although a significant number of patients who develop myopathy experience relief from their discomfort if one statin is substituted for another, approximately 60% of these individuals exhibit persistent pain on all statins. Thus, another approach must be considered for people who cannot tolerate the side effects of statin therapy.
A recently completed placebo-controlled trial showed that many patients who are statin-intolerant may benefit from using red yeast rice. This study showed statistically significant improvements – comparable to prescription statins – in total and LDL cholesterol levels in the red yeast rice group when compared to placebo.
Notably, there was no significant difference in adverse events between red-yeast-rice and placebo groups in the trial: Reports of body pain and serum markers for liver and muscle damage were similar in both groups. (Becker D, et al. Red yeast rice for dyslipidemia in statin-intolerant patients: a randomized trial. Ann Intern Med. 2009;150:830-839)
Although red yeast rice does not yet have a track record which matches that of statins, it is racking up some impressive numbers in studies that evaluate its ability to prevent cardiovascular events. (Lu Z, et al. Chinese Coronary Secondary Prevention Study Group. Effect of Xuezhikang, an extract from red yeast rice, on coronary events in a Chinese population with previous myocardial infarction. Am J Cardiol. 2008;101:1689-1693)
All indications are that red yeast rice is a safe and effective alternative for people with hypercholesterolemia who cannot tolerate statins. And, at a cost of $25 – $45 monthly, red yeast rice might also be a viable choice for people who cannot tolerate the price of prescription medications.
Author John Muroto
Unfortunately, statin drugs are associated with significant side effects, and many carry a high price tag. A one-month supply of a prescription statin can cost anywhere from $30 for generic medications to well over $100 for brand-name drugs. For people without insurance prescription coverage – or for those whose physicians prescribe brands that aren’t on an insurance company’s formulary – the cost of controlling one’s cholesterol can quickly mount.
Red Yeast Rice May Be an Alternative to Prescription Statin Drugs
Red yeast rice is the fermented product of a yeast species, Monascus purpureus, grown on rice. It has been used in China for medicinal and non-medicinal purposes for over a millennium.
Red yeast rice contains at least eight statin-like compounds – called monacolins – which inhibit HMG-CoA reductase, the liver enzyme that manufactures cholesterol in humans. One of the monacolins in red yeast rice (monacolin K) is chemically identical to lovastatin, a potent HMG-CoA reductase inhibitor that is commonly prescribed for patients with high cholesterol levels.
Ten years ago, red yeast rice (also known as “cholestin”) was relatively unknown in the United States. American scientists were just beginning to duplicate research that had already been completed in China – research which demonstrated that red yeast rice reduced total serum cholesterol levels between 11 and 32 percent. (Morelli V, Zoorob R. Alternative therapies: part II. Congestive heart failure and hypercholesterolemia. Am Fam Phys. 2000;62[6]:1325-30)
A 1999 trial in the U.S. involving 83 hyperlipidemic patients showed that red yeast rice lowered total cholesterol levels approximately 15%, and LDL levels decreased about 22%. These results were similar to those conferred by prescription statin agents available at that time. (Heber D, et al. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr 1999;69:231-6)
Red Yeast Rice Compares Favorably with Statin Drugs in Efficacy and Side Effects
The true incidence of adverse events caused by statin drugs is a matter of debate: Many patients who develop one of the most common side effects, muscle pain (myopathy), may not report it to their doctors, or physicians may attribute their patients’ complaints to other causes.
Some studies show the incidence of statin-related myopathy to be around 10%, but it is interesting to note that, in a survey of patients for whom the cost of medications was not an issue, 40% of prescriptions for lipid-lowering drugs weren’t filled, leading some experts to believe that the rate of side effects is much higher and that it influences patients’ adherence to treatment. (Avorn J, et al. Persistence of use of lipid-lowering medications: a cross-national study. JAMA. 1998;279:1458-1462)
Although a significant number of patients who develop myopathy experience relief from their discomfort if one statin is substituted for another, approximately 60% of these individuals exhibit persistent pain on all statins. Thus, another approach must be considered for people who cannot tolerate the side effects of statin therapy.
A recently completed placebo-controlled trial showed that many patients who are statin-intolerant may benefit from using red yeast rice. This study showed statistically significant improvements – comparable to prescription statins – in total and LDL cholesterol levels in the red yeast rice group when compared to placebo.
Notably, there was no significant difference in adverse events between red-yeast-rice and placebo groups in the trial: Reports of body pain and serum markers for liver and muscle damage were similar in both groups. (Becker D, et al. Red yeast rice for dyslipidemia in statin-intolerant patients: a randomized trial. Ann Intern Med. 2009;150:830-839)
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Although red yeast rice does not yet have a track record which matches that of statins, it is racking up some impressive numbers in studies that evaluate its ability to prevent cardiovascular events. (Lu Z, et al. Chinese Coronary Secondary Prevention Study Group. Effect of Xuezhikang, an extract from red yeast rice, on coronary events in a Chinese population with previous myocardial infarction. Am J Cardiol. 2008;101:1689-1693)
All indications are that red yeast rice is a safe and effective alternative for people with hypercholesterolemia who cannot tolerate statins. And, at a cost of $25 – $45 monthly, red yeast rice might also be a viable choice for people who cannot tolerate the price of prescription medications.
Author John Muroto
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