red rice as a lipid lowering treatment

Last reviewed 12/2022

• Red yeast rice is a common food item found in China, used for many centuries to enhance the colour and flavour of food, as well as a traditional medicine for digestive and vascular functions
  • in the late 1990s, dietary supplement companies commercialised red yeast rice extracts able to reduce cholesterol as efficiently as statin drugs, but were only able to sell it until 2001
  • in the spring of 2001, the US Food and Drug Administration (FDA) banned the sale of any dietary supplements containing red yeast rice or xuezhikang (1)
    • this decision was made because Cholestin (R), a red yeast rice extract supplied by Pharmanex, failed to conform to the Dietary Supplement and Health Education Act (DSHEA) as was purported to contain an active compound equivalent to the statin drug Mevacor(R) or lovastatin
      
      
• production of red rice
  • fermented red rice is produced traditionally by fermenting washed and cooked rice with red wine mash, Polygonum grass juice, and alum water
  • commercially prepared red yeast rice extract is fermented during 9 days with a specific strain of red yeast called Monascus purpureus Went at a temperature of 25 deg C, and at a pH range of 5 to 6
    • rice is then air-dried, pulverised and encapsulated into gel capsules
    • monacolin K is present in red rice fermented with Monascus purpureus Went, and is identical to lovastatin
      
      
• red rice as a lipid lowering drug
  • red yeast rice may lower total cholesterol (TC) by 13-26%, low-density lipoprotein cholesterol (LDL-C) by 21-33%, and triglycerides (TG) by 13-34%, in humans
  • seems that the amount of HMG-CoA reductase inhibitors present in a dose of 2.4 g of red rice fermented with Monascus purpureus Went (9.6 mg) yields similar hypolipidemic effects to a dose of 10-40 mg of lovastatin
  • red rice for dylipidaemia in statin intolerant patients
    • trial evaluated the tolerability of red yeast rice versus pravastatin in patients unable to tolerate other statins because of myalgia
      • a small study was conducted in a community-based setting in Philadelphia, Pennsylvania
        • 43 adults with dyslipidemia and a history of statin discontinuation because of myalgia were randomly assigned to red yeast rice 2,400 mg twice daily or pravastatin 20 mg twice daily for 12 weeks
        • incidence of withdrawal from medication owing to myalgia was 5% (1 of 21) in the red yeast rice group and 9% (2 of 22) in the pravastatin group (p = 0.99).
        • low-density lipoprotein cholesterol level decreased 30% in the red yeast rice group and 27% in the pravastatin group
  • reduction of cardiovascular outcomes
    • a study was conducted to determine the effects of Xuezhikang (XZK), a partially purified extract of red yeast rice, on lipoprotein and CV end points in Chinese patients who experienced a previous myocardial infarction (5)
      • nearly 5,000 of these patients with average low-density lipoprotein cholesterol levels at baseline were randomly assigned either to placebo or to XZK daily for an average of 4.5 years
      • primary end point was a major coronary event that included nonfatal myocardial infarction and death from coronary heart disease
        • frequencies of the primary end point were 10.4% in the placebo group and 5.7% in the XZK-treated group, with absolute and relative decreases of 4.7% and 45%, respectively
        • treatment with XZK also significantly decreased CV and total mortality by 30% and 33%, the need for coronary revascularization by 1/3, and lowered total and low-density lipoprotein cholesterol and triglycerides, but raised high-density lipoprotein cholesterol levels

Reference:

• 1) Heber D et al. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. American Journal of Clinical Nutrition 1999;69(2): 231-236
• 2) SoRelle R. Appeals court says Food and Drug Administration can regulate cholestin. Circulation 200;102 (7): E9012?E9013.
• 3) Li, C et al. Monascus purpureus-fermented rice (red yeast rice): a natural food product that lowers blood cholesterol in animal models of hypercholesterolemia. Nutrition Research 1998;18 (1): 71-81
• 4) Becker DJ et al. Red yeast rice for dyslipidemia in statin-intolerant patients: a randomized trial.Ann Intern Med. 2009 Jun 16;150(12):830-9, W147-9
• 5) Lu Z et al.Effect of Xuezhikang, an extract from red yeast Chinese rice, on coronary events in a Chinese population with previous myocardial infarction. Am J Cardiol. 2008 Jun 15;101(12):1689-93.