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This paper reviews the role of red yeast rice, the most effective cholesterol-lowering nutraceutical. Daily consumption results in a reduction in LDL-cholesterol of up to 15% to 25% within 6 to 8 weeks due to its mild effect as an inhibitor of 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase. Proportionate decreases in total cholesterol, non-HDL cholesterol, apolipoprotein B, and high-sensitivity C-reactive protein also occur.
Red yeast rice might be a therapeutic choice for lifestyle management in low-risk patients who are unable to tolerate statins or other LDL cholesterol–lowering strategies.
This abstract is available on the publisher's site.
The extracts of red yeast rice (RYR) are currently the most effective cholesterol-lowering nutraceuticals. This activity is mainly due to monacolin K, a weak reversible inhibitor of 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase, whose daily consumption causes a reduction in low-density lipoprotein (LDL)-cholesterol plasma levels up to 15% to 25% within 6 to 8 weeks. The decrease in LDL-cholesterol is accompanied by a proportional decrease in total and non-high-density lipoprotein cholesterol, plasma apolipoprotein B, and high-sensitivity C-reactive protein. Some trials suggest that RYR use is associated with improvement in endothelial function and arterial stiffness, whereas a long-term study supports its role in the prevention of cardiovascular events. Despite the statin-like mechanism of action, the risk related to 3 to 10 mg monacolin K taken per day is minimal (mild myalgia in previously severely statin-intolerant subjects). RYR could represent 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.