Cardiovascular risk may be skin deep

Red yeast rice (RYR) is used in preparation of traditional Chinese cooking. It is also used for medicinal treatments. Red rice yeast is prepared by using a fungus, Monascus purpureus, fermented with rice. The use of Red yeast rice dates back to the Ming Dynasty around 1500.

Red rice yeast extracts contain starch, plant based sterols, isoflavones, and monounsaturated fatty acids, and other compounds.

Red rice yeast has become popular due to its cholesterol lowering properties. Depending on fermentation variables and the strains of Monascus, red rice yeast may have some trace amounts of naturally occurring monacolins. Monacolin K is also known as lovastatin, a patented prescription statin drug, Mevacor. It is important to note that Mevacor is the synthetically produced version not the naturally occurring form of lovastatin. Why is this important? Because the synthetic version is much stronger and has been known to produce serious adverse side effects for some people.

Red rice yeast rice works in a similar fashion as statins by interfering with the production of cholesterol in the liver. “It works much the way a statin would work, by reducing the amount of cholesterol that the liver makes, but in a much gentler level,” said Dr. Christopher Cannon a cardiologist at Boston’s Brigham and Women’s Hospital.

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The most recent study published in the Annals of Internal Medicine involved 62 patients of a large cardiology practice who had previously taken prescription statins, such as Lipitor or Zocor, but had experienced severe muscle pains. Red yeast rice has been shown to reduce LDL, “bad” cholesterol in previous studies and based on this, researchers from the University of Pennsylvania and Thomas Jefferson University set out to research the effects of this supplement in patients with high cholesterol and a history of SAM (Statin Associated Myalgia). The study was funded by the Commonwealth of Pennsylvania, with additional support from NCCAM.

Both groups involved with the study received counseling on lifestyle changes, information on cardiovascular disease, exercise, nutrition and relaxation therapy. Half of the participants also took 1,800 mg of red yeast rice supplements daily. The participants taking the red rice yeast experienced a reduction of LDL, the “bad cholesterol,” of 27 percent over a twenty four week period. The placebo group who were not taking red yeast rice saw LDL lowered by only 6 percent.

Red yeast rice did not show any meaningful benefit on raising high-density lipoprotein (HDL, or “good” cholesterol), it did not show and reduction in triglycerides, no weight loss, or reduction pain severity.

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The study also showed that red yeast rice did not measurably impact blood levels of liver enzymes or creatinine phosphokinase (CPK). This is important because some people who take statin drugs suffer from elevated liver enzymes, and because statin therapy can also be the cause of two rare but serious health problems, myositis (muscle inflammation) and rhabdomyolysis (severe muscle breakdown), both evidenced by high levels of CPK.

“I was pleasantly surprised with the degree of LDL lowering,” said Dr. Daniel Rader a lipid specialist at the University of Pennsylvania School of Medicine and an author of the study. “I have to confess, I did not expect this degree of LDL lowering. And there were many fewer side effects than expected.”

Chuck Jones, 59, from Yardley, Pa., started taking red yeast rice supplements in the study and saw his total cholesterol level plummet, from 221 to 135.

“I was very excited,” Jones told ABC News. I was able to be off the statin drug that had been prescribed, which meant I could have a pain-free life.”

Thee American Journal of Cardiology published a recent report claiming heart attack patients in China were 45 percent less likely to have another attack within five years when they took daily supplements of red rice yeast.

This randomized, double-blind, placebo-controlled trial was the first we are aware of to study red yeast rice in patients who are unable to tolerate statin drugs because of muscle pain. These results imply that red yeast rice may be a cholesterol-lowering alternative for those who suffer from SAM.


  • Becker DJ, Gordon RY, Halbert SC, et al. Red yeast rice for dyslipidemia in statin-intolerant patients. Annals of Internal Medicine. 2009;150(12):830–839.