Red yeast rice with monacolin K for the improvement of hyperlipidemia: A narrative review

Low-density lipoprotein cholesterol (LDL-C) is the most causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Red yeast rice (RYR) is a nutraceutical widely used as a lipid-lowering dietary supplement. The main cholesterol-lower agents in RYR are monacolins, particularly monacolin K, a weak reversible inhibitor of 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase, whose daily consumption (up to 10 mg/day) reduces LDL-C plasma levels up to 34% within 6-8 weeks when compared to placebo. The reduction in LDL-C is often accompanied by lower levels of plasma apolipoprotein B, total cholesterol, matrix metalloproteinases 2 and 9, high-sensitivity C-reactive protein, non-high-density lipoprotein cholesterol, and blood pressure. RYR has also demonstrated favorable reductions of up to 45% compared to placebo in the risk of ASCVD events in secondary prevention studies. The mechanism of action is similar to statins. When consumed appropriately, RYR is associated with only minimal side effects. Mild myalgia may be seen in patients who cannot tolerate low-dose statins. In individuals with no additional ASCVD risk factors, RYR is a safe and effective supplement in treating mild to moderate hyperlipidemia.