It has been well established that a high serum cholesterol level is a predisposing factor to other diseases, most notably, cardiovascular disease. It has also been documented that controlling cholesterol levels can reduce the risk for these diseases and improve a person's quality of life. Strict adherence to an antilipidemic diet and drug regimen can help prevent morbidity and mortality. Among the current lipid-lowering agents, the hydroxy-methyl- glutaryl coenzyme (HMG-CoA) reductase inhibitors are among the most effective agents for the reduction of total cholesterol and LDL cholesterol levels. However, because of their expense, these drugs are not widely available in developing countries. This is of particular public health concern in China. Therefore, natural alternatives that are abundantly available are being investigated for their ability to reduce serum cholesterol levels effectively and safely.

Red yeast rice is one traditional Chinese material that has been shown in animal and pilot human studies to effectively lower serum lipid levels. Red yeast rice, also known as Monascus purpureus rice, is derived from the strain of M purpureus Went yeast and is prepared by a traditional rice fermentation method. It has been shown that red yeast rice contains compounds with HMG-CoA reductase inhibitor activity, which is responsible for the inhibition of cholesterol synthesis in the liver. In addition, red yeast rice also contains unsaturated fatty acids that may also help reduce serum lipids.

In order to better understand the effectiveness of red yeast rice, Wang and colleagues performed a randomized, single-blind trial in 502 patients who were diagnosed with hyperlipidemia. Patients who were eligible for the study had a serum total cholesterol (TC) greater than or equal to 230 mg/dL, low density lipoprotein cholesterol (LDL-C) greater than or equal to 130 mg/dL, or triglycerides (TG) between the value of 200-400 mg/dL. Also, the patients had a high density lipoprotein (HDL) less than or equal to 40 mg/dL for men or HDLless than or equal to 45 mg/dL for women. Patients were then randomized into one of four groups: groups A, C, and D were the treatment groups and group B was the control group. Patients in the treatment groups were given 600 mg of red yeast rice twice a day (1200 mg/d) whereas the patients in the control group were given Jiaogulan (Gynostemma pentaphylla; a Chinese herb with putative hypolipidemic properties, three tablets twice a day (1200 mg/d).

A total of 446 patients completed this study. After 4 weeks of therapy with red yeast rice, the total cholesterol level was significantly decreased by 17.1% whereas the reduction of total cholesterol in the control group was 4.8%. In addition, LDL-C in the treatment group was reduced by an average of 24.6% versus an average of 6.3% in the control group. Serum TG were decreased by an average of 19.8% in the treatment group and 9.2% in the control group. HDL-C increased by 12.8% and 4.9% in the treatment and control group respectively. At the end of 8 weeks of treatment, the patients in the treatment group had an average reduction in total cholesterol of 22.7% (p-value < 0.001) versus an average reduction of 7% in the control group. The LDL-C was reduced by 30.9%. This reduction was significantly greater than that in the control group. Also, TG were reduced by 34.1% and 12.8% in the treatment and control groups, respectively. HDL-C at the end of 8 weeks of treatment were increased by 19.9% and 8.4% in the treatment and control group, respectively. This change was also significantly greater in the red yeast rice group than in the positive control group.

During this study, the occurrence of adverse effects was rare. Even in patients who experienced adverse effects, they were mild and resolved quickly. Adverse events that were experienced include heartburn, flatulence, and dizziness.

In conclusion, the authors of this study believe that red yeast rice is a "highly effective and well tolerated dietary supplement that can be used to regulate elevated serum cholesterol and triglycerides." Nevertheless, these findings will be met with some skepticism. Already, red yeast rice supplements are appearing on the US market with little evidence of the safest and most effective dose. It is not known if persons taking prescription drugs to control lipid levels may experience drug interactions or allergic reactions to this product.

References

Wang J, Zongliang L, Chi J, et al. Multicenter clinical trial of the serum lipid-lowering effects of a Monascus Purpureus (Red Yeast) rice preparation from traditional Chinese medicine. Current Therapeutic Research 1997;58(12):964-78.

© 1998 VirSci Corporation.