Red yeast rice is made from fermented rice containing the mold, Monascus purpureus and is also marketed as Cholestin and Xuezhikang supplements.  It is most known for its lipid lowering properties and possibly reduced risk for cardiovascular events.  The lipid lowering effects appear to reduce the total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C), triglycerides (TG) and possibly increase the high density lipoprotein cholesterol (HDL-C).1-13  For an explanation for how red yeast rice is able to improve the lipid profile, please review volume 2, issue 44 in the Natural Medicines archives.1-10

The table below summarizes the effects of red yeast rice on the various lipid indices or parameters.1-10  As noted, the majority of the literature and lipid lowering effects reflect the use of red yeast rice in doses totaling 1200 mg per day (usually given as 600 mg twice daily by mouth).  While 2400 mg daily has also been studied, it is difficult to discern whether this additional dose confers any additional lipid lowering benefits that are of clinical significance.  The average change in lipid parameters are as follows:  a reduction in TC by 11-30%, reduction in TG by 10-43%, reduction in LDL-C by 17-35%, and an increase in HDL up to 22%.  There is also some limited data suggesting that red yeast rice can also reduce c-reactive protein (CRP) levels.2,3,11

The consistency in the changes of the lipid profile across several different studies would suggest that red yeast rice in doses of at least 600 mg by mouth twice daily does provide a beneficial effect.  Whether or not these improvements in lipid parameters helps patients to achieve their patient specific cholesterol goals or if it translates into an improvement in mortality across all patient populations is not definitively known.

References:

1. Li JJ, Wang Y, Nie SP et al.  Xuezhikang, an extract of cholestin, decreases plasma inflammatory markers and endothelin-1, improve exercise-induced ischemia and subjective feelings in patients with cardiac syndrome X.  Int J Card 2007;122:82-4.  
2. Hu Cl, Li YB, Tang YH et al.  Effects of withdrawal of Xuezhikang, an extract of cholestin, on lipid profile and C-reactive protein: a short-term time course study in patients with coronary artery disease.  Cariovasc Drugs Ther 2006;20:185-191.  
3. Li JJ, Hu SS, Fang CH et al.  Effects of xuezhikang, an extract of cholestin, on lipid profile and C-reactive protein: a short-term course study in patients with stable angina.  Clinica Chimica Acta  2005;352:217-24.  
4. Cicero AFG, Brancaleoni M, Laghi L et al.  Antihyperlipidaemic effect of a Monascus purpureus brand dietary supplement on a large sample of subjects at low risk for cardiovascular disease: a pilot study.  Complement Ther Med  2005;13:273-8.  
5. Zhao SP, Liu L, Cheng YC et al.  Effects of xuezhikang, a cholestin extract, on reflecting postprandial triglyceridemia after a high-fat meal in patients with coronary heart disease.  Atherosclerosis  2003;168:375-80.  
6. Keithley JK, Swanson B, Sha BE et al.  A pilot study of the safety and efficacy of cholestin in treating HIV-related dyslipidemia.  Nutrition  2002;18:201-4. 
7. Gheith O, Sheashaa H, Abdelsalam M et al.  Efficacy and safety of Monascus purpureus Went rice in subjects with secondary hyperlipidemia.  Clin Exp Nephrol 2008;12:189-194.  
8. Liu L, Zhao SP, Cheng YC et al. Xuezhikang decreases serum lipoprotein(a) and C-reactive protein concentrations in patients with coronary heart disease.  Clinical Chemistry  2003;49:1347-1352.  
9. Lin CC, Li TC, Lai MM.  Efficacy and safety of Monascus purpureus Went rice in subjects with hyperlipidemia.  Eur J Endocrinol 2005;153:679-86. 
10. Zhao SP, Lu ZL, Du BM et al.  Xuezhikang, an extract of cholestin, reduces cardiovascular events in type 2 diabetes patients with coronary heart disease: subgroup analysis of patients with type 2 diabetes from China coronary secondary prevention study (CCSPS).  J Card Pharmacol  2007;49:81-4. 
11. Li JJ, Lu ZL, Kou WR et al.  Beneficial impact of Xuezhikang on cardiovascular events and mortality in elderly hypertensive patients with previous myocardial infarction from China Coronary Secondary Prevention Study (CCSPS).  J Clin Pharmacol  2009;49:947-956.  
12. Lu Z, Kou W, Du B 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;101:1689-93.  
13. Lu ZL, Collaborative Group for China Coronary Secondary Prevention Using Xuezhikang.  China coronary secondary prevention study (CCSPS).  Zhonghua Xin Xue Guan Bing Za Zhi  2005;33:109-15.
14. Food and Drug Administration.  FDA warns consumers to avoid red yeast rice products promoted on internet as treatments for high cholesterol products found to contain unauthorized drug.  FDA News Release.  August 9, 2007.

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