Red Yeast Rice and Cholesterol

  • Medical Author:
    Dennis Lee, MD

    Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Who are suitable candidates for red yeast rice products?

There is not yet consensus among scientists and doctors as to the role, if any, of red yeast rice in treating elevated cholesterol. Therefore a doctor familiar with a patient's personal medical condition and his/her family history of heart diseases should be prescribing cholesterol-lowering measures.

Generally in the United States, when diet,weight loss, and exercise are insufficient in lowering cholesterol to optimal levels, many doctors recommend using a statin drug since large long-term trials have consistently shown that statins [such as pravastatin (Pravachol), simvastatin (Zocor), lovastatin (Mevacor), and atorvastatin (Lipitor)] are safe and effective in lowering LDL cholesterol and decreasing the risk of heart attacks and strokes.

Although similar studies are not available for red yeast rice products, given the minimal amounts of cholesterol lowering substances that they are allowed to contain in the U.S., it would be expected that legal red yeast rice products would not be very effective at lowering cholesterol levels.

Who are not suitable candidates for red yeast rice products?

Patients with moderate to severe cholesterol abnormalities, and patients who are at high risk of developing heart attacks or strokes are not candidates for red yeast rice. Examples of patients that are at high risk of heart attacks include

  • patients who had prior heart attacks and strokes,
  • patients with diabetes mellitus, and
  • patients with atherosclerosis in the arteries that supply blood to the brain and to the extremities (peripheral artery disease).

In these patients, red yeast rice containing legal amounts of cholesterol lowering substances (along with weight loss, diet, and exercise) is not potent enough to achieve the degree of cholesterol lowering desired.

Medically reviewed by Robert J. Bryg, MD; Board Certified Internal Medicine with subspecialty in Cardiovascular Disease


American Journal of Clinical Nutrition (1999; 69:231-7)

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