RYR has a long history of use in East Asia as both a traditional medicine and food. In <a href="/other/traditional-chinese-medicine/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Traditional Chinese Medicine&lt;/h6&gt;&lt;p&gt;Traditional Chinese Medicine (TCM) is a collection of herbs, fungi, or berries that have historical usage as medicine in mainland China and sometimes nearby areas.&lt;/p&gt;&lt;/div&gt;">traditional Chinese medicine</a>, the first record of its use dates back to the Tang Dynasty (618–907 A.D.). RYR was used for enhancing blood circulation, reducing blood stasis and turbidity, strengthening the spleen, and promoting digestion, as well as treating limb weakness, diarrhea, and bone defects.<a href="#ref-7" id="ref-link-7" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Zhu B, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/31849687" target="\_blank" rel="noopener noreferrer"&gt;Red Yeast Rice: A Systematic Review of the Traditional Uses, Chemistry, Pharmacology, and Quality Control of an Important Chinese Folk Medicine.
&lt;/a&gt;&lt;/p&gt;Front Pharmacol (2019)&lt;/div&gt;'>[7]</a><a href="#ref-23" id="ref-link-23" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Bin Wu, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/32832555" target="\_blank" rel="noopener noreferrer"&gt;Promotion of Bone Formation by Red Yeast Rice in Experimental Animals: A Systematic Review and Meta-Analysis
&lt;/a&gt;&lt;/p&gt;Biomed Res Int (2020 Aug 8)&lt;/div&gt;'>[23]</a> Apart from its use as a medicine, RYR has long been used to produce alcoholic beverages and a variety of fermented foods, and as a food additive to enhance flavor, add color, and act as a natural preservative.<a href="#ref-27" id="ref-link-27" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Fukami H, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/33803982" target="\_blank" rel="noopener noreferrer"&gt;A Review of Red Yeast Rice, a Traditional Fermented Food in Japan and East Asia: Its Characteristic Ingredients and Application in the Maintenance and Improvement of Health in Lipid Metabolism and the Circulatory System.
&lt;/a&gt;&lt;/p&gt;Molecules (2021-Mar-15)&lt;/div&gt;'>[27]</a>

What are the traditional uses of red yeast rice?

Red yeast rice (RYR) is a fermented rice with a long history of use as a food and medicine in East Asia.<a href="#ref-8" id="ref-link-8" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Buzzelli L, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/37931717" target="\_blank" rel="noopener noreferrer"&gt;Alternative lipid lowering strategies: State-of-the-art review of red yeast rice.
&lt;/a&gt;&lt;/p&gt;Fitoterapia (2023-Nov-04)&lt;/div&gt;'>[8]</a> RYR is produced by fermenting white rice (Oryza sativa) with an edible fungus, most commonly Monascus purpureus, which results in the production of a variety of bioactive compounds and pigments, the latter of which imparts a reddish-purple color to the rice.<a href="#ref-7" id="ref-link-7" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Zhu B, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/31849687" target="\_blank" rel="noopener noreferrer"&gt;Red Yeast Rice: A Systematic Review of the Traditional Uses, Chemistry, Pharmacology, and Quality Control of an Important Chinese Folk Medicine.
&lt;/a&gt;&lt;/p&gt;Front Pharmacol (2019)&lt;/div&gt;'>[7]</a> The primary active compound in RYR is thought to be monacolin K, which is structurally identical to the cholesterol-lowering medication lovastatin.<a href="#ref-7" id="ref-link-7" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Zhu B, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/31849687" target="\_blank" rel="noopener noreferrer"&gt;Red Yeast Rice: A Systematic Review of the Traditional Uses, Chemistry, Pharmacology, and Quality Control of an Important Chinese Folk Medicine.
&lt;/a&gt;&lt;/p&gt;Front Pharmacol (2019)&lt;/div&gt;'>[7]</a> However, the type and amount of monacolins present in RYR can vary depending on the fermentation conditions and the type of yeast used.<a href="#ref-9" id="ref-link-9" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Fogacci F, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/30844537" target="\_blank" rel="noopener noreferrer"&gt;Safety of red yeast rice supplementation: A systematic review and meta-analysis of randomized controlled trials.
&lt;/a&gt;&lt;/p&gt;Pharmacol Res (2019-May)&lt;/div&gt;'>[9]</a> The majority of research on RYR has examined its effects on <a href="/conditions/dyslipidemia/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Dyslipidemia&lt;/h6&gt;&lt;p&gt;Dyslipidemia is an imbalance in blood lipids in the body including cholesterol and triglycerides. Poor diet, tobacco use, and genetic factors can all contribute to dyslipidemia.&lt;/p&gt;&lt;/div&gt;">dyslipidemia</a> and <a href="/conditions/general-cardiovascular-health/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;General Cardiovascular Health&lt;/h6&gt;&lt;p&gt;Cardiovascular health refers to the overall ability of the heart and blood vessels to distribute blood, nutrients, and gasses throughout the body.&lt;/p&gt;&lt;/div&gt;">general cardiovascular health</a>, with promising results.

What is red yeast rice?

There is currently a lack of evidence to suggest that RYR supplementation promotes bone health. In animal studies, RYR seems to increase the proliferation of osteoblasts (cells involved in bone formation), increase <a href="/outcomes/bone-specific-alkaline-phosphatase/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Bone-specific Alkaline Phosphatase&lt;/h6&gt;&lt;p&gt;Bone-specific alkaline phosphatase is an enzyme produced by osteoblasts (bone cells). It is thought to function in calcification of the bone matrix and is a marker of bone health.&lt;/p&gt;&lt;/div&gt;">alkaline phosphatase</a>, and increase <a href="/outcomes/bone-mineral-density/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Bone Mineral Density&lt;/h6&gt;&lt;p&gt;Bone mineral density (BMD) is the density of mineral in bone tissue (more mass in the same area causing an increase in density), and is thought to reflect structural integrity of bones. Improving BMD reduces the risk of osteoporosis and falls in the elderly.&lt;/p&gt;&lt;/div&gt;">bone mineral density</a>.<a href="#ref-23" id="ref-link-23" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Bin Wu, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/32832555" target="\_blank" rel="noopener noreferrer"&gt;Promotion of Bone Formation by Red Yeast Rice in Experimental Animals: A Systematic Review and Meta-Analysis
&lt;/a&gt;&lt;/p&gt;Biomed Res Int (2020 Aug 8)&lt;/div&gt;'>[23]</a> However, these effects have not been validated in human clinical trials. Interestingly, <a href="/glossary/observational-study/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Observational study&lt;/h6&gt;&lt;p&gt;An observational study is designed to find a relationship between natural exposures and outcomes. There are no intentional interventions by researchers in observational studies and a cause-and-effect relationship usually cannot be determined.&lt;/p&gt;&lt;/div&gt;">observational research</a> on statin medications suggests that statin therapy is associated with a reduced risk of fractures, but the few <a href="/glossary/randomized-controlled-trial/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Randomized controlled trial&lt;/h6&gt;&lt;p&gt;Randomized controlled trials (RCTs) are the gold standard for determining whether an intervention actually causes any effects. The use of randomization and control groups helps eliminate the effects of factors other than the treatment being studied.&lt;/p&gt;&lt;/div&gt;">randomized controlled trials</a> that have been done have generally not found an effect of statins on <a href="/outcomes/bone-mineral-density/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Bone Mineral Density&lt;/h6&gt;&lt;p&gt;Bone mineral density (BMD) is the density of mineral in bone tissue (more mass in the same area causing an increase in density), and is thought to reflect structural integrity of bones. Improving BMD reduces the risk of osteoporosis and falls in the elderly.&lt;/p&gt;&lt;/div&gt;">bone mineral density</a>.<a href="#ref-24" id="ref-link-24" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;An T, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/27888285" target="\_blank" rel="noopener noreferrer"&gt;Efficacy of statins for osteoporosis: a systematic review and meta-analysis.
&lt;/a&gt;&lt;/p&gt;Osteoporos Int (2017-Jan)&lt;/div&gt;'>[24]</a>

Does red yeast rice impact bone health?

While RYR has demonstrated lipid-modulating efficacy comparable to moderate-intensity statin therapy, there are several important factors that prevent it from being a replacement for statin medications. First, there is a much larger body of evidence supporting the effectiveness and relative safety of statin medications compared to RYR both in the short-term and long-term, and it is well established that statins can lower <a href="/outcomes/ldl-c/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Low-density lipoprotein (LDL)&lt;/h6&gt;&lt;p&gt;LDL carries cholesterol from the liver to other parts of the body. Because higher levels of LDL cholesterol (LDL-C) tend to increase the risk of cardiovascular disease (CVD), LDL-C is often called the “bad cholesterol” (as opposed to HDL-C) — but the reality is more complex.&lt;/p&gt;&lt;/div&gt;">LDL</a> cholesterol and reduce the risk of heart attacks, strokes, and mortality.<a href="#ref-25" id="ref-link-25" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Chou R, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/35997724" target="\_blank" rel="noopener noreferrer"&gt;Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.
&lt;/a&gt;&lt;/p&gt;JAMA (2022-Aug-23)&lt;/div&gt;'>[25]</a><a href="#ref-26" id="ref-link-26" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Mills EJ, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/20934984" target="\_blank" rel="noopener noreferrer"&gt;Efficacy and safety of statin treatment for cardiovascular disease: a network meta-analysis of 170,255 patients from 76 randomized trials.
&lt;/a&gt;&lt;/p&gt;QJM (2011-Feb)&lt;/div&gt;'>[26]</a> As prescription medications, the quality of statins is tightly regulated, and you can be highly confident that your medication contains the labeled amount of the active ingredient. As a supplement, RYR is not regulated for quality and batch-to-batch variability, and poor manufacturing practices can result in both inadequate or unknown amounts of the active compounds, and an increased likelihood of the supplement containing potentially harmful compounds. Additionally, in some countries (including Canada and the US), the sale of RYR supplements with anything more than trace amounts of monacolin K is prohibited, which would be expected to dramatically reduce its effectiveness.

Can red yeast rice be a replacement for statin medications?

In clinical trials, RYR consistently demonstrates the ability to improve lipid profiles in people with <a href="/conditions/dyslipidemia/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Dyslipidemia&lt;/h6&gt;&lt;p&gt;Dyslipidemia is an imbalance in blood lipids in the body including cholesterol and triglycerides. Poor diet, tobacco use, and genetic factors can all contribute to dyslipidemia.&lt;/p&gt;&lt;/div&gt;">dyslipidemia</a>. RYR seems to reduce low-density lipoprotein (<a href="/outcomes/ldl-c/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Low-density lipoprotein (LDL)&lt;/h6&gt;&lt;p&gt;LDL carries cholesterol from the liver to other parts of the body. Because higher levels of LDL cholesterol (LDL-C) tend to increase the risk of cardiovascular disease (CVD), LDL-C is often called the “bad cholesterol” (as opposed to HDL-C) — but the reality is more complex.&lt;/p&gt;&lt;/div&gt;">LDL</a>) cholesterol, triglyercides, <a href="/outcomes/total-cholesterol/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Total cholesterol&lt;/h6&gt;&lt;p&gt;Total cholesterol refers to all the cholesterol in your blood (HDL-C and LDL-C). It is distinct from triglycerides.&lt;/p&gt;&lt;/div&gt;">total cholesterol</a>, and <a href="/outcomes/apolipoprotein-b/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Apolipoprotein B&lt;/h6&gt;&lt;p&gt;Apolipoprotein B is the primary apolipoprotein (the protein part of a lipoprotein) for &lt;em&gt;low-density lipoprotein&lt;/em&gt; (LDL), the lipoprotein found in LDL cholesterol. Higher circulating levels of apolipoprotein B is likely the key factor that allows for fatty plaque to build-up in arteries.&lt;/p&gt;&lt;/div&gt;">apolipoprotein B</a>; it also seems to increase high-density lipoprotein (<a href="/outcomes/hdl/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;High-density lipoprotein (HDL)&lt;/h6&gt;&lt;p&gt;&lt;em&gt;High-density lipoprotein&lt;/em&gt; (HDL) is a particle that carries cholesterol from your blood to your liver. Low levels of &lt;em&gt;HDL cholesterol&lt;/em&gt; (HDL-C) are associated with a higher risk of &lt;em&gt;cardiovascular disease&lt;/em&gt; (CVD), which is why HDL-C is often called the “good cholesterol” (as opposed to LDL-C) — but the reality is more complex.&lt;/p&gt;&lt;/div&gt;">HDL</a>) cholesterol.<a href="#ref-5" id="ref-link-5" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Li P, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/35111069" target="\_blank" rel="noopener noreferrer"&gt;Red Yeast Rice for Hyperlipidemia: A Meta-Analysis of 15 High-Quality Randomized Controlled Trials.
&lt;/a&gt;&lt;/p&gt;Front Pharmacol (2021)&lt;/div&gt;'>[5]</a><a href="#ref-10" id="ref-link-10" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Rahmani P, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/36259545" target="\_blank" rel="noopener noreferrer"&gt;Impact of red yeast rice supplementation on lipid profile: a systematic review and meta-analysis of randomized-controlled trials.
&lt;/a&gt;&lt;/p&gt;Expert Rev Clin Pharmacol (2023-Jan)&lt;/div&gt;'>[10]</a> Overall, RYR is thought to reduce LDL cholesterol by 15 to 25% within 6 to 8 weeks, and its effect on lipid profiles is comparable to moderate-intensity statin medications (first-line cholesterol-lowering medications).<a href="#ref-11" id="ref-link-11" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Arrigo F G Cicero, Federica Fogacci, Alberto Zambon. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/33538260" target="\_blank" rel="noopener noreferrer"&gt;Red Yeast Rice for Hypercholesterolemia: JACC Focus Seminar
&lt;/a&gt;&lt;/p&gt;J Am Coll Cardiol (2021 Feb 9)&lt;/div&gt;'>[11]</a><a href="#ref-5" id="ref-link-5" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Li P, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/35111069" target="\_blank" rel="noopener noreferrer"&gt;Red Yeast Rice for Hyperlipidemia: A Meta-Analysis of 15 High-Quality Randomized Controlled Trials.
&lt;/a&gt;&lt;/p&gt;Front Pharmacol (2021)&lt;/div&gt;'>[5]</a> RYR may improve markers of <a href="/conditions/atherosclerosis/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Atherosclerosis&lt;/h6&gt;&lt;p&gt;Atherosclerosis is the buildup of lipid-rich plaque on arteries’ interior lining. While symptomless early on, it can lead to artery blockage and increased clot formation, which can cause a wide range of serious diseases, most commonly coronary heart disease and stroke. Lifestyle factors, such as poor diet, little exercise, and smoking, can be integral in the progression of atherosclerosis and its associated diseases.&lt;/p&gt;&lt;/div&gt;">atherosclerosis</a> and protect against <a href="/outcomes/major-adverse-cardiac-events-mace/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Major Adverse Cardiac Events&lt;/h6&gt;&lt;p&gt;Major adverse cardiac events (MACE), also known as major adverse cardiovascular events, is an umbrella term that represents a variety of severe cardiovascular outcomes. There is no standardized definition of MACE and it varies between studies, but it can include nonfatal Heart Attack Risk|heart attack, nonfatal stroke risk|stroke, cardiovascular disease mortality|cardiovascular mortality, all-cause mortality, unstable angina, heart failure risk|heart failure, and unplanned coronary revascularization. MACE is used as a composite endpoint in research to help evaluate the effectiveness of an intervention in preventing serious cardiovascular events.&lt;/p&gt;&lt;/div&gt;">major adverse cardiac events</a>; however, most of this research has been conducted in Chinese populations, and its generalizability to other populations is not clearly established.<a href="#ref-3" id="ref-link-3" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Wang S, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/36120360" target="\_blank" rel="noopener noreferrer"&gt;Effectiveness of red yeast rice on carotid atherosclerosis: A systematic review and meta-analysis.
&lt;/a&gt;&lt;/p&gt;Front Pharmacol (2022)&lt;/div&gt;'>[3]</a><a href="#ref-12" id="ref-link-12" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Yuan R, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/35264949" target="\_blank" rel="noopener noreferrer"&gt;Red Yeast Rice Preparations Reduce Mortality, Major Cardiovascular Adverse Events, and Risk Factors for Metabolic Syndrome: A Systematic Review and Meta-analysis.
&lt;/a&gt;&lt;/p&gt;Front Pharmacol (2022)&lt;/div&gt;'>[12]</a><a href="#ref-4" id="ref-link-4" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Sungthong B, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/32066811" target="\_blank" rel="noopener noreferrer"&gt;Efficacy of red yeast rice extract on myocardial infarction patients with borderline hypercholesterolemia: A meta-analysis of randomized controlled trials.
&lt;/a&gt;&lt;/p&gt;Sci Rep (2020-Feb-17)&lt;/div&gt;'>[4]</a> RYR may also reduce systemic inflammation, as suggested by reductions in <a href="/outcomes/c-reactive-protein/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;C-Reactive Protein (CRP)&lt;/h6&gt;&lt;p&gt;C-Reactive protein is a biomarker of systemic inflammation. It's often used as a marker of cardiovascular disease risk, although it doesn't necessarily contribute directly to cardiovascular conditions.&lt;/p&gt;&lt;/div&gt;">C-reactive protein</a>, although this effect is less thoroughly researched.<a href="#ref-13" id="ref-link-13" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Li JJ, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/15653117" target="\_blank" rel="noopener noreferrer"&gt;Effects of xuezhikang, an extract of cholestin, on lipid profile and C-reactive protein: a short-term time course study in patients with stable angina.
&lt;/a&gt;&lt;/p&gt;Clin Chim Acta (2005-Feb)&lt;/div&gt;'>[13]</a><a href="#ref-14" id="ref-link-14" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Zhao SP, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/15313947" target="\_blank" rel="noopener noreferrer"&gt;Xuezhikang, an extract of cholestin, protects endothelial function through antiinflammatory and lipid-lowering mechanisms in patients with coronary heart disease.
&lt;/a&gt;&lt;/p&gt;Circulation (2004-Aug-24)&lt;/div&gt;'>[14]</a><a href="#ref-15" id="ref-link-15" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Liu L, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/12881451" target="\_blank" rel="noopener noreferrer"&gt;Xuezhikang decreases serum lipoprotein(a) and C-reactive protein concentrations in patients with coronary heart disease.
&lt;/a&gt;&lt;/p&gt;Clin Chem (2003-Aug)&lt;/div&gt;'>[15]</a>

What are red yeast rice’s main benefits?

RYR appears to be well-tolerated by most people, and generally, studies have not found differences in rates of side effects between RYR and placebo.<a href="#ref-9" id="ref-link-9" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Fogacci F, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/30844537" target="\_blank" rel="noopener noreferrer"&gt;Safety of red yeast rice supplementation: A systematic review and meta-analysis of randomized controlled trials.
&lt;/a&gt;&lt;/p&gt;Pharmacol Res (2019-May)&lt;/div&gt;'>[9]</a><a href="#ref-16" id="ref-link-16" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Gerards MC, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/25897793" target="\_blank" rel="noopener noreferrer"&gt;Traditional Chinese lipid-lowering agent red yeast rice results in significant LDL reduction but safety is uncertain - a systematic review and meta-analysis.
&lt;/a&gt;&lt;/p&gt;Atherosclerosis (2015-Jun)&lt;/div&gt;'>[16]</a> Despite this, several case reports have suggested that, on rare occasions, RYR supplementation at normal dosages (equivalent to 3–10 mg daily of monacolin K) may cause rhabdomyolysis (dangerous muscle breakdown) or hepatitis (liver inflammation).<a href="#ref-17" id="ref-link-17" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Banach M, Norata GD. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/37831308" target="\_blank" rel="noopener noreferrer"&gt;Rhabdomyolysis or Severe Acute Hepatitis Associated with the Use of Red Yeast Rice Extracts: an Update from the Adverse Event Reporting Systems.
&lt;/a&gt;&lt;/p&gt;Curr Atheroscler Rep (2023-Nov)&lt;/div&gt;'>[17]</a> Rhabdomyolysis is a known risk of treatment with prescription statin medications, including lovastatin, and is estimated to occur in 1 in every 10,000 people.<a href="#ref-18" id="ref-link-18" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Bhavin B Adhyaru, Terry A Jacobson. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/30375494" target="\_blank" rel="noopener noreferrer"&gt;Safety and efficacy of statin therapy
&lt;/a&gt;&lt;/p&gt;Nat Rev Cardiol (2018 Dec)&lt;/div&gt;'>[18]</a><a href="#ref-19" id="ref-link-19" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Mendes P, Robles PG, Mathur S. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/24799748" target="\_blank" rel="noopener noreferrer"&gt;Statin-induced rhabdomyolysis: a comprehensive review of case reports.
&lt;/a&gt;&lt;/p&gt;Physiother Can (2014)&lt;/div&gt;'>[19]</a> Hepatitis has also very rarely been observed with lovastatin treatment.<a href="#ref-20" id="ref-link-20" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Perdices EV, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/25075655" target="\_blank" rel="noopener noreferrer"&gt;Hepatotoxicity associated with statin use: analysis of the cases included in the Spanish Hepatotoxicity Registry.
&lt;/a&gt;&lt;/p&gt;Rev Esp Enferm Dig (2014-Apr)&lt;/div&gt;'>[20]</a> Additionally, RYR supplements can contain citrinin which is a potentially harmful compound produced during fermentation. Citrinin can be toxic to the liver and kidneys and care should be taken to choose an RYR supplement that is citrinin-free.<a href="#ref-7" id="ref-link-7" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Zhu B, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/31849687" target="\_blank" rel="noopener noreferrer"&gt;Red Yeast Rice: A Systematic Review of the Traditional Uses, Chemistry, Pharmacology, and Quality Control of an Important Chinese Folk Medicine.
&lt;/a&gt;&lt;/p&gt;Front Pharmacol (2019)&lt;/div&gt;'>[7]</a>
Importantly, monacolin K is metabolized by cytochrome P450 3A4 (CYP3A4) enzymes. Medications or foods that inhibit CYP3A4 (e.g., verapamil, clarithromycin, ketoconazole, ritonavir, grapefruit) can lead to increased levels of monacolin K in the blood and this combination should be avoided.<a href="#ref-9" id="ref-link-9" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Fogacci F, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/30844537" target="\_blank" rel="noopener noreferrer"&gt;Safety of red yeast rice supplementation: A systematic review and meta-analysis of randomized controlled trials.
&lt;/a&gt;&lt;/p&gt;Pharmacol Res (2019-May)&lt;/div&gt;'>[9]</a> Additionally, RYR should not be taken in addition to statin medications. This combination may increase the risk of serious side effects and isn’t likely to provide additional therapeutic benefits.<a href="#ref-17" id="ref-link-17" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Banach M, Norata GD. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/37831308" target="\_blank" rel="noopener noreferrer"&gt;Rhabdomyolysis or Severe Acute Hepatitis Associated with the Use of Red Yeast Rice Extracts: an Update from the Adverse Event Reporting Systems.
&lt;/a&gt;&lt;/p&gt;Curr Atheroscler Rep (2023-Nov)&lt;/div&gt;'>[17]</a><a href="#ref-5" id="ref-link-5" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Li P, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/35111069" target="\_blank" rel="noopener noreferrer"&gt;Red Yeast Rice for Hyperlipidemia: A Meta-Analysis of 15 High-Quality Randomized Controlled Trials.
&lt;/a&gt;&lt;/p&gt;Front Pharmacol (2021)&lt;/div&gt;'>[5]</a>
Lastly, there is a concerning degree of variability in the content of monacolin K in RYR, and most supplements are not transparent about how much of this active compound they contain. For example, a study conducted in the United States found that the amount of monacolin K in 26 tested supplements differed up to 60-fold.<a href="#ref-21" id="ref-link-21" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Cohen PA, Avula B, Khan IA. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/28641460" target="\_blank" rel="noopener noreferrer"&gt;Variability in strength of red yeast rice supplements purchased from mainstream retailers.
&lt;/a&gt;&lt;/p&gt;Eur J Prev Cardiol (2017-Sep)&lt;/div&gt;'>[21]</a> This could lead to inconsistencies in the effectiveness of RYR supplementation.

What are red yeast rice’s main drawbacks?

RYR contains a variety of compounds with biological activity, but monacolins — a class of metabolites produced through fungal fermentation — are considered the main active ingredients. Monacolins, particularly monacolin K, work in the same way as statin medications, which involves the inhibition of a key enzyme involved in cholesterol synthesis, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase.<a href="#ref-4" id="ref-link-4" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Sungthong B, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/32066811" target="\_blank" rel="noopener noreferrer"&gt;Efficacy of red yeast rice extract on myocardial infarction patients with borderline hypercholesterolemia: A meta-analysis of randomized controlled trials.
&lt;/a&gt;&lt;/p&gt;Sci Rep (2020-Feb-17)&lt;/div&gt;'>[4]</a> Therefore, RYR effectively reduces the body's own synthesis of cholesterol. Interestingly, the pigments found in RYR may also contribute to this lipid-lowering effect. Animal research suggests that these pigments may influence lipid metabolism and lead to an increase in the excretion of cholesterol, triglycerides, and bile acids in the feces.<a href="#ref-22" id="ref-link-22" class="ref-link popover" data-tooltip='&lt;div&gt;&lt;p class="mb-3"&gt;Zhou W, et al. &lt;a href="https://pubmed.ncbi.nlm.nih.gov/30720827" target="\_blank" rel="noopener noreferrer"&gt;Monascus yellow, red and orange pigments from red yeast rice ameliorate lipid metabolic disorders and gut microbiota dysbiosis in Wistar rats fed on a high-fat diet.
&lt;/a&gt;&lt;/p&gt;Food Funct (2019-Feb-20)&lt;/div&gt;'>[22]</a>

How does red yeast rice work?

Red Yeast Rice

Cardiovascular Health

Red Yeast Rice: What You Need To Know

Defined Organism Substance - Monascus

Effectiveness of red yeast rice on carotid atherosclerosis: A systematic review and meta-analysis.

Efficacy of red yeast rice extract on myocardial infarction patients with borderline hypercholesterolemia: A meta-analysis of randomized controlled trials.

Red Yeast Rice for Hyperlipidemia: A Meta-Analysis of 15 High-Quality Randomized Controlled Trials.

The effects of red yeast rice dietary supplement on blood pressure, lipid profile, and C-reactive protein in hypertension: A systematic review.

Red Yeast Rice: A Systematic Review of the Traditional Uses, Chemistry, Pharmacology, and Quality Control of an Important Chinese Folk Medicine.

Alternative lipid lowering strategies: State-of-the-art review of red yeast rice.

Safety of red yeast rice supplementation: A systematic review and meta-analysis of randomized controlled trials.

Impact of red yeast rice supplementation on lipid profile: a systematic review and meta-analysis of randomized-controlled trials.

Red Yeast Rice for Hypercholesterolemia: JACC Focus Seminar

Red Yeast Rice Preparations Reduce Mortality, Major Cardiovascular Adverse Events, and Risk Factors for Metabolic Syndrome: A Systematic Review and Meta-analysis.

Effects of xuezhikang, an extract of cholestin, on lipid profile and C-reactive protein: a short-term time course study in patients with stable angina.

Xuezhikang, an extract of cholestin, protects endothelial function through antiinflammatory and lipid-lowering mechanisms in patients with coronary heart disease.

Xuezhikang decreases serum lipoprotein(a) and C-reactive protein concentrations in patients with coronary heart disease.

Traditional Chinese lipid-lowering agent red yeast rice results in significant LDL reduction but safety is uncertain - a systematic review and meta-analysis.

Rhabdomyolysis or Severe Acute Hepatitis Associated with the Use of Red Yeast Rice Extracts: an Update from the Adverse Event Reporting Systems.

Safety and efficacy of statin therapy

Statin-induced rhabdomyolysis: a comprehensive review of case reports.

Hepatotoxicity associated with statin use: analysis of the cases included in the Spanish Hepatotoxicity Registry.

Variability in strength of red yeast rice supplements purchased from mainstream retailers.

Monascus yellow, red and orange pigments from red yeast rice ameliorate lipid metabolic disorders and gut microbiota dysbiosis in Wistar rats fed on a high-fat diet.

Promotion of Bone Formation by Red Yeast Rice in Experimental Animals: A Systematic Review and Meta-Analysis

Efficacy of statins for osteoporosis: a systematic review and meta-analysis.

Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.

Efficacy and safety of statin treatment for cardiovascular disease: a network meta-analysis of 170,255 patients from 76 randomized trials.

A Review of Red Yeast Rice, a Traditional Fermented Food in Japan and East Asia: Its Characteristic Ingredients and Application in the Maintenance and Improvement of Health in Lipid Metabolism and the Circulatory System.

Nick Milazzo

Natalka Roshak

Katie Jantz

Atherosclerosis

Atherosclerotic Signs

Diabetes & Blood Sugar

Type 2 Diabetes

Low-density lipoprotein (LDL)

High-density lipoprotein (HDL)

Total cholesterol

Triglycerides

Cardiovascular Disease

Heart Attack Risk

Cardiovascular Disease Mortality

General Cardiovascular Health

Dyslipidemia

Apolipoprotein B

Apolipoprotein A

Xuezhikang Capsule for Type 2 Diabetes with Hyperlipemia: A Systematic Review and Meta-Analysis of Randomized Clinical Trails.

RYR has a long history of use in East Asia as both a traditional medicine and food. In <a href="/other/traditional-chinese-medicine/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Traditional Chinese Medicine&lt;/h6&gt;&lt;p&gt;Traditional Chinese Medicine (TCM) is a collection of herbs, fungi, or berries that have historical usage as medicine in mainland China and sometimes nearby areas.&lt;/p&gt;&lt;/div&gt;">traditional Chinese medicine</a>, the first record of its use dates back to the Tang Dynasty (618–907 A.D.). RYR was used for enhancing blood circulation, reducing blood stasis and turbidity, strengthening the spleen, and promoting digestion, as well as treating limb weakness, diarrhea, and bone defects.[reference|url=https://pubmed.ncbi.nlm.nih.gov/31849687|title=Red Yeast Rice: A Systematic Review of the Traditional Uses, Chemistry, Pharmacology, and Quality Control of an Important Chinese Folk Medicine.|published=2019|authors=Zhu B, Qi F, Wu J, Yin G, Hua J, Zhang Q, Qin L|journal=Front Pharmacol|][reference|url=https://pubmed.ncbi.nlm.nih.gov/32832555|title=Promotion of Bone Formation by Red Yeast Rice in Experimental Animals: A Systematic Review and Meta-Analysis|published=2020 Aug 8|authors=Bin Wu, Jie-Feng Huang, Bang-Jian He, Chen-Wei Huang, Jian-Hua Lu|journal=Biomed Res Int|] Apart from its use as a medicine, RYR has long been used to produce alcoholic beverages and a variety of fermented foods, and as a food additive to enhance flavor, add color, and act as a natural preservative.[reference|url=https://pubmed.ncbi.nlm.nih.gov/33803982|title=A Review of Red Yeast Rice, a Traditional Fermented Food in Japan and East Asia: Its Characteristic Ingredients and Application in the Maintenance and Improvement of Health in Lipid Metabolism and the Circulatory System.|published=2021-Mar-15|authors=Fukami H, Higa Y, Hisano T, Asano K, Hirata T, Nishibe S|journal=Molecules|]

Red yeast rice (RYR) is a fermented rice with a long history of use as a food and medicine in East Asia.[reference|url=https://pubmed.ncbi.nlm.nih.gov/37931717|title=Alternative lipid lowering strategies: State-of-the-art review of red yeast rice.|published=2023-Nov-04|authors=Buzzelli L, Segreti A, Di Gioia D, Lemme E, Squeo MR, Nenna A, Di Gioia G|journal=Fitoterapia|] RYR is produced by fermenting white rice (Oryza sativa) with an edible fungus, most commonly Monascus purpureus, which results in the production of a variety of bioactive compounds and pigments, the latter of which imparts a reddish-purple color to the rice.[reference|url=https://pubmed.ncbi.nlm.nih.gov/31849687|title=Red Yeast Rice: A Systematic Review of the Traditional Uses, Chemistry, Pharmacology, and Quality Control of an Important Chinese Folk Medicine.|published=2019|authors=Zhu B, Qi F, Wu J, Yin G, Hua J, Zhang Q, Qin L|journal=Front Pharmacol|] The primary active compound in RYR is thought to be monacolin K, which is structurally identical to the cholesterol-lowering medication lovastatin.[reference|url=https://pubmed.ncbi.nlm.nih.gov/31849687|title=Red Yeast Rice: A Systematic Review of the Traditional Uses, Chemistry, Pharmacology, and Quality Control of an Important Chinese Folk Medicine.|published=2019|authors=Zhu B, Qi F, Wu J, Yin G, Hua J, Zhang Q, Qin L|journal=Front Pharmacol|] However, the type and amount of monacolins present in RYR can vary depending on the fermentation conditions and the type of yeast used.[reference|url=https://pubmed.ncbi.nlm.nih.gov/30844537|title=Safety of red yeast rice supplementation: A systematic review and meta-analysis of randomized controlled trials.|published=2019-May|authors=Fogacci F, Banach M, Mikhailidis DP, Bruckert E, Toth PP, Watts GF, Reiner Ž, Mancini J, Rizzo M, Mitchenko O, Pella D, Fras Z, Sahebkar A, Vrablik M, Cicero AFG, ,|journal=Pharmacol Res|] The majority of research on RYR has examined its effects on <a href="/conditions/dyslipidemia/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Dyslipidemia&lt;/h6&gt;&lt;p&gt;Dyslipidemia is an imbalance in blood lipids in the body including cholesterol and triglycerides. Poor diet, tobacco use, and genetic factors can all contribute to dyslipidemia.&lt;/p&gt;&lt;/div&gt;">dyslipidemia</a> and <a href="/conditions/general-cardiovascular-health/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;General Cardiovascular Health&lt;/h6&gt;&lt;p&gt;Cardiovascular health refers to the overall ability of the heart and blood vessels to distribute blood, nutrients, and gasses throughout the body.&lt;/p&gt;&lt;/div&gt;">general cardiovascular health</a>, with promising results.

There is currently a lack of evidence to suggest that RYR supplementation promotes bone health. In animal studies, RYR seems to increase the proliferation of osteoblasts (cells involved in bone formation), increase <a href="/outcomes/bone-specific-alkaline-phosphatase/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Bone-specific Alkaline Phosphatase&lt;/h6&gt;&lt;p&gt;Bone-specific alkaline phosphatase is an enzyme produced by osteoblasts (bone cells). It is thought to function in calcification of the bone matrix and is a marker of bone health.&lt;/p&gt;&lt;/div&gt;">alkaline phosphatase</a>, and increase <a href="/outcomes/bone-mineral-density/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Bone Mineral Density&lt;/h6&gt;&lt;p&gt;Bone mineral density (BMD) is the density of mineral in bone tissue (more mass in the same area causing an increase in density), and is thought to reflect structural integrity of bones. Improving BMD reduces the risk of osteoporosis and falls in the elderly.&lt;/p&gt;&lt;/div&gt;">bone mineral density</a>.[reference|url=https://pubmed.ncbi.nlm.nih.gov/32832555|title=Promotion of Bone Formation by Red Yeast Rice in Experimental Animals: A Systematic Review and Meta-Analysis|published=2020 Aug 8|authors=Bin Wu, Jie-Feng Huang, Bang-Jian He, Chen-Wei Huang, Jian-Hua Lu|journal=Biomed Res Int|] However, these effects have not been validated in human clinical trials. Interestingly, <a href="/glossary/observational-study/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Observational study&lt;/h6&gt;&lt;p&gt;An observational study is designed to find a relationship between natural exposures and outcomes. There are no intentional interventions by researchers in observational studies and a cause-and-effect relationship usually cannot be determined.&lt;/p&gt;&lt;/div&gt;">observational research</a> on statin medications suggests that statin therapy is associated with a reduced risk of fractures, but the few <a href="/glossary/randomized-controlled-trial/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Randomized controlled trial&lt;/h6&gt;&lt;p&gt;Randomized controlled trials (RCTs) are the gold standard for determining whether an intervention actually causes any effects. The use of randomization and control groups helps eliminate the effects of factors other than the treatment being studied.&lt;/p&gt;&lt;/div&gt;">randomized controlled trials</a> that have been done have generally not found an effect of statins on <a href="/outcomes/bone-mineral-density/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Bone Mineral Density&lt;/h6&gt;&lt;p&gt;Bone mineral density (BMD) is the density of mineral in bone tissue (more mass in the same area causing an increase in density), and is thought to reflect structural integrity of bones. Improving BMD reduces the risk of osteoporosis and falls in the elderly.&lt;/p&gt;&lt;/div&gt;">bone mineral density</a>.[reference|url=https://pubmed.ncbi.nlm.nih.gov/27888285|title=Efficacy of statins for osteoporosis: a systematic review and meta-analysis.|published=2017-Jan|authors=An T, Hao J, Sun S, Li R, Yang M, Cheng G, Zou M|journal=Osteoporos Int|]

While RYR has demonstrated lipid-modulating efficacy comparable to moderate-intensity statin therapy, there are several important factors that prevent it from being a replacement for statin medications. First, there is a much larger body of evidence supporting the effectiveness and relative safety of statin medications compared to RYR both in the short-term and long-term, and it is well established that statins can lower <a href="/outcomes/ldl-c/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Low-density lipoprotein (LDL)&lt;/h6&gt;&lt;p&gt;LDL carries cholesterol from the liver to other parts of the body. Because higher levels of LDL cholesterol (LDL-C) tend to increase the risk of cardiovascular disease (CVD), LDL-C is often called the “bad cholesterol” (as opposed to HDL-C) — but the reality is more complex.&lt;/p&gt;&lt;/div&gt;">LDL</a> cholesterol and reduce the risk of heart attacks, strokes, and mortality.[reference|url=https://pubmed.ncbi.nlm.nih.gov/35997724|title=Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.|published=2022-Aug-23|authors=Chou R, Cantor A, Dana T, Wagner J, Ahmed AY, Fu R, Ferencik M|journal=JAMA|][reference|url=https://pubmed.ncbi.nlm.nih.gov/20934984|title=Efficacy and safety of statin treatment for cardiovascular disease: a network meta-analysis of 170,255 patients from 76 randomized trials.|published=2011-Feb|authors=Mills EJ, Wu P, Chong G, Ghement I, Singh S, Akl EA, Eyawo O, Guyatt G, Berwanger O, Briel M|journal=QJM|] As prescription medications, the quality of statins is tightly regulated, and you can be highly confident that your medication contains the labeled amount of the active ingredient. As a supplement, RYR is not regulated for quality and batch-to-batch variability, and poor manufacturing practices can result in both inadequate or unknown amounts of the active compounds, and an increased likelihood of the supplement containing potentially harmful compounds. Additionally, in some countries (including Canada and the US), the sale of RYR supplements with anything more than trace amounts of monacolin K is prohibited, which would be expected to dramatically reduce its effectiveness.

In clinical trials, RYR consistently demonstrates the ability to improve lipid profiles in people with <a href="/conditions/dyslipidemia/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Dyslipidemia&lt;/h6&gt;&lt;p&gt;Dyslipidemia is an imbalance in blood lipids in the body including cholesterol and triglycerides. Poor diet, tobacco use, and genetic factors can all contribute to dyslipidemia.&lt;/p&gt;&lt;/div&gt;">dyslipidemia</a>. RYR seems to reduce low-density lipoprotein (<a href="/outcomes/ldl-c/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Low-density lipoprotein (LDL)&lt;/h6&gt;&lt;p&gt;LDL carries cholesterol from the liver to other parts of the body. Because higher levels of LDL cholesterol (LDL-C) tend to increase the risk of cardiovascular disease (CVD), LDL-C is often called the “bad cholesterol” (as opposed to HDL-C) — but the reality is more complex.&lt;/p&gt;&lt;/div&gt;">LDL</a>) cholesterol, triglyercides, <a href="/outcomes/total-cholesterol/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Total cholesterol&lt;/h6&gt;&lt;p&gt;Total cholesterol refers to all the cholesterol in your blood (HDL-C and LDL-C). It is distinct from triglycerides.&lt;/p&gt;&lt;/div&gt;">total cholesterol</a>, and <a href="/outcomes/apolipoprotein-b/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Apolipoprotein B&lt;/h6&gt;&lt;p&gt;Apolipoprotein B is the primary apolipoprotein (the protein part of a lipoprotein) for &lt;em&gt;low-density lipoprotein&lt;/em&gt; (LDL), the lipoprotein found in LDL cholesterol. Higher circulating levels of apolipoprotein B is likely the key factor that allows for fatty plaque to build-up in arteries.&lt;/p&gt;&lt;/div&gt;">apolipoprotein B</a>; it also seems to increase high-density lipoprotein (<a href="/outcomes/hdl/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;High-density lipoprotein (HDL)&lt;/h6&gt;&lt;p&gt;&lt;em&gt;High-density lipoprotein&lt;/em&gt; (HDL) is a particle that carries cholesterol from your blood to your liver. Low levels of &lt;em&gt;HDL cholesterol&lt;/em&gt; (HDL-C) are associated with a higher risk of &lt;em&gt;cardiovascular disease&lt;/em&gt; (CVD), which is why HDL-C is often called the “good cholesterol” (as opposed to LDL-C) — but the reality is more complex.&lt;/p&gt;&lt;/div&gt;">HDL</a>) cholesterol.[reference|url=https://pubmed.ncbi.nlm.nih.gov/35111069|title=Red Yeast Rice for Hyperlipidemia: A Meta-Analysis of 15 High-Quality Randomized Controlled Trials.|published=2021|authors=Li P, Wang Q, Chen K, Zou S, Shu S, Lu C, Wang S, Jiang Y, Fan C, Luo Y|journal=Front Pharmacol|][reference|url=https://pubmed.ncbi.nlm.nih.gov/36259545|title=Impact of red yeast rice supplementation on lipid profile: a systematic review and meta-analysis of randomized-controlled trials.|published=2023-Jan|authors=Rahmani P, Melekoglu E, Tavakoli S, Malekpour Alamdari N, Rohani P, Sohouli MH|journal=Expert Rev Clin Pharmacol|] Overall, RYR is thought to reduce LDL cholesterol by 15 to 25% within 6 to 8 weeks, and its effect on lipid profiles is comparable to moderate-intensity statin medications (first-line cholesterol-lowering medications).[reference|url=https://pubmed.ncbi.nlm.nih.gov/33538260|title=Red Yeast Rice for Hypercholesterolemia: JACC Focus Seminar|published=2021 Feb 9|authors=Arrigo F G Cicero, Federica Fogacci, Alberto Zambon|journal=J Am Coll Cardiol|][reference|url=https://pubmed.ncbi.nlm.nih.gov/35111069|title=Red Yeast Rice for Hyperlipidemia: A Meta-Analysis of 15 High-Quality Randomized Controlled Trials.|published=2021|authors=Li P, Wang Q, Chen K, Zou S, Shu S, Lu C, Wang S, Jiang Y, Fan C, Luo Y|journal=Front Pharmacol|] RYR may improve markers of <a href="/conditions/atherosclerosis/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Atherosclerosis&lt;/h6&gt;&lt;p&gt;Atherosclerosis is the buildup of lipid-rich plaque on arteries’ interior lining. While symptomless early on, it can lead to artery blockage and increased clot formation, which can cause a wide range of serious diseases, most commonly coronary heart disease and stroke. Lifestyle factors, such as poor diet, little exercise, and smoking, can be integral in the progression of atherosclerosis and its associated diseases.&lt;/p&gt;&lt;/div&gt;">atherosclerosis</a> and protect against <a href="/outcomes/major-adverse-cardiac-events-mace/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;Major Adverse Cardiac Events&lt;/h6&gt;&lt;p&gt;Major adverse cardiac events (MACE), also known as major adverse cardiovascular events, is an umbrella term that represents a variety of severe cardiovascular outcomes. There is no standardized definition of MACE and it varies between studies, but it can include nonfatal Heart Attack Risk|heart attack, nonfatal stroke risk|stroke, cardiovascular disease mortality|cardiovascular mortality, all-cause mortality, unstable angina, heart failure risk|heart failure, and unplanned coronary revascularization. MACE is used as a composite endpoint in research to help evaluate the effectiveness of an intervention in preventing serious cardiovascular events.&lt;/p&gt;&lt;/div&gt;">major adverse cardiac events</a>; however, most of this research has been conducted in Chinese populations, and its generalizability to other populations is not clearly established.[reference|url=https://pubmed.ncbi.nlm.nih.gov/36120360|title=Effectiveness of red yeast rice on carotid atherosclerosis: A systematic review and meta-analysis.|published=2022|authors=Wang S, Chen Y, Wang R, Ma B, Wang Z, Tang G, Wang S, He Y, Qu L|journal=Front Pharmacol|][reference|url=https://pubmed.ncbi.nlm.nih.gov/35264949|title=Red Yeast Rice Preparations Reduce Mortality, Major Cardiovascular Adverse Events, and Risk Factors for Metabolic Syndrome: A Systematic Review and Meta-analysis.|published=2022|authors=Yuan R, Yuan Y, Wang L, Xin Q, Wang Y, Shi W, Miao Y, Leng SX, Chen K, Cong W,|journal=Front Pharmacol|][reference|url=https://pubmed.ncbi.nlm.nih.gov/32066811|title=Efficacy of red yeast rice extract on myocardial infarction patients with borderline hypercholesterolemia: A meta-analysis of randomized controlled trials.|published=2020-Feb-17|authors=Sungthong B, Yoothaekool C, Promphamorn S, Phimarn W|journal=Sci Rep|] RYR may also reduce systemic inflammation, as suggested by reductions in <a href="/outcomes/c-reactive-protein/" class="popover" data-tooltip="&lt;div&gt;&lt;h6&gt;C-Reactive Protein (CRP)&lt;/h6&gt;&lt;p&gt;C-Reactive protein is a biomarker of systemic inflammation. It's often used as a marker of cardiovascular disease risk, although it doesn't necessarily contribute directly to cardiovascular conditions.&lt;/p&gt;&lt;/div&gt;">C-reactive protein</a>, although this effect is less thoroughly researched.[reference|url=https://pubmed.ncbi.nlm.nih.gov/15653117|title=Effects of xuezhikang, an extract of cholestin, on lipid profile and C-reactive protein: a short-term time course study in patients with stable angina.|published=2005-Feb|authors=Li JJ, Hu SS, Fang CH, Hui RT, Miao LF, Yang YJ, Gao RL|journal=Clin Chim Acta|][reference|url=https://pubmed.ncbi.nlm.nih.gov/15313947|title=Xuezhikang, an extract of cholestin, protects endothelial function through antiinflammatory and lipid-lowering mechanisms in patients with coronary heart disease.|published=2004-Aug-24|authors=Zhao SP, Liu L, Cheng YC, Shishehbor MH, Liu MH, Peng DQ, Li YL|journal=Circulation|][reference|url=https://pubmed.ncbi.nlm.nih.gov/12881451|title=Xuezhikang decreases serum lipoprotein(a) and C-reactive protein concentrations in patients with coronary heart disease.|published=2003-Aug|authors=Liu L, Zhao SP, Cheng YC, Li YL|journal=Clin Chem|]

RYR appears to be well-tolerated by most people, and generally, studies have not found differences in rates of side effects between RYR and placebo.[reference|url=https://pubmed.ncbi.nlm.nih.gov/30844537|title=Safety of red yeast rice supplementation: A systematic review and meta-analysis of randomized controlled trials.|published=2019-May|authors=Fogacci F, Banach M, Mikhailidis DP, Bruckert E, Toth PP, Watts GF, Reiner Ž, Mancini J, Rizzo M, Mitchenko O, Pella D, Fras Z, Sahebkar A, Vrablik M, Cicero AFG, ,|journal=Pharmacol Res|][reference|url=https://pubmed.ncbi.nlm.nih.gov/25897793|title=Traditional Chinese lipid-lowering agent red yeast rice results in significant LDL reduction but safety is uncertain - a systematic review and meta-analysis.|published=2015-Jun|authors=Gerards MC, Terlou RJ, Yu H, Koks CH, Gerdes VE|journal=Atherosclerosis|] Despite this, several case reports have suggested that, on rare occasions, RYR supplementation at normal dosages (equivalent to 3–10 mg daily of monacolin K) may cause rhabdomyolysis (dangerous muscle breakdown) or hepatitis (liver inflammation).[reference|url=https://pubmed.ncbi.nlm.nih.gov/37831308|title=Rhabdomyolysis or Severe Acute Hepatitis Associated with the Use of Red Yeast Rice Extracts: an Update from the Adverse Event Reporting Systems.|published=2023-Nov|authors=Banach M, Norata GD|journal=Curr Atheroscler Rep|] Rhabdomyolysis is a known risk of treatment with prescription statin medications, including lovastatin, and is estimated to occur in 1 in every 10,000 people.[reference|url=https://pubmed.ncbi.nlm.nih.gov/30375494|title=Safety and efficacy of statin therapy|published=2018 Dec|authors=Bhavin B Adhyaru, Terry A Jacobson|journal=Nat Rev Cardiol|][reference|url=https://pubmed.ncbi.nlm.nih.gov/24799748|title=Statin-induced rhabdomyolysis: a comprehensive review of case reports.|published=2014|authors=Mendes P, Robles PG, Mathur S|journal=Physiother Can|] Hepatitis has also very rarely been observed with lovastatin treatment.[reference|url=https://pubmed.ncbi.nlm.nih.gov/25075655|title=Hepatotoxicity associated with statin use: analysis of the cases included in the Spanish Hepatotoxicity Registry.|published=2014-Apr|authors=Perdices EV, Medina-Cáliz I, Hernando S, Ortega A, Martín-Ocaña F, Navarro JM, Peláez G, Castiella A, Hallal H, Romero-Gómez M, González-Jiménez A, Robles-Díaz M, Lucena MI, Andrade RJ|journal=Rev Esp Enferm Dig|] Additionally, RYR supplements can contain citrinin which is a potentially harmful compound produced during fermentation. Citrinin can be toxic to the liver and kidneys and care should be taken to choose an RYR supplement that is citrinin-free.[reference|url=https://pubmed.ncbi.nlm.nih.gov/31849687|title=Red Yeast Rice: A Systematic Review of the Traditional Uses, Chemistry, Pharmacology, and Quality Control of an Important Chinese Folk Medicine.|published=2019|authors=Zhu B, Qi F, Wu J, Yin G, Hua J, Zhang Q, Qin L|journal=Front Pharmacol|]
Importantly, monacolin K is metabolized by cytochrome P450 3A4 (CYP3A4) enzymes. Medications or foods that inhibit CYP3A4 (e.g., verapamil, clarithromycin, ketoconazole, ritonavir, grapefruit) can lead to increased levels of monacolin K in the blood and this combination should be avoided.[reference|url=https://pubmed.ncbi.nlm.nih.gov/30844537|title=Safety of red yeast rice supplementation: A systematic review and meta-analysis of randomized controlled trials.|published=2019-May|authors=Fogacci F, Banach M, Mikhailidis DP, Bruckert E, Toth PP, Watts GF, Reiner Ž, Mancini J, Rizzo M, Mitchenko O, Pella D, Fras Z, Sahebkar A, Vrablik M, Cicero AFG, ,|journal=Pharmacol Res|] Additionally, RYR should not be taken in addition to statin medications. This combination may increase the risk of serious side effects and isn’t likely to provide additional therapeutic benefits.[reference|url=https://pubmed.ncbi.nlm.nih.gov/37831308|title=Rhabdomyolysis or Severe Acute Hepatitis Associated with the Use of Red Yeast Rice Extracts: an Update from the Adverse Event Reporting Systems.|published=2023-Nov|authors=Banach M, Norata GD|journal=Curr Atheroscler Rep|][reference|url=https://pubmed.ncbi.nlm.nih.gov/35111069|title=Red Yeast Rice for Hyperlipidemia: A Meta-Analysis of 15 High-Quality Randomized Controlled Trials.|published=2021|authors=Li P, Wang Q, Chen K, Zou S, Shu S, Lu C, Wang S, Jiang Y, Fan C, Luo Y|journal=Front Pharmacol|]
Lastly, there is a concerning degree of variability in the content of monacolin K in RYR, and most supplements are not transparent about how much of this active compound they contain. For example, a study conducted in the United States found that the amount of monacolin K in 26 tested supplements differed up to 60-fold.[reference|url=https://pubmed.ncbi.nlm.nih.gov/28641460|title=Variability in strength of red yeast rice supplements purchased from mainstream retailers.|published=2017-Sep|authors=Cohen PA, Avula B, Khan IA|journal=Eur J Prev Cardiol|] This could lead to inconsistencies in the effectiveness of RYR supplementation.

RYR contains a variety of compounds with biological activity, but monacolins — a class of metabolites produced through fungal fermentation — are considered the main active ingredients. Monacolins, particularly monacolin K, work in the same way as statin medications, which involves the inhibition of a key enzyme involved in cholesterol synthesis, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase.[reference|url=https://pubmed.ncbi.nlm.nih.gov/32066811|title=Efficacy of red yeast rice extract on myocardial infarction patients with borderline hypercholesterolemia: A meta-analysis of randomized controlled trials.|published=2020-Feb-17|authors=Sungthong B, Yoothaekool C, Promphamorn S, Phimarn W|journal=Sci Rep|] Therefore, RYR effectively reduces the body's own synthesis of cholesterol. Interestingly, the pigments found in RYR may also contribute to this lipid-lowering effect. Animal research suggests that these pigments may influence lipid metabolism and lead to an increase in the excretion of cholesterol, triglycerides, and bile acids in the feces.[reference|url=https://pubmed.ncbi.nlm.nih.gov/30720827|title=Monascus yellow, red and orange pigments from red yeast rice ameliorate lipid metabolic disorders and gut microbiota dysbiosis in Wistar rats fed on a high-fat diet.|published=2019-Feb-20|authors=Zhou W, Guo R, Guo W, Hong J, Li L, Ni L, Sun J, Liu B, Rao P, Lv X|journal=Food Funct|]

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