Red Yeast Rice for Dyslipidemia in Statin-Intolerant Patients

Abstract

Statin-associated myalgias represent a significant health concern as they often limit the ability of patients to receive the mortality benefits associated with statin therapy. Randomized controlled trials show rates of statin-associated myalgias ranging between 1% and 5%, with some rates as high as 15%, although not significantly different from placebo-treated patients [1, 2]. Although not often associated with creatinine phosphokinase (CPK) level elevations or progression to rhabdomyolysis, the symptoms can be disconcerting to patients and are a frequent cause of statin discontinuation. A variety of strategies have been attempted to manage this challenge, including decreasing the statin dose, trying alternative statins or other lipid-lowering agents, and intensifying therapeutic lifestyle changes [3]. An additional tool used by many patients and physicians has been red yeast rice (Monascus purpureus). The mechanism of action is not completely understood, although the active agent is thought to be monacolin K, a 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor produced as the pharmaceutical lovastatin. However, red yeast rice also contains other monacolins that may have similar or different effects, making red yeast rice not a “true” statin medication. Thus far, widespread use of red yeast has been limited by the variety of preparations (as it is a dietary supplement rather than a pharmaceutical) and the relative paucity of data on its safety and efficacy relative to statin drugs. Many clinicians do use red yeast rice as an alternative for their statinintolerant patients; however, no randomized controlled trial has examined using red yeast rice to treat patients with statin-associated myalgias.