Is red-yeast rice a safe and effective alternative to statins?
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Q: Is red-yeast rice a safe and effective alternative to statins? Evidence-based answer: Yes, but perhaps not the red yeast rice extracts available in the United States. In patients with known coronary artery disease and dyslipidemia (secondary prevention), therapy with red-yeast rice extract containing naturally-occurring lovastatin is associated with a 30% reduction in coronary heart disease (CHD) mortality and a 60% reduction in myocardial infarction (MI), similar to the effect of statin medications (strength of recommendation [SOR]: B, randomized controlled trials [RCTs] in China). In patients older than 65 years with hypertension and a previous MI, the rate of adverse effects from lovastatin-containing red-yeast rice is 2.1% (SOR: B, RCT in China). In patients with previous statin intolerance, the rates of myalgias and treatment discontinuation with lovastatin-containing red-yeast rice therapy are similar to either placebo or another statin (SOR: C, low powered RCTs). The US Food and Drug Administration (FDA) doesn't allow lovastatin-containing red-yeast rice products on the US market; physicians should be aware that products purchased by patients online contain variable amounts of lovastatin.
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