Red Yeast Rice, Statins and Cholesterol

A lot of my patients have asked about taking red yeast rice as a 'natural' alternative to statins for preventing vascular disease.  Setting aside for now the more important question of whether or not a particular patient should use a statin to prevent or control vascular disease, it turns out that the red yeast rice issue is complicated as well.  A recent review of this issue and the history of red rice yeast and statins by The Skeptical Cardiologist blog explains this well.

The fungus in red yeast rice was found to have several chemicals that lowered cholesterol.  One of these, now called lovastatin, became Mevacor, the first name brand statin medication.  Because of this, red yeast rice has been promoted as an alternative to prescription statins.  

Unfortunately, red yeast rice has a number of problems as a medication.   It has numerous other chemicals including citrinin which can cause kidney failure. The amount of the active ingredients that lower cholesterol vary widely among different commercial red yeast rice products.   Several products found to contain significant levels of lovastatin have been pulled from the market by the FDA as an unapproved drug.

So while some red yeast rice products can lower cholesterol, there are several additional risks involved in taking red yeast rice compared to taking a standardized, inexpensive generic lovastatin.  

Should you be taking lovastatin or one of the other statin drugs?  There have been a lot of recent changes of the guidelines for testing and treatment of cholesterol and some ongoing controversy about these guidelines.  Whether or not the potential benefits of a statin outweigh the risks such as muscle problems, diabetes, etc. depends a lot upon your medical and family history.  Review all this with your physician.

UptoDate: Can foods or supplements lower cholesterol?

Photo By FotoosVanRobin (Flickr: Red yeast rice) [CC BY-SA 2.0 (], via Wikimedia Commons