Red Yeast Rice as a natural source of Monacolin K – the efficacy among patients with dyslipidemia. A literature review
DOI:
https://doi.org/10.12775/JEHS.2026.88.69385Keywords
Red yeast rice, Monacolin K, LDL-cholesterolAbstract
Background: Dyslipidemia is a common disease worldwide associated with increased cardiovascular risk. It is associated with many possible health consequences. An important issue in the treatment of dyslipidemia is lifestyle modification. Moreover, the use of nutraceuticals and pharmacological treatment is equally important. Red yeast rice contains monacolin K, which can reduce plasma levels of low-density lipoprotein cholesterol and total cholesterol. Moreover, contains gamma-aminobutyric acid, which has antihyperlipidemic effects.
Aim: This article aims to review current evidence on the effectiveness of the treating of dyslipidemia with Monacolin K, which is contained in Red Yeast Rice.
Material and Methods: A literature review was conducted from the PubMed and Google Scholar databases. Key phrases as “red yeast rice”, “monacolin K” and “LDL-cholesterol” were used.
Results and conclusion: Supplementation with a low daily dose of red yeast rice, which contains Monacolin K can reduce the risk of cardiovascular diseases among patients with dyslipidemia by lowering plasma levels of low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC).
References
[1] Tina Heinz, Jan Philipp Schuchardt, Katharina Möller, Peyman Hadji, Andreas Hahn, Low daily dose of 3 mg monacolin K from RYR reduces the concentration of LDL-C in a randomized, placebo-controlled intervention, Nutrition Research, Volume 36, Issue 10, 2016, Pages 1162-1170, ISSN 0271-5317, https://doi.org/10.1016/j.nutres.2016.07.005
[2] Minamizuka T, Koshizaka M, Shoji M, et al. Low dose red yeast rice with monacolin K lowers LDL cholesterol and blood pressure in Japanese with mild dyslipidemia: A multicenter, randomized trial. Asia Pac J Clin Nutr. 2021;30(3):424-435. doi:10.6133/apjcn.202109_30(3).0009
[3] Gerards MC, Terlou RJ, Yu H, Koks CH, Gerdes VE. Traditional Chinese lipid-lowering agent red yeast rice results in significant LDL reduction but safety is uncertain - a systematic review and meta-analysis. Atherosclerosis. 2015;240(2):415-423. doi:10.1016/j.atherosclerosis.2015.04.004
[4] Xiong X, Wang P, Li X, Zhang Y, Li S. The effects of red yeast rice dietary supplement on blood pressure, lipid profile, and C-reactive protein in hypertension: A systematic review. Crit Rev Food Sci Nutr. 2017;57(9):1831-1851. doi:10.1080/10408398.2015.1018987
[5] Nguyen T, Karl M, Santini A. Red Yeast Rice. Foods. 2017;6(3):19. Published 2017 Mar 1. doi:10.3390/foods6030019
[6] Zixiao Xiong, Xiaohua Cao, Qinyou Wen, Zhiting Chen, Zuxin Cheng, Xinying Huang, Yangxin Zhang, Chuannan Long, Yi Zhang, Zhiwei Huang, An overview of the bioactivity of monacolin K / lovastatin, Food and Chemical Toxicology, Volume 131, 2019, 110585, ISSN 0278-6915, https://doi.org/10.1016/j.fct.2019.110585
[7] Cicero AFG, Fogacci F, Zambon A. Red Yeast Rice for Hypercholesterolemia: JACC Focus Seminar. J Am Coll Cardiol. 2021;77(5):620-628. doi:10.1016/j.jacc.2020.11.056
[8] Zhu B, Qi F, Wu J, et al. Red Yeast Rice: A Systematic Review of the Traditional Uses, Chemistry, Pharmacology, and Quality Control of an Important Chinese Folk Medicine. Front Pharmacol. 2019;10:1449. Published 2019 Dec 2. doi:10.3389/fphar.2019.01449
[9] Krotowska, Katarzyna. (2024). Monacolin K in the treatment of hypercholesterolemia - chance or threat?. Journal of Education, Health and Sport. 75. 56419. 10.12775/JEHS.2024.75.56419.
[10] Ozierański, Krzysztof & Grabowski, Marcin. (2021). The role of monacolin in the treatment of dyslipidaemia. Pediatria i Medycyna Rodzinna. 17. 221-226. 10.15557/PiMR.2021.0034.
[11] Villano I, La Marra M, Allocca S, et al. The Role of Nutraceutical Supplements, Monacolin K and Astaxanthin, and Diet in Blood Cholesterol Homeostasis in Patients with Myopathy. Biomolecules. 2022;12(8):1118. Published 2022 Aug 14. doi:10.3390/biom12081118
[12] Cicero AFG, Fogacci F, Banach M. Red Yeast Rice for Hypercholesterolemia. Methodist Debakey Cardiovasc J. 2019;15(3):192-199. doi:10.14797/mdcj-15-3-192
[13] Hadjimbei, Elena. (2024). Monacolin K supplementation in patients with hypercholesterolemia: A systematic review of clinical trials. Semergen. 50. 10.1016/j.semerg.2023.102156.
[14] Heinz, Tina & Schuchardt, Jan Philipp & Möller, Katharina & Hadji, Peyman & Hahn, Andreas. (2016). LDL-cholesterol-lowering effect of monacolin K from red yeast rice extract – results of a randomized, placebo-controlled intervention study. Nutrition Research. 36. 10.1016/j.nutres.2016.07.005.
[15] English K. Red yeast rice with monacolin K for the improvement of hyperlipidemia: A narrative review. World J Clin Cases. 2025;13(27):105415. doi:10.12998/wjcc.v13.i27.105415
[16] Cicero AFG, Fogacci F, Stoian AP, Toth PP. Red Yeast Rice for the Improvement of Lipid Profiles in Mild-to-Moderate Hypercholesterolemia: A Narrative Review. Nutrients. 2023;15(10):2288. Published 2023 May 12. doi:10.3390/nu15102288
[17] Trogkanis E, Karalexi MA, Sergentanis TN, Kornarou E, Vassilakou T. Safety and Efficacy of the Consumption of the Nutraceutical "Red Yeast Rice Extract" for the Reduction of Hypercholesterolemia in Humans: A Systematic Review and Meta-Analysis. Nutrients. 2024;16(10):1453. Published 2024 May 11. doi:10.3390/nu16101453
[18] Tobert JA, Newman CB. Statin tolerability: In defence of placebo-controlled trials. Eur J Prev Cardiol. 2016;23(8):891-896. doi:10.1177/2047487315602861
[19] Cohen PA, Avula B, Khan IA. Variability in strength of red yeast rice supplements purchased from mainstream retailers. Eur J Prev Cardiol. 2017;24(13):1431-1434. doi:10.1177/2047487317715714
[20] EFSA NDA Panel (EFSA Panel on Nutrition, Novel Foods and Food Allergens), Turck, D., Bohn, T., Cámara, M., Castenmiller, J., De Henauw, S., Hirsch Ernst, K.I., Jos, Á., Mangelsdorf, I., McNulty, B., Naska, A., Pentieva, K., Siani, A., Thies, F., Matijević, L., Martinez, S. V., & Maciuk, A. (2025). Scientific Opinion on additional scientific data related to the safety of monacolins from red yeast rice submitted pursuant to Article 8(4) of Regulation (EC) No 1925/2006. EFSA Journal, 23(2), e9276. https://doi.org/10.2903/j.efsa.2025.9276
[21] LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Red Yeast Rice. [Updated 2018 Jun 4]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK548168/
[22] Fogacci F, Giovannini M, Di Micoli V, et al. Evaluation of the effect of a dietary supplementation with a red yeast rice and fish oil-containing nutraceutical on lipid pattern, high sensitivity C-reactive protein, and endothelial function in moderately hypercholesterolaemic subjects: a double-blind, placebo-controlled, randomized clinical trial. Arch Med Sci Atheroscler Dis. 2023;8:e182-e189. Published 2023 Dec 30. doi:10.5114/amsad/177444
[23] Cicero AFG, Colletti A, Bajraktari G, et al. Lipid-lowering nutraceuticals in clinical practice: position paper from an International Lipid Expert Panel. Nutr Rev. 2017;75(9):731-767. doi:10.1093/nutrit/nux047
[24] Kłosiewicz-Latoszek L, Cybulska B, Stoś K, Tyszko P. Hypolipaemic nutraceutics: red yeast rice and Armolipid, berberine and bergamot. Ann Agric Environ Med. 2021;28(1):81-88. doi:10.26444/aaem/130629
[25] Derosa G, Bonaventura A, Bianchi L, et al. A randomized, placebo-controlled study on the effects of a nutraceutical combination of red yeast rice, silybum marianum and octasonol on lipid profile, endothelial and inflammatory parameters. J Biol Regul Homeost Agents. 2014;28(2):317-324.
[26] Spigoni V, Aldigeri R, Antonini M, et al. Effects of a New Nutraceutical Formulation (Berberine, Red Yeast Rice and Chitosan) on Non-HDL Cholesterol Levels in Individuals with Dyslipidemia: Results from a Randomized, Double Blind, Placebo-Controlled Study. Int J Mol Sci. 2017;18(7):1498. Published 2017 Jul 12. doi:10.3390/ijms18071498
[27] Trimarco B, Benvenuti C, Rozza F, Cimmino CS, Giudice R, Crispo S. Clinical evidence of efficacy of red yeast rice and berberine in a large controlled study versus diet. Med J Nutrition Metab. 2011;4(2):133-139. doi:10.1007/s12349-010-0043-6
[28] Allkanjari O, Menniti-Ippolito F, Ippoliti I, Di Giacomo S, Piccioni T, Vitalone A. A descriptive study of commercial herbal dietary supplements used for dyslipidemia-Sales data and suspected adverse reactions. Phytother Res. 2022;36(6):2583-2604. doi:10.1002/ptr.7473
[29] Cicero AFG, Fogacci F, Tocci G, et al. Three arms, double-blind, non-inferiority, randomized clinical study testing the lipid-lowering effect of a novel dietary supplement containing red yeast rice and artichoke extracts compared to Armolipid Plus® and placebo. Arch Med Sci. 2023;19(5):1169-1179. Published 2023 Jun 17. doi:10.5114/aoms/167969
[30] Angelopoulos N, Paparodis RD, Androulakis I, Boniakos A, Argyrakopoulou G, Livadas S. Low Dose Monacolin K Combined with Coenzyme Q10, Grape Seed, and Olive Leaf Extracts Lowers LDL Cholesterol in Patients with Mild Dyslipidemia: A Multicenter, Randomized Controlled Trial. Nutrients. 2023;15(12):2682. Published 2023 Jun 9. doi:10.3390/nu15122682
[31] EFSA ANS Panel (EFSA Panel Food Additives and Nutrient Sources added to Food), Younes M, Aggett P, Aguilar F, Crebelli R, Dusemund B, Filipič M, Frutos MJ, Galtier P, Gott D, Gundert-Remy U, Kuhnle GG, Lambré C, Leblanc J-C, Lillegaard IT, Moldeus P, Mortensen A, Oskarsson A, Stankovic I, Waalkens-Berendsen I, Woutersen RA, Andrade RJ, Fortes C, Mosesso P, Restani P, Pizzo F, Smeraldi C and Wright M, 2018. Scientific opinion on the safety of monacolins in red yeast rice. EFSA Journal 2018;16(8):5368, 46 pp. https://doi.org/10.2903/j.efsa.2018.5368
[32] Souyoul, S.A., Saussy, K.P. & Lupo, M.P. Nutraceuticals: A Review. Dermatol Ther (Heidelb) 8, 5–16 (2018). https://doi.org/10.1007/s13555-018-0221-x
[33] István G. Télessy, Chapter 24 - Nutraceuticals, Editor(s): Ram B. Singh, Ronald Ross Watson, Toru Takahashi, The Role of Functional Food Security in Global Health, Academic Press, 2019, Pages 409-421, ISBN 9780128131480,
https://doi.org/10.1016/B978-0-12-813148-0.00024-4
[34] Aronson JK. Defining 'nutraceuticals': neither nutritious nor pharmaceutical. Br J Clin Pharmacol. 2017;83(1):8-19. doi:10.1111/bcp.12935
[35] Ronis MJJ, Pedersen KB, Watt J. Adverse Effects of Nutraceuticals and Dietary Supplements. Annu Rev Pharmacol Toxicol. 2018;58:583-601. doi:10.1146/annurev-pharmtox-010617-052844
[36] Andrea Poli, Carlo M. Barbagallo, Arrigo F.G. Cicero, Alberto Corsini, Enzo Manzato, Bruno Trimarco, Franco Bernini, Francesco Visioli, Alfio Bianchi, Giuseppe Canzone, Claudio Crescini, Saula de Kreutzenberg, Nicola Ferrara, Marco Gambacciani, Andrea Ghiselli, Carla Lubrano, Giuseppe Marelli, Walter Marrocco, Vincenzo Montemurro, Damiano Parretti, Roberto Pedretti, Francesco Perticone, Roberto Stella, Franca Marangoni, Nutraceuticals and functional foods for the control of plasma cholesterol levels. An intersociety position paper, Pharmacological Research, Volume 134, 2018, Pages 51-60, ISSN 1043-6618, https://doi.org/10.1016/j.phrs.2018.05.015.
[37] Mazza A, Lenti S, Schiavon L, et al. Effect of Monacolin K and COQ10 supplementation in hypertensive and hypercholesterolemic subjects with metabolic syndrome. Biomed Pharmacother. 2018;105:992-996. doi:10.1016/j.biopha.2018.06.076
[38] Magno S, Ceccarini G, Pelosini C, et al. LDL-cholesterol lowering effect of a new dietary supplement: an open label, controlled, randomized, cross-over clinical trial in patients with mild-to-moderate hypercholesterolemia. Lipids Health Dis. 2018;17(1):124. Published 2018 May 24. doi:10.1186/s12944-018-0775-8
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Copyright (c) 2026 Aleksandra Simlat, Aleksandra Sado, Bartłomiej Lisik, Filip Skowierzak, Klaudia Kozyra, Sylwia Kozieł-Kwit, Wiktoria Rogowska, Krzysztof Szada-Borzyszkowski, Mariusz Wręczycki, Kacper Sawczuk
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