Monacolin K as a Natural Alternative for Synthetic Statins
DOI:
https://doi.org/10.12775/QS.2024.37.57648Keywords
monacolin k, hypercholesterolemia, red yeast rice, supplementationAbstract
Introduction: This review paper aims to verify the safety of monacolin K, examine the effect on blood cholesterol levels, discuss the contribution to the reduction of cardiovascular risk and indicate examples of pleiotropic effects of this substance.
Materials and methods: A review of chosen literature in the PubMed database was conducted, using the following key words: ,,Monacolin K”, ,,Hypercholesterolemia’’, ,,Red yeast rice’’, ,,Supplementation’’.
Summary: Monacolin K is considered to be natural statin contained in fermented red rice or oyster mushroom. The use of monacolin K may contribute to the development of mild muscle pain or rhabdomyolysis, but it is noticed less frequently than in treatment with synthetic statins. In addition, there are also concerns about liver and/or kidney damage, headaches and/or dizziness, musculoskeletal symptoms and gastrointestinal disturbances in some people, especially when high doses of monacolin K are used. Monacolin K lowers the level of cholesterol in the blood and contributes to reducing the risk of cardiovascular diseases. Furthermore, monacolin K has anti-inflammatory effects and anti-cancer mechanisms.
Conclusions: Monacolin K improves the lipid profile by lowering low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and total cholesterol (TC) levels which indirectly reduces the cardiovascular risk with less frequently observed side effects. Monacolin K has many pleiotropic effects like anti-inflammatory and anti-cancer mechanisms by inhibiting cancer cell proliferation and stimulating apoptosis. It should be emphasized that the long-term safety of regular use of these preparations has not been fully documented. Some people taking these supplements experience side effects similar to those seen with statins. Both health benefits and side effects should be further investigated in future studies.
References
1. Sirtori CR. The pharmacology of statins. Pharmacol Res. 2014;88:3-11. doi:10.1016/j.phrs.2014.03.002
2. Alloubani A, Nimer R, Samara R. Relationship between Hyperlipidemia, Cardiovascular Disease and Stroke: A Systematic Review. Curr Cardiol Rev. 2021;17(6):e051121189015. doi:10.2174/1573403X16999201210200342
3. Ward NC, Watts GF, Eckel RH. Statin Toxicity. Circ Res. 2019;124(2):328-350. doi:10.1161/CIRCRESAHA.118.312782
4. Fogacci F, Banach M, Mikhailidis DP, et al. Safety of red yeast rice supplementation: A systematic review and meta-analysis of randomized controlled trials. Pharmacol Res. 2019;143:1-16. doi:10.1016/j.phrs.2019.02.028
5 .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
6. 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
7. Santos S, Gomes S, Carvalho I, Bonito I, Carmo C. Rhabdomyolysis Related to Red Yeast Rice Ingestion. Cureus. 2023;15(1):e33532. Published 2023 Jan 9. doi:10.7759/cureus.33532
8.Pirillo A, Norata GD. The burden of hypercholesterolemia and ischemic heart disease in an ageing world. Pharmacol Res. 2023;193:106814. doi:10.1016/j.phrs.2023.106814
9. Law MR, Wald NJ, Rudnicka AR. Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. BMJ. 2003;326(7404):1423. doi:10.1136/bmj.326.7404.1423
10. Verhoeven V, Lopez Hartmann M, Remmen R, Wens J, Apers S, Van Royen P. Red yeast rice lowers cholesterol in physicians - a double blind, placebo controlled randomized trial. BMC Complement Altern Med. 2013;13:178. Published 2013 Jul 18. doi:10.1186/1472-6882-13-178
11. Gojkovic T, Vladimirov S, Kotur-Stevuljevic J, et al. Effects of monacolin K-containing nutraceutical on cholesterol homeostasis re-establishment and CVD risk reduction in hypercholesterolemic subjects. Eur Rev Med Pharmacol Sci. 2021;25(16):5261-5267. doi:10.26355/eurrev_202108_26546
12. Li Y, Jiang L, Jia Z, et al. A meta-analysis of red yeast rice: an effective and relatively safe alternative approach for dyslipidemia. PLoS One. 2014;9(6):e98611. Published 2014 Jun 4. doi:10.1371/journal.pone.0098611
13. Heinz T, Schuchardt JP, Möller K, Hadji P, Hahn A. Low daily dose of 3 mg monacolin K from RYR reduces the concentration of LDL-C in a randomized, placebo-controlled intervention. Nutr Res. 2016;36(10):1162-1170. doi:10.1016/j.nutres.2016.07.005
14. Heber D, Yip I, Ashley JM, Elashoff DA, Elashoff RM, Go VL. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr. 1999;69(2):231-236. doi:10.1093/ajcn/69.2.231
15.Ong YC, Aziz Z. Systematic review of red yeast rice compared with simvastatin in dyslipidaemia. J Clin Pharm Ther. 2016;41(2):170-179. doi:10.1111/jcpt.12374
16. D'Assante R, De Luca M, Ferraro S, et al. Beneficial Metabolic Effect of a Nutraceuticals Combination (Monacolin K, Yeasted Red Rice, Polyphenolic Extract of Annurca Apple and Berberine) on Acquired Hypercholesterolemia: A Prospective Analysis. Metabolites. 2021;11(4):223. Published 2021 Apr 6. doi:10.3390/metabo11040223
17.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
18. Cicero AF, Morbini M, Parini A, et al. Effect of red yeast rice combined with antioxidants on lipid pattern, hs-CRP level, and endothelial function in moderately hypercholesterolemic subjects. Ther Clin Risk Manag. 2016;12:281-286. Published 2016 Feb 23. doi:10.2147/TCRM.S91817
19. Verhoeven V, Van der Auwera A, Van Gaal L, et al. Can red yeast rice and olive extract improve lipid profile and cardiovascular risk in metabolic syndrome?: A double blind, placebo controlled randomized trial. BMC Complement Altern Med. 2015;15:52. Published 2015 Mar 10. doi:10.1186/s12906-015-0576-9
20. Kato S, Smalley S, Sadarangani A, et al. Lipophilic but not hydrophilic statins selectively induce cell death in gynaecological cancers expressing high levels of HMGCoA reductase. J Cell Mol Med. 2010;14(5):1180-1193. doi:10.1111/j.1582-4934.2009.00771.x
21. Menter DG, Ramsauer VP, Harirforoosh S, et al. Differential effects of pravastatin and simvastatin on the growth of tumor cells from different organ sites. PLoS One. 2011;6(12):e28813. doi:10.1371/journal.pone.0028813
22. Huang BZ, Chang JI, Li E, Xiang AH, Wu BU. Influence of Statins and Cholesterol on Mortality Among Patients With Pancreatic Cancer. J Natl Cancer Inst. 2016;109(5):10.1093/jnci/djw275. Published 2016 Dec 31. doi:10.1093/jnci/djw275
23. Craig EL, Stopsack KH, Evergren E, et al. Statins and prostate cancer-hype or hope? The epidemiological perspective. Prostate Cancer Prostatic Dis. 2022;25(4):641-649. doi:10.1038/s41391-022-00554-1
24. Borgquist S, Bjarnadottir O, Kimbung S, Ahern TP. Statins: a role in breast cancer therapy?. J Intern Med. 2018;284(4):346-357. doi:10.1111/joim.12806
25. Hong MY, Seeram NP, Zhang Y, Heber D. Anticancer effects of Chinese red yeast rice versus monacolin K alone on colon cancer cells. J Nutr Biochem. 2008;19(7):448-458. doi:10.1016/j.jnutbio.2007.05.012
26. Poynter JN, Gruber SB, Higgins PD, et al. Statins and the risk of colorectal cancer. N Engl J Med. 2005;352(21):2184-2192. doi:10.1056/NEJMoa043792
27. Da Porto A, Donnini D, Vanin F, et al. Effects of Monacolin K in Nondiabetic Patients with NAFLD: A Pilot Study. Nutrients. 2023;15(8):1887. Published 2023 Apr 14. doi:10.3390/nu15081887
28. Decout A, Katz JD, Venkatraman S, Ablasser A. The cGAS-STING pathway as a therapeutic target in inflammatory diseases. Nat Rev Immunol. 2021;21(9):548-569. doi:10.1038/s41577-021-00524-z
29. Couillin I, Riteau N. STING Signaling and Sterile Inflammation. Front Immunol. 2021;12:753789. Published 2021 Oct 1. doi:10.3389/fimmu.2021.753789
30. Onsa-Ard A, Thongboontho R, Munkong N, et al. Anti-Inflammatory Effects of Red Rice Bran Extract Ameliorate Type I Interferon Production via STING Pathway. Foods. 2022;11(11):1622. Published 2022 May 30. doi:10.3390/foods11111622
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Julia Kozakiewicz, Aleksandra Okońska, Michał Ziemba, Kamil Kościelecki, Agnieszka Kalisz, Magdalena Krakowiak, Aleksandra Kaczmarek

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 88
Number of citations: 0