Review
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2025; 13(27): 105415
Published online Sep 26, 2025. doi: 10.12998/wjcc.v13.i27.105415
Red yeast rice with monacolin K for the improvement of hyperlipidemia: A narrative review
Kevan English
Kevan English, Department of Internal Medicine, University of Nebraska Medical Center College of Medicine, Omaha, NE 68198, United States
Author contributions: English K wrote the original draft, contributed to conceptualization, writing, reviewing, and editing; The author read and approved the final version of the manuscript.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kevan English, MD, Department of Internal Medicine, University of Nebraska Medical Center College of Medicine, S 42nd and Emile St, Omaha, NE 68198, United States. keenglish@unmc.edu
Received: January 22, 2025
Revised: April 19, 2025
Accepted: June 19, 2025
Published online: September 26, 2025
Processing time: 196 Days and 7.4 Hours
Abstract

Low-density lipoprotein cholesterol (LDL-C) is the most causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Red yeast rice (RYR) is a nutraceutical widely used as a lipid-lowering dietary supplement. The main cholesterol-lower agents in RYR are monacolins, particularly monacolin K, a weak reversible inhibitor of 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase, whose daily consumption (up to 10 mg/day) reduces LDL-C plasma levels up to 34% within 6-8 weeks when compared to placebo. The reduction in LDL-C is often accompanied by lower levels of plasma apolipoprotein B, total cholesterol, matrix metalloproteinases 2 and 9, high-sensitivity C-reactive protein, non-high-density lipoprotein cholesterol, and blood pressure. RYR has also demonstrated favorable reductions of up to 45% compared to placebo in the risk of ASCVD events in secondary prevention studies. The mechanism of action is similar to statins. When consumed appropriately, RYR is associated with only minimal side effects. Mild myalgia may be seen in patients who cannot tolerate low-dose statins. In individuals with no additional ASCVD risk factors, RYR is a safe and effective supplement in treating mild to moderate hyperlipidemia.

Keywords: Hyperlipidemia; Red yeast rice; Monacolin K; Low-density lipoprotein; Atherosclerosis; Lovastatin; Coronary artery disease; Statin; Cholesterol

Core Tip: Red yeast rice (RYR) has cholesterol-lowering properties due to its active ingredient, monacolin K (MK), which mainly inhibits 3-hydroxy-3-methylglutaryl coenzyme A reductase. It is an excellent option for patients with mild to moderate dyslipidemia and low atherosclerotic cardiovascular disease risk factors who otherwise would not qualify for statin therapy. RYR can also serve as a valuable alternative in patients with statin intolerance or patients who otherwise are against medical treatment. Although effective, it is noteworthy to mention that the quantity of MK in commercial RYR products varies by brand. This article narratively reviews some existing data on RYR in the treatment of mild to moderate dyslipidemia.