Heart Attack and Red Yeast Rice

Red yeast rice is a traditional Chinese substance made by fermenting a type of yeast called Monascus purpureus over rice. Various formulations of this product have been used in China since at least 800 AD as a food and also as a medicinal substance within the context of Traditional Chinese Herbal medicine.

Red yeast rice contains properties that are similar or even identical to those of prescription statins. Like statins, red yeast rice may support heart health by controlling high cholesterol.

Red yeast rice contains naturally occurring substances similar (and, in some cases, identical) to cholesterol-lowering prescription drugs in the statin family. Statins lower cholesterol and reduce inflammation.

Read more details about Red Yeast Rice.

A double-blind study performed in China compared an alcohol extract of red yeast rice (Xuezhikang) against placebo in almost 5,000 people with heart disease.²⁵ Over a 4-year study period, use of the supplement reportedly reduced heart attack rate by about 45% as compared to placebo, and total mortality by about 35%.

At least three other studies, all from this same original population of participants, have found similar results in diabetics with heart disease²⁶ and in patients with previous heart attack,^27,28 with surprisingly large reductions in the rates of coronary events (eg, heart attack) and death. Some experts consider these findings to be potentially unreliable because the levels of reported benefit are so high and so similar.

The dosage of red yeast rice used in most studies is 1.2 to 2.4 g of red yeast rice powder daily. However, due to patent-infringement suits by the manufacturer of a statin drug that is naturally present in red yeast rice, the most studied red yeast rice product has been taken off the market, and it is not clear whether the remaining products have greater or lesser potency.

• Chinese herbalist; acupuncturist
• Integrative MD
• Naturopathic doctor

Safety Issues

In clinical trials, use of red yeast rice has not been associated with any significant side effects. However, red yeast rice contains naturally occurring statin drugs, and use of statin drugs can cause side effects ranging from minor to life-threatening. Some of the most common include muscle pain, joint pain, liver inflammation, and peripheral nerve damage; severe breakdown of muscle tissue (rhabdomyolysis) leading to kidney failure has also occurred. It is almost certain that red yeast rice can cause the same problems if it is used by enough people, and there are at least two case reports in the literature of muscle injury caused by red yeast rice; in one case, rhabdomyolosis developed. ¹ Due to the relative lack of regulation of supplement manufacture, the statin content of red yeast rice products is unpredictable, and this could increase potential risk. In addition, red yeast rice may at times contain the toxic substance citrinin. ² Based on the known effects of statins, pregnant or nursing women, women likely to become pregnant, young children, and people with liver or kidney disease should not use red yeast rice. Furthermore, red yeast rice should not be combined with fibrate drugs , cyclosporine , erythromycin-family drugs, antifungal drugs, or high-dose niacin . Finally, it would not make sense to combine red yeast rice with standard statin drugs.

Statin drugs are known to interfere with the body’s ability to produce the natural substance CoQ 10 , ^{3 4} and one animal study found the same effect with red yeast rice. ⁵ For this reason, people taking red yeast rice could conceivably benefit from CoQ 10 supplementation; however, this has not yet been proven. (See the full article on Statins for more information.)

Interactions You Should Know About

If you are taking fibrate drugs , cyclosporine , erythromycin-family drugs, antifungal drugs, or high-dose niacin , do not use red yeast rice.

If you use red yeast rice to keep your cholesterol levels down, taking the herb St. John’s wort may impair the effectiveness of red yeast rice and cause your cholesterol to rise.

1. Prasad GV, Wong T, Meliton G, et al. Rhabdomyolysis due to red yeast rice ( Monascus purpureus ) in a renal transplant recipient. Transplantation. 2002;74:1200-1201.
2. Liu BH, Wu TS, Su MC, et al. Evaluation of citrinin occurrence and cytotoxicity in Monascus fermentation products. J Agric Food Chem. 2005;53:170-175.
3. Silver MA, Langsjoen PH, Szabo S, Patil H, Zelinger A. Effect of atorvastatin on left ventricular diastolic function and ability of coenzyme Q10 to reverse that dysfunction. Am J Cardiol. 94(10):1306-10.
4. Rundek T, Naini A, Sacco R, Coates K, DiMauro S. Atorvastatin decreases the coenzyme Q10 level in the blood of patients at risk for cardiovascular disease and stroke. Arch Neurol. 61(6):889-92.
5. Yang HT, Lin SH, Huang SY, et al. Acute administration of red yeast rice ( Monascus purpureus ) depletes tissue coenzyme Q(10) levels in ICR mice. Br J Nutr. 2005;93:131-135.

25. Du BM, Lu ZL, Chen Z, et al. The beneficial effects of lipid-lowering therapy with Xuezhikang on cardiac events and total mortality in coronary heart disease patients with or without hypertension: a random, double-blinded, placebo controlled clinical trial. Zhonghua Xin Xue Guan Bing Za Zhi. 2006;34:890-894.
26. Zhao SP, Lu ZL, Du BM, et al. Xuezhikang, an extract of cholestin, reduces cardiovascular events in type 2 diabetes patients with coronary heart disease: subgroup analysis of patients with type 2 diabetes from China coronary secondary prevention study (CCSPS). J Cardiovasc Pharmacol. 2007;49:81-84.
27. Ye P, Lu ZL, Du BM, et al. Effect of xuezhikang on cardiovascular events and mortality in elderly patients with a history of myocardial infarction: a subgroup analysis of elderly subjects from the China Coronary Secondary Prevention Study. J Am Geriatr Soc. 2007;55:1015-1022.
28. Lu Z, Kou W, Du B, et al. Effect of xuezhikang, an extract from red yeast chinese rice, on coronary events in a chinese population with previous myocardial infarction. Am J Cardiol. 2008;101:1689-1693.