A type of red yeast fermented on rice, used in Chinese cuisine and sold in the United States as the dietary supplement Cholestin, has been shown to lower the level of blood cholesterol for some people in two preliminary studies presented at the AHA's epidemiology and prevention conference, March 25.
Elevated levels of certain types of cholesterol in the blood have been associated with a higher risk of heart attack. However, because there are no long-term studies that show the red yeast rice to be as safe and effective as diet and/or cholesterol-lowering prescription drugs, the American Heart Association urges individuals with elevated cholesterol levels to consult with their physician before introducing Cholestin into a cholesterol lowering regimen.
"Elevated cholesterol levels need to be evaluated and monitored closely by a physician so that appropriate steps can be taken to lower individuals" level of LDL cholesterol ('bad cholesterol') in their blood," says Thomas A. Pearson, M.D., Ph.D., chairman of the American Heart Association's population science committee and chairman of community and preventive medicine at the University of Rochester School of Medicine, Rochester, NY.
"The first step for most people is to make some changes in their diet -- for example by lowering the amount of saturated fat they eat and by increasing the amount of fruits, vegetables, whole grains and low-fat dairy products they consume," says Pearson. Most dietary saturated fat is derived from animal products, such as red meat, butter, cheese and whole milk.
If diet alone does not help to lower the LDL cholesterol in an individual's blood, there are several steps that can be taken, all of which use prescription medications that have been rigorously tested by the U.S. Food and Drug Administration for safety and effectiveness. Statin drugs, such as lovastatin, pravastatin, and simvastatin, are a new class of cholesterol-lowering drugs that are easy to take, cause few side effects and are very effective at lowering cholesterol levels, says Pearson.
Many studies have reported that lowering LDL cholesterol with statin drugs is associated with lower rates of heart attacks -- which is why the American Heart Association recommends statin drugs for cholesterol-lowering as a second step after lifestyle modifications including lowering fat in the diet.
"Red yeast rice, a strain of pulverized rice fermented with red yeast, is a Chinese condiment that has been used for many years contains several naturally occurring statins including lovastatin, a very effective agent for lowering cholesterol levels," says Pearson.
"Many people may assume that a naturally occurring substance, such as the red yeast rice, would be a more desirable choice for lowering their cholesterol, in comparison to prescription medications," says Pearson. "However, people need to take into consideration that comprehensive studies have been done only on the prescription statins, and we don't know if the naturally occurring statins behave in exactly the same way.
"Individuals who may feel more comfortable with ingesting a food product than a prescription drug may not realize that the red yeast fermented on rice used in Chinese cooking is used in much smaller quantities than the food supplement sold in the United States. Therefore, people may be venturing into the unknown by using the substance in much higher amounts than were used in Chinese cooking," says Pearson. In addition, although Cholestin is less expensive than some of the prescription drugs, many health care plans do cover statin drugs, but will not cover dietary supplements.
"At present, too little is known to make scientifically sound statements about whether the red yeast rice will be a new option in the treatment of elevated blood cholesterol. We can say that statin drugs, manufactured with high levels of quality control and used in a carefully monitored medical setting, are highly effective in lowering cholesterol levels in the blood. The red yeast data to date are very interesting, and we would like to encourage research into its long-term effectiveness and safety," says Pearson.