According to the 2004 World Health Organization Global Health Risk report, high blood cholesterol is the 6th leading risk factor for death globally. Although diet and lifestyle modifications are often recommended as the primary therapy for high blood cholesterol, medications are often required to lower cholesterol to an acceptable range.
Statins are the first-line drugs to lower blood cholesterol, especially the more atherogenic LDL cholesterol. In some people, statins can also raise levels of heart-protective HDL cholesterol. Statins work by inhibiting HMG-CoA reductase, the rate-limiting enzyme that makes cholesterol in the liver. By interfering with cholesterol production, statins may slow down a process known as atherosclerosis, a pathological result of plaque formation in the arteries that precedes most cardiovascular diseases, including high blood pressure, stroke and heart attack.
Classes of Statins
Statins are isolated from fungus, which use pathways similar to those in cholesterol synthesis to make cytoskeletons and cell walls. Various statins have been isolated from different species of fungus, including lovastatin, pravastatin, simvastatin, fluvastatin, atorvastatin, and rosuvastatin. Not all statins are created equal, however. Some are more potent and can be taken at lower doses. And some can cause more side effects than others. Simvastatin, for example, is more likely to cause side effects at higher doses, especially when combined with medications for irregular heart beat.
Potential Benefits of Statins
In addition to lowering cholesterol, statins are being investigated for protection against bone loss, as well as against some forms of cancer, gallstones, and dementia. For example, in an American Academy of Orthopedic Surgeons review of studies, it was found that the use of statins was associated with increased bone density and reduced risk of fractures among older women, although some of the study results reviewed were less favorable. And a 2010 Danish study published in the "American Journal of Epidemiology" found that long-term use of statins is associated with a lower risk of gallstones.
Red Yeast Rice: Overview
Red yeast rice is fermented with the yeast strain Monascus purpureus. Red yeast rice has been used for centuries in Asian countries as a food coloring agent and a medication for indigestion, diarrhea and poor blood circulation. In western countries, red yeast supplements are used as an alternative therapy to lower total cholesterol and LDL cholesterol and increase levels of good HDL cholesterol. The active ingredients in red yeast rice are the same as in prescription statins. Cholestin was once the most popular red yeast supplement sold in the United States, until it was found to contain lovastatin, an FDA-approved statin drug. The FDA has since considered statin-containing red yeast products unapproved illegal drugs. But as of 2008, Americans spent $20 million on red yeast supplements per year.
Problems with Red Yeast Rice
A just-released study in the Oct 25, 2010 issue of the "Journal Archives of Internal Medicine" found that one-third of red yeast products contain citrinin, a compound potentially toxic to the kidneys. Red yeast contains other statinlike active ingredients in addition to lavastatin known as monacolins, some of which have not been isolated. The amounts of cholesterol-lowering ingredients can vary up to 100-fold among different red yeast preparations, resulting in the vastly diverging effects seen with different products.
Common Side Effects Shared by Statins and Red Yeast Rice
High dose of statins can cause muscle pains and occasionally rhadomyolysis, a condition in which muscles break down and release kidney-damaging proteins into the bloodstream. These side effects are shared by red yeast supplements. The depletion of coenzyme Q10, a factor involved in energy production in the cell, is thought to be partially responsible for the side effects. Co-supplementation of CoQ10 may help to prevent muscle pain, but you should always consult your doctor before taking any supplement. Whether from a statin or a red yeast product, side effects vary among individuals and are more common in people who are older, female, have smaller body frames and who have underlying kidney or liver diseases.
- MayoClinic.com: Statins
- MedlinePlus: Red Yeast
- Am J Epidemiol; Long-term Statin Use and the Risk of Gallstone Disease: A Population-based Case-Control Study; R Erichsen, et al.; 2010
- American Academy of Orthopedic Surgeons: Statins and Bone Health
- JAMA News Release: Active Ingredient Levels Vary Among Red Yeast Rice Supplements
- WHO: Global Health Risks