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Link to the News: This Month’s Picks with Pithy Commentary
Red Yeast Rice Goes Head-to-Head with Statins: Equal Efficacy with Fewer Side Effects
Recent studies have examined the efficacy and tolerability of red yeast rice for hyperlipidemia. In one study, researchers at the University of Pennsylvania School of Medicine compared red yeast rice (2,400 mg twice daily) with pravastatin (20 mg twice daily) for tolerability and efficacy in 43 individuals with high cholesterol and a history of statin-drug discontinuation because of myalgia. After 12 weeks, LDL-cholesterol decreased by 30 percent in the red yeast rice group and by 27 percent in the pravastatin group, indicating equal efficacy. Am J Cardiol 2010;105:198-204.
Red Yeast Rice: Effective Lipid Lowering without the Side Effects of Statin Drugs
Researchers at the University of Tennessee Medical Center found red yeast rice to have fewer side effects than conventional lipid-lowering medications. After examining 1,400 patient records, they identified 25 individuals who were taking red yeast rice (1,200 mg at bedtime) and had made no other changes in lipid-lowering medications for at least four weeks. Side effects of previous treatment included myalgias (68%), GI disturbances (16%), and/or elevated liver enzymes (8%). After an average of 79 days red yeast rice was tolerated by 92 percent of patients. Total cholesterol decreased by 15 percent and LDL-cholesterol by 21 percent. Am J Cardiol 2010;105:664-666.
Red Yeast Rice and Policosanol – Even Safe and Effective for Children
With childhood obesity on the rise, elevated cholesterol has become a significant problem in this patient population. A combination of red yeast rice and policosanol was tested in a double-blind trial on 40 children (ages 8-16) with familial hyperlipidemia. They received either a supplement of 200 mg red yeast rice and 10 mg policosanol or placebo once daily for eight weeks. After a four-week washout period the children were crossed over to the other treatment for another eight weeks. The supplement resulted in significant lowering of total cholesterol by 18.5 percent, LDL-cholesterol by 25.1 percent, and apolipoprotein B (another cardiovascular risk factor) by 25.3 percent. No adverse effects on liver or muscle enzymes were observed. Nutr Metab Cardiovasc Dis 2010 Feb 10. [Epub ahead of print]
Red Yeast Rice: Possible Synergism with Policosanol and Berberine
Another double-blind study examined the effects on lipid lowering, endothelial function, and insulin sensitivity of a nutrient/botanical combination with a daily dose of red yeast rice (200 mg), policosanol (10 mg), and berberine (500 mg). Fifty patients (average age 55) were given the supplement combination or a placebo for six weeks. Significant reductions in total- and LDL-cholesterol and triglycerides along with improvements in insulin sensitivity and flow-mediated vasodilation occurred in the treatment group compared to the placebo group. Nutr Metab Cardiovasc Dis 2009 Aug 19. [Epub ahead of print]
Some Potential Benefits of Statin Drugs Offset by a CoQ10 Deficiency
Because statin drugs inhibit an enzyme that is responsible for cholesterol synthesis, which is also necessary for CoQ10 synthesis, it has long been thought that statin-induced myalgias and other side effects are, at least in part, due to a CoQ10 deficiency. A recent study supports this contention. Patients with atherosclerosis-related congestive heart failure (CHF) are often given statins to help prevent the heart enlargement and other associated changes that decrease heart function. However, a recent study of rosuvastatin for this purpose did not find it prevented such cardiac remodeling. This comparison study found after 12 months of statin therapy that CHF patients had significantly lower levels of CoQ10 compared to matched CHF patients who were not on a statin; collagen turnover was also higher in the statin group. The researchers suggest beneficial effects of statins in this population are offset by these two factors. Int J Cardiol 2010 Jan 18. [Epub ahead of print]
CoQ10 May Not Be the Only Nutrient Deficiency Associated with Statin-related Side Effects
Serum vitamin D levels were measured in 621 individuals taking a statin drug, 128 of whom had myalgia. The myalgia patients had significantly lower levels of 25-hydroxyvitamin D than the 493 asymptomatic statin users (28.6 ng/mL in the myalgia group versus 34.2 ng/mL in the asymptomatic group). Further analysis showed 64 percent of myalgia patients were low in vitamin D compared to 43 percent of asymptomatic subjects. A subset of 38 myalgia patients was subsequently supplemented with 50,000 IU of vitamin D2 weekly for 12 weeks, resulting in an increase in average vitamin D levels to 48.2 ng/mL and resolution of myalgia symptoms, despite continuation of statins. While the myalgia patients had average lower levels of vitamin D than the asymptomatic patients, the average of the asymptomatic patients (34 ng/mL) was still borderline low. Since the building block of vitamin D is cholesterol, it is not surprising this population could generally be low in vitamin D. Transl Res 2009;153:11-16.
Commentary: What is the Take-Home Message from these Studies?
This series of recently published studies demonstrates that red yeast rice, with or without the addition of other supplements such as policosanol, can effectively reduce lipid levels comparable to prescription statin medications, but without significant side effects. Furthermore, the dosage of red yeast rice in the two studies in which it was combined with policosanol was significantly lower than the dosages used in studies when it was used alone, possibly indicating a synergistic effect of the two nutrients.
Since significant evidence indicates a statin-induced CoQ10 deficiency may be a cause of side effects associated with the medication, it is essential to supplement CoQ10 in patients on statins. While the association between CoQ10 and statins has long been known, a vitamin D deficiency associated with statin-induced myalgia has only recently been reported. Thus, it is essential to test vitamin D levels and supplement accordingly.
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