Red Yeast Rice Improves Heart
Health in More Ways Than One

or close to a century we have been aware of the relationship between cholesterol and our hearts. Clearly stated, increased fat and cholesterol intake increases our risk of heart disease. Thanks to well-publicized medical findings, gone from most of our diets are cheesecake, potato chips, ice cream, and a host of other fat-laden foods. And if they're not gone, we tend to eat them with so much guilt that the pleasure they provide has certainly been tempered. But these changes in diet really are for the better, and as a nation, we have decreased our intake of cholesterol and saturated fats to the extent that our total blood cholesterol levels have declined. From 1978 to 1991, for example, the average adult total cholesterol level decreased from 213 to 203 mg/dL (milligrams per deciliter of blood).1 Healthy cholesterol levels are considered to be under 200 mg/dL, and the ideal threshold value may be lower than that.

The amount of cholesterol that is present in our blood may not make immediate sense to many of us, so let's put the numbers in perspective. For total cholesterol, any value below 200 mg/dL is what you want to hear when the doctor tells you the results of your cholesterol test. Total cholesterol is composed of LDL (low-density lipoprotein, or "bad" cholesterol) and HDL (high-density lipoprotein, or "good" cholesterol), and LDL levels are normally much higher than HDL levels. Much research has demonstrated that anything you can do to increase your HDL levels and decrease your LDL levels will benefit your cardiovascular health. Table 1 shows the National Cholesterol Education Program Expert Panel's current guidelines for cholesterol levels.2


As the name implies, a lipoprotein is a molecular complex consisting of a protein and a lipid (lipids are fatty substances, such as cholesterol). Both LDL and HDL incorporate cholesterol in their structures, but LDL contains much more of it than HDL does. LDL transports cholesterol to cells that need it (yes, cholesterol is vital to our health), but it can also cause extensive damage to our system by depositing excess cholesterol on the inner walls of our blood vessels. These deposits, called plaque, typically include other substances as well, such as fats, calcium, and cellular debris (see Figure 1). They impede the flow of blood through the circulatory system and are the cause of atherosclerosis. The higher the LDL level in our blood, the more excess cholesterol there is to deposit.

Figure 1. As plaque builds up, it can become either stable or unstable. 
Unstable plaque is more prone to sudden rupture, a potentially life-threatening event.

By contrast, high HDL levels are associated with a decreased risk of atherosclerosis, because HDL transports excess cholesterol from the tissues to the liver for metabolism and excretion. Now you know why we desire low LDL levels and high HDL levels in our blood. Even so, would you want to have really low levels of LDL? Actually, no. As mentioned above, cholesterol is an essential molecule in your body. It is the precursor of many other steroids, such as pregnenolone and all the sex hormones (both male and female), and it is important for the synthesis of vitamin D, the bile acids (which aid in digestion), and cell membranes.

Clearly stated, increased fat and
cholesterol intake increases our
risk of heart disease.

Cholesterol is synthesized in the liver, and your body makes two to three times more of it than you get in your diet. So even if you didn't consume any cholesterol, you would still have a lot of it circulating in your bloodstream. In fact, restricting dietary intake of cholesterol is not an effective means of treating high cholesterol in many patients, because their livers produce such large amounts. These individuals are frequently given cholesterol-synthesis inhibitors (e.g., lovastatin, simvistatin, pravastatin, fluvastatin, atorvastatin, and cerivastatin), which decrease LDL levels by 20-60%. They provide the additional benefits of reducing triglycerides (the dominant form of fat in your diet) by 10-35% and elevating HDL levels by 2-12%.2 Unfortunately, however, because prescription statin drugs contain a very high concentration of these compounds, they may have significant side effects in some people.


A recent study reconfirms that high HDL levels and low triglycerides decrease the risk of heart disease.3 It was found that men with conventional risk factors for ischemic heart disease (heart disease caused by an inadequate blood supply to the heart muscle's own cells - ironic, isn't it?) can considerably lower their risk if they maintain high levels of HDL and low levels of triglycerides in their blood. Risk factors for ischemic heart disease (IHD) identified in this study and used to classify participants as either high-risk or low-risk were:

  • LDL levels above 170 mg/dL
  • Blood pressure above 150/100 mm Hg, or taking blood pressure medicine
  • Low level of physical activity (less than 4 hours/week)
  • Smoking

Over an 8-year period, men 53-74 years old (average age 63) with low risk factors who participated in the study developed IHD with an incidence of 9.8-12.2% if they had high triglyceride/low HDL levels (bad), but with an incidence of only 4.0-5.1% if they had low triglyceride/high HDL levels (good). A similar reduction in the rate of IHD was observed in men with high risk factors: the incidence of IHD in the high-triglyceride/low-HDL subjects was 12.2-16.4%, whereas it was only 3.7-5.3% in the low-triglyceride/high-HDL subjects. Not surprisingly, individuals with intermediate values had intermediate chances of developing IHD. These data come from a very large sampling of men, 2906 in all. For the purpose of the study, they were assigned to groups based on triglyceride (TG) and HDL levels.

A recent study reconfirms that high
HDL levels and low triglycerides
decrease the risk of heart disease.

So get out your medical records and see where you stand, or have your lipids tested by your doctor. If your triglyceride level is a little high and your HDL is a little low, take heart - help may be available. Some things are beyond your control, of course, such as a family history of heart disease, growing older, or having diabetes. You simply can't change these things. One sobering statistic is that people aged 65-74 die of heart disease at a rate 21 times higher than people aged 55-64.4 But you do have control in other ways. The most important lifestyle factors are to make sure that you have a healthy diet, maintain cardiovascular fitness through exercise, don't smoke, and lose some weight if you're carrying around a few extra pounds. In addition, you may be able to regulate your HDL and LDL levels by adding a supplement to your diet.


Wouldn't it be great if you could reduce the amount of cholesterol your liver makes? The amount in your blood would decrease as well, and your risk for heart disease would diminish. As it turns out, your liver does respond to what you eat in its decision to make cholesterol. The more saturated fat you eat, the more cholesterol your liver makes. This process isn't well understood, but it does explain why high triglyceride levels increase the risk of heart disease and why your cholesterol levels can rise in response to diet.

Decreases in LDL and
triglycerides are similar with each
treatment, yet red yeast rice
appears to increase beneficial
HDL levels substantially
compared to the drug lovastatin.

Is there anything you can eat to decrease the amount of cholesterol synthesized by your liver? Yes! The Chinese have employed an ingredient in their cuisine for hundreds of years that is credited with improving blood circulation.5 This ingredient, red yeast rice, is composed of rice and fermented yeast and is added to food as a preservative and to improve flavor. Whether or not the Chinese were aware of its circulatory benefits through the centuries is unclear. In any case, red yeast rice has generated much interest among medical researchers, given that it can both lower the levels of triglycerides and total cholesterol and raise protective HDL levels.

With patients receiving 1200 mg per day of red yeast rice supplements, Chinese researchers have shown that in as little as 4 weeks, total cholesterol was reduced by as much as 17%, while triglycerides were reduced by 20%.6 After 8 weeks, the reductions were 23% and 34%, respectively. In addition, HDL levels rose during the treatment - by 13% after 4 weeks and by 20% after 8 weeks. Red yeast rice clearly contributes to heart health in more ways than one.

What is the active ingredient in red yeast rice? If you're familiar with cholesterol-lowering drugs, you already know the answer. Red yeast rice contains substances called statins - nine types, in fact. One of them is lovastatin, which is also found in Mevacor®, a commonly prescribed medication for cholesterol reduction. The effect of lovastatin is to inhibit the action of a specific liver enzyme required for the synthesis of cholesterol. The result is less "bad" cholesterol (LDL) and, surprisingly, more "good" cholesterol (HDL). Which is just what we want, of course, because it reduces the risk of atherosclerosis and, ultimately, of heart attack.

Both the prescription drug lovastatin and natural red yeast rice reduce cholesterol when administered to subjects with high levels of it, although, because of other natural active ingredients. Each of these agents produces similar decreases in LDL and triglycerides, yet red yeast rice appears to increase beneficial HDL levels substantially compared to the drug lovastatin (see Table 2).

These data suggest that the natural form of lovastatin, or some other compound in red yeast rice, is more effective than the synthetic form available by prescription.6,7

The Chinese have employed an
ingredient in their cuisine for
hundreds of years that is credited
with improving blood circulation.
This ingredient, red yeast rice,
is composed of
rice and fermented yeast.

Cardiovascular health is important for living the kind of life you desire. Chances are that you can improve your life by lowering your LDL and triglyceride levels while boosting your HDL levels. This is sometimes difficult to do by diet and exercise alone. Red yeast rice may provide an added means for accomplishing your cardiovascular goals. It is a natural cholesterol-lowering agent. When used in conjunction with a low fat/low cholesterol diet and regular exercise, this food may help you achieve healthy cholesterol levels and allow you to reach your goal of improving your cardiac fitness.


  1. Burt VL, Whelton P, Roccella EJ. Prevalence of hypertension in the U.S. adult population. Results from the Third National Health and Nutrition Examination Survey. 1988-­1991. Hypertension 1995;25:305­-13.
  2. Deedwania PC. Is lipid-lowering worthwhile for older patients? Geriatrics 2000;55:22-­8.
  3. Jeppesen J, Hein HO, Saudicani P, Gyntelberg F. Low triglycerides - high high-density lipoprotein cholesterol and risk of ischemic heart disease. Arch Int Med 2001;161:361­-6.
  4. US Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report 2001;50:90-­3.
  5. Stuart MD. Chinese Materia Medica - Vegetable Kingdom. Taipei, Republic of China, Southern Materials Center, Inc., 1979.
  6. Perreault S, Hamilton VH, Lavoie R, Grover S. Treating hyperlipidemia for the primary prevention of coronary diesase: are higher doses of lovastatin cost-effective? Arch Int Med 1998;158(4):375­81.
  7. Heber D, Yip I, Ashley JM, Elashoff DA, Elashoff RM, Go VLW. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr 1999;69:231-­6.

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