Red yeast rice, red fermented rice, red kojic rice, red koji rice, anka, or ang-kak, is a bright reddish purple fermented rice, which acquires its colour from being cultivated with the mold Monascus purpureus.
Clinical evidence
The amount typically used in clinical trials is 1200-2400 mg/day of red yeast rice containing approximately 10 mg total monacolins of which half are monacolin K. This does raise a question about the function of the other monacolins and non-monacolin compounds in the products, as the monacolin K content is lower than what is usually considered effective for lovastatin (20-80 mg/dy). In 2006 Liu et al. published a meta-analysis of clinical trials. The article cited 93 published, controlled clinical trials (91 published in Chinese). Total cholesterol decreased by 35 mg/dl, LDL-cholesterol by 28 mg/dl, triglycerides by 35 mg/dl, and HDL-cholesterol increased by 6 mg/dl. The incidence of reported adverse effects ranged from 1.3% to 36%.[9] Of the clinical trials reviewed in the meta-analysis, the only study conducted in the United States reported a 22% reduction of LDL-cholesterol after 12 weeks.[10]
Subsequent to the 2006 meta-analysis there are a number of articles reporting on a massive trial conducted in China: the China Coronary Secondary Prevention Study (CCSPS). Close to 5000 post-heart attack patients were enrolled for an average of 4.5 years to either receive a placebo or a RYR product named Xuezhikang (???). This is a patented-process (U.S. patent #6,046,022), ethanol extract of red yeast rice, with a total monacolins content of approx. 0.8%. It is also sold as Lipascor. Key CCSPS results: in the treated group risk of subsequent heart attacks was reduced by 45%, cardio deaths by 31%, and all-cause deaths by 33%. Some of the articles report on subsets of the population, i.e., just diabetics or just hypertensives.[11][12][13][14][15][16]
These heart attack and cardiovascular death outcomes appear to be better than what has been reported for prescription drugs. A 2008 review pointed out that the cardioprotective effects of statins in Japanese populations occur at lower doses than are needed in Western populations, and theorized that the low amount of monacolins found in Xuezhikang may be more effectively athero-protective than expected in the Chinese population in the CCSPS study for the same reason. Others have speculated that phytosterols or unknown substances in Xuezhikang also contribute to the benefits.[17]
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