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Extracts of Chinese red yeast rice (RYR, a traditional dietary seasoning of Monascus purpureus) contains several active ingredients including lovastatin, and several trials of its possible lipid-lowering effects have been conducted. This meta-analysis assesses the effectiveness and safety of RYR preparations on lipid modification in primary hyperli...
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... RYR preparations were tested in the included trials: The RYR dietary supplement (Cholestin), and the Chinese proprietary medicines Xuezhikang and Zhibituo. Their constituents, dosages, and treatment regimens are listed in Table 1. All trials reported lipid profile outcome and 77 trials also reported adverse effects. ...
Citations
... Congruently with the present study, previous systematic reviews and meta-analyses have also reported positive effects of RYR extract consumption [35,36], enhancing the evidence that the use of RYR extract seems to significantly reduce both total cholesterol and LDL-C to a similar extent. Overall, short-term clinical studies have shown that preparations with RYR extract have short-term positive effects in the treatment of hypercholesterolemia [10], while larger clinical trials have shown that the above nutraceutical may also contribute to a lower risk of cardiovascular events as secondary prevention in the long run [37]. ...
Previous studies have shown encouraging results regarding the efficacy and safety of nutraceuticals, such as “red yeast rice (RYR) extract”, on reducing hypercholesterolemia in humans. A systematic review and meta-analysis was conducted from January 2012 to May 2022. The search was strictly focused on clinical trials that examined the association between RYR extract consumption and parameters of the lipid profile in humans. Fourteen double-blinded clinical trials were identified. The interventions lasted 4–24 weeks. In most studies, there was one intervention group and one control group. RYR extract consumption statistically significantly reduced total cholesterol (mean absolute reduction: 37.43 mg/dL; 95% confidence interval [CI]: −47.08, −27.79) and low-density lipoprotein cholesterol (LDL-C; mean absolute reduction: 35.82 mg/dL; 95% CI: −43.36, −28.29), but not high-density lipoprotein cholesterol, triglycerides and apolipoproteins A-I and B. As regards the safety, RYR extract was considered a safe choice with neither threatening nor frequent side effects. The consumption of RYR extract by people with hypercholesterolemia was associated with statistically significant reduction in total cholesterol and LDL-C, whereas it was not associated with an increase in life-threatening side effects. Further research on specific subpopulations and outcomes could establish a consensus on determining the clinical benefits and potential risks, if any, of this nutraceutical.
... In addition to conventional pharmacological therapy (ACE inhibitors, beta-blockers, statins, fibrates and PCSK9 inhibitors), nutraceutical solutions have been proposed in recent years as contributing factors to reduce cardiovascular risk [4,5]. Accordingly, nutraceuticals may act on the reduction of lipid risk markers, including total cholesterol (TC), lowdensity lipoprotein (LDL-C), and triglycerides (TG), and can be divided on the basis of their mechanism of action: sterols and glucomannan may reduce LDL by decreasing the intestinal adsorption of endogenous cholesterol [6,7], while red yeast, garlic, panthetine and policosanols inhibit hepatic cholesterol synthesis [8]. ...
Cardiovascular diseases (CVDs) represent the leading cause of global mortality with 1.7 million deaths a year. One of the alternative systems to drug therapy to minimize the risk of CVDs is represented by alpha-linolenic acid (ALA), an essential fatty acid of the omega-3 series, known for its cholesterol-lowering effect. The main purpose of this review is to analyze the effects of ALA and investigate the relevant omega-6/omega-3 ratio in order to maintain functionally beneficial effects. Concerning the lipid-lowering preventive effects, ALA may favorably affect the values of LDL-C and triglycerides in both adult and pediatric populations. Furthermore, ALA has shown protective effects against hypertension, contributing to balancing blood pressure through customary diet. According to the 2009 EFSA statement, dietary ALA may contribute to reducing the risk of CVDs, thanks to anti-hypertensive, anti-atherosclerotic and cardioprotective effects.
... In addition to conventional pharmacological therapy (ACE inhibitors, beta-blockers, statins, fibrates and PCSK9 inhibitors), nutraceutical solutions have been proposed in recent years as contributing factors to reduce cardiovascular risk [4,5]. Accordingly, nutraceuticals may act on the reduction of lipid risk markers, including Total Cholesterol (TC), Low-Density Lipoprotein (LDL-C), and triglycerides (TG) and can be divided on the basis of their mechanism of action. ...
... In a meta-analysis of controlled trials conducted by Khalesi et al [49] the intake of ALA-rich sesame fractions is associated with a reduction of TG. As a result, the consumption of sesame did not 4 significantly change the TC (-0.32 mmol/L, 95% CI: -0.75 to 0.11; p=0.14, I2 =96 %), LDL-C (-0.15 mmol/L, 95 % CI: -0.50 to 0.19; p = 0.39, I2 = 96 %) or HDL-C levels (0.01 mmol/L, 95% CI:-0.00 to 0.02; p= 0.16, I2 = 0 %). However, a significant reduction was observed in serum TG levels (-0.24 mmol/L, 95 % CI: -0.32 to -0.15; p <0.001, I2 = 84 %) after consumption of sesame. ...
Cardiovascular diseases (CVDs) represent the leading cause of global mortality with 1,7 million deaths a year. One of the alternative systems to drug therapy to minimize the risk of CVDs is represented by alpha-linolenic acid (ALA), an essential fatty acid of the Omega-3 series, known for its cholesterol-lowering effect. The main purpose of this review is to analyze the effects of ALA and investigate the relevant n-6/n-3 ratio in order to maintain functionally beneficial effects. Concerning the lipid-lowering preventive effects, ALA may favorably affect the values of LDL-C and triglycerides in either adult and pediatric populations and it has a positive and protective effect against hypertension, suggesting that ALA is an useful diet-related antihypertensive compound. According to the 2009 EFSA statement, dietary ALA may contribute to reducing the risk of CVDs, thanks to anti-hypertensive, anti-atherosclerotic and cardio-protective effects.
... The incidence and prevalence of hyperlipidemia are increasing all over the world, which has become an important public health problem in recent years. The study of blood lipid reduction drugs has also become a hot spot of research, especially in terms of herbal products and Traditional Chinese Medicine [11][12][13][14][15][16]. Ginger (Zingiber officinale Roscoe, Zingiberacae) is the fresh root of perennial herb ginger, also known as "ginger root", "spicy cloud", or "hook fingers". ...
The aim of this research is to investigate lipid-lowering influence of dietary ginger (Zingier officinales Rocs) polysaccharides (GPS) on hyperlipidemia rats. Rat models with hyperlipidemia was established by high-fat food diet (HFD). Comparing to GP-negative model group, GPS attenuated several effects of HFD feeding, including the levels of blood lipid biochemistry, serum inflammatory markers (tumor necrosis factor TNF-a, interleukin IL-6), antioxidant capacity (superoxide dismutase SOD, glutathione peroxidase GSH-Px, total antioxidant capacity T-AOC, propylene dialdehyde MDA), uric acid and immune index. 16 S rDNA gene sequencing of fecal samples showed that GPS increased the growth of Akkermansia muciniphila and decreased the proportion of Firmicutes to Bacteroidetes; This changes in microbial community structure can help prevent diet-induced metabolic disease. These results suggest that GPs may act on the gut, changing the structure of the gut microbial community, thereby reducing intestinal and systemic inflammation, thus improved metabolic outcomes.
... Dietary supplements based on RYR, which were initially approved in China and a few countries in Europe, typically include 5-10 mg of monacolin K, and its impact on decreasing cholesterol levels has been comprehensively proven in a metaanalysis of clinical evidence published up to the year 2005. According to the findings of Liu and colleagues, there was a notable reduction in total cholesterol, total fat, and LDL-C, in addition to a good effect on HDL-C 59 . When compared to a control group that followed the Mediterranean diet, a more recent multi-center, randomized clinical trial using 10 mg of monacolin K combined with 10 mg of coenzyme Q10 (CoQ10) found a significant reduction in blood levels of TC, total fat and LDL. ...
The medical disorder known as hyperlipidemia is characterized by unusually high amount of lipids in the blood (fatty substances). This illness is also associated with being overweight. Even though hypolipidemic drugs are commonly used to treat cardiovascular diseases and stroke, there is a possibility that they may cause undesirable side effects. Many different medicinal plants have been successfully utilized in the treatment of various conditions in India. The treatment of hyperlipidemia was the primary focus of this investigation into the therapeutic properties of a variety of plants.
... RYR was widely used as traditional medicine and food sources because it has a powerful cholesterollowering effect. Monacolin K was isolated as a key enzyme from RYR and is used as a cholesterol lowering agent under the name of lovastatin in the pharmaceutical industry (Liu et al., 2006). It is involved in the inhibition of the early stages of cholesterol biosynthesis by suppressing the activity of 3-hydroxy-methyl glutaryl-coenzyme A (HMG-CoA) reductase (Heber, 2001). ...
A R T I C L E I N F O Keywords: Anti-obesity High-fat diet Kimchi Monacolin K Red yeast rice A B S T R A C T Red yeast rice is fermented rice with Monascus purpureus and contains monacolin K, which decreases cholesterol levels. Here, the anti-obesity effect of kimchi with red yeast rice (RYRK) was investigated in vitro and in vivo. Initially, the anti-obesity effect of RYRK was examined by measuring triglyceride (TG) content and obesity-related gene expression in 3T3-L1 adipocytes. RYRK (100 mg/kg) were then orally administered for 8 weeks with a high-fat diet. Body weight and serum GOT and GPT were measured. The inhibitory effect of RYRK on lipid profiles and accumulation was assessed. RYRK significantly reduced TG content and obesity-related gene expression with low cytotoxicity (p < 0.05). RYRK significantly reduced body weight and serum and hepatic lipid profiles without hepatic damage (p < 0.05). RYRK inhibited lipid accumulation in H&E and ORO results. Overall, the anti-obesity effect of RYRK was established, resulting in a better understanding of the health benefits of kimchi.
... Furthermore, RYR contains phytosterols, fiber and niacin, which collectively may exert cholesterol-lowering effects [15]. Several studies, including animal studies, randomized controlled trials and meta-analyses, have reported the beneficial effects of RYR on reducing circulating TC or LDL-C concentrations [13,[16][17][18][19][20]. In addition, RYR and its bioactive components have been reported to downregulate the gene expressions of HMG-CoA reductase [19] and Niemann-Pick-C1-Like 1 (NPC1L1) [20] and upregulate the gene expressions of LDL receptor (LDLR) and Cholesterol 7-alpha hydroxylase (CYP7A1) [13,20], indicating that they may decrease circulating TC and LDL-C concentrations via the inhibition of cholesterol synthesis and the absorption and promotion of hepatic cholesterol uptake and bile acid synthesis. ...
... Previous studies have reported the cholesterol-lowering effect of supplementation with natto or RYR alone in both human subjects and experimental animals [10][11][12][13][16][17][18][19][20]. However, in the current study, combined supplementation with NR at a dose of 0.3 g/kg BW/day for 12 weeks did not significantly change fasting plasma concentrations of TC, LDL-C, HDL-C or non-HDL-C. ...
We aimed to examine the effect of natto and red yeast rice (NR) supplementation on lipid and lipoprotein profiles, gene expressions of cholesterol metabolism, and the composition of gut microbiota in ApoE-/- mice. Forty-one male ApoE-/- mice aged 7–8 wks old were randomly fed a control diet (CD), CD + NR (oral gavage at 0.3 g/kg BW/day), high-fat and high-cholesterol diet (HFD), or HFD + NR for 12 wks. Fasting blood samples, liver and intestine tissues and fecal samples were collected at week 12. Biochemical parameters, gene expressions in cholesterol metabolism and gut microbiota composition and diversity were measured using standard methods. NR supplementation had no significant effect on lipid and lipoprotein profiles. Compared with the HFD group, HFD + NR resulted in higher mRNA expressions of HMGCR and CYP7A1 (both P-NR < 0.05) and ABCA1 (P-diet*NR = 0.0134, P-NR = 0.0407), lower mRNA expression of PCSK9 (P-diet*NR = 0.0002), lower fasting glucose concentrations (P-diet*NR = 0.0011), and lower relative abundance of genera Bacteroides and Lactococcus (both P-NR < 0.01) and Coriobacteriaceae_UCG-002 (P-diet*NR = 0.0007). The relative abundance of Lactococcus was inversely correlated with HMGCR and CYP7A1, and the relative abundance of Coriobacteriaceae_UCG-002 was positively correlated with PCSK9 and inversely correlated with ABCA1 (all P < 0.05). These findings suggest that NR supplementation may regulate gene expressions in cholesterol metabolism via changes in the gut microbiota in HFD-fed ApoE-/- mice.
... Red yeast rice is produced by the fermentation of mycelia of Monascus purpureus and has shown potential as an agent for bone formation [65]. Red yeast rice promotes the proliferation of osteoblasts and increases the expression of alkaline phosphatase (ALP), a glycoprotein related to osteoblastic function. ...
Spinal fusion is one of the most common procedures performed in spinal surgery. The increasing complexity and frequency with which this operation is performed has led to a rise in postoperative complications and delayed recovery. Perioperative care of patients with spinal conditions aims to adequately manage pain and accelerate the return to function following surgery. Tradi- tional pharmaceutical interventions, especially opioid utilization, are associated with delayed recovery and significant adverse effects. As such, many studies are now evaluating the benefits and efficacy of non-pharmacological therapies for enhancing recovery after spinal fusion surgery. In this review, the mechanism of acupuncture relative to postoperative pain control and symptom reduction will be discussed. Additionally, this review examines the implications of malnutrition, current preclinical and clinical approaches for improving nutritional status, and various forms of physical rehabilitation that aim to combat postopera- tive complications and support recovery after spinal fusion surgery.
... Concerning the safety profile, no significant differences have been observed between active and placebo groups [159]. These data confirmed the results obtained in the Chinese meta-analysis by Liu et al. that included 93 RCTs and a total of 9625 participants [160]. ...
Currently, the nutraceutical approach to treat dyslipidaemia is increasing in use, and in many cases is used by physicians as the first choice in the treatment of patients with borderline values. Nutraceuticals represent an excellent opportunity to treat the preliminary conditions not yet showing the pathological signs of dyslipidaemia. Their general safety, the patient's confidence, the convincing proof of efficacy and the reasonable costs prompted the market of new preparations. Despite this premise, many nutraceutical products are poorly formulated and do not meet the minimum requirements to ensure efficacy in normalizing blood lipid profiles, promoting cardiovascular protection, and normalizing disorders of glycemic metabolism. In this context, bioaccessibility and bioavailability of the active compounds is a crucial issue. Little attention is paid to the proper formulations needed to improve the overall bioavailability of the active molecules. According to these data, many products prove to be insufficient to ensure full enteric absorption. The present review analysed the literature in the field of nutraceuticals for the treatment of dyslipidemia, focusing on resveratrol, red yeast rice, berberine, and plant sterols, which are among the nutraceuticals with the greatest formulation problems, highlighting bioavailability and the most suitable formulations.
... The first FDA-approved secondary metabolite was Lovastatin, to lower cholesterol levels. In oyster mushrooms [42], red yeast rice [43], and Pu-erh [44], Lovastatin occurs naturally in low concentrations. Their mode of action is inhibition of HMG-CoA reductase, and it is the enzyme responsible for converting HMG-CoA to mevalonate. ...
Natural products are substances that are confined from living organisms, they are in the form of primary or secondary metabolites. Secondary metabolites are compounds with varied chemical structures, produced by some plants and strains of microbial species. Unlike primary metabolites (nucleotides, amino acids, carbohydrates , and lipids) that are essential for growth, secondary metabolites are not. Secondary metabolites are produced or synthesized during the stationary stage. In this chapter, we will discuss secondary metabolites from natural products synthesized mainly by plants, fungi, and bacteria. Plants synthesize a large diversity of secondary metabolites; plant secondary metabolites are split into four groups namely alkaloids, phenolic compounds, terpenoids, and glucosinolates. Several classes of fungal and bacterial secondary metabolites, their sources, and pharmacological uses associated with the secondary metabolites are also discussed. Therefore, several classes of secondary metabolites are responsible for the biological and pharmacological activities of plants and herbal medicines.
