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Cardiovascular diseases (CVD) account for 31% of all deaths, making them the leading cause of death worldwide. Hyperlipidemia is a major risk factor of CVD. Statins, one of the most commonly prescribed type of lipid-lowering drugs in the world, are widely recognized as effective in the prevention and treatment of CVD as they inhibit 3-hydroxy-3-methyl glutaryl coenzyme A reductase, reduce endogenous cholesterol synthesis, and increase LDL clearance by promoting LDL receptor expression. However, adverse reactions to statins and stain-associated symptoms (SAS) (i.e. muscle, metabolic, liver and nervous system) have limited the use of statins. An alternative to statins, red yeast rice (RYR), is a traditional medicine and functional food that has a long history. Relatively small doses of RYR (equivalent to 5–7 mg of lovastatin daily) have been reported to have a similar effect to the 20–40 mg dose of pure lovastatin alone in lowering serum cholesterol, suggesting that RYR contains cholesterol-lowering bioactive substances. This review is the first to summarize the material basis of synergistic enhancing efficacy and reducing adverse reactions in the lipid-lowering effect of RYR, highlight the lipid-lowering advantages of RYR, and provide reference for the development and application of RYR in functional foods and drugs.

Red yeast rice: a functional food used to reduce hyperlipidemia