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Background  Phytosterols and red yeast rice are largely studied cholesterol-lowering nutraceuticals, respectively inhibiting the bowel absorption and liver synthesis of cholesterol. Our aim was to test the effect on lipid profile of phytosterols, red yeast rice and their association.    Methods  We performed a three parallel arms, double blind, clinical trial randomizing 90 moderately hypercholesterolemic subjects to treatment with phytosterols 800 mg (group 1), red yeast rice standardized to contain 5 mg monacolins from  Monascus purpureus  (group 2), or both combined nutraceuticals (group 3).    Results  After 8 weeks of treatment, in group 1 no significant variation of lipid parameters has been detected. In group 2 a significant reduction ( p  < 0.001) of LDL-Cholesterol (−20.5% vs. baseline) and Apolipoprotein B (−14.4% vs. baseline) as it occurred in group 3 (LDL-Cholesterol vs. baseline: −27.0%, Apolipoprotein B vs. baseline: -19.0%) ( P  < 0.001). LDL-Cholesterol and Apolipoprotein B changes were significantly different comparing group 2 with group 1 ( P  < 0.05), and group 3 with group 1 ( P  < 0.05). LDL-Cholesterol change was also significantly higher in group 3 than in group 2 ( P  < 0.05).    Conclusion  The association of phytosterol and red yeast rice seems to have additive cholesterol lowering effect, reaching a clinically significant LDL-Cholesterol reduction in mildly hypercholesterolemic patients.    Trial registration  ClinicalTrial.gov ID:  NCT02603276 , Registered 27/08/2015.

nutrition and metabolism

Effect of a short-term dietary supplementation with phytosterols, red yeast rice or both on lipid pattern in moderately hypercholesterolemic subjects: a three-arm, double-blind, randomized clinical trial