Chinese red yeast rice for primary hyperlipidemia: a meta-analysis of randomized controlled trials

Jianping Liu^1 ,4  , Jing Zhang²  , Yi Shi³  , Sameline Grimsgaard¹  , Terje Alraek¹  and Vinjar Fønnebø^{1  1}National Research Centre in Complementary and Alternative Medicine (NAFKAM), University of Tromso, Tromso N-9037, Norway²Evidence-Based Medicine Centre in Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Cai Lun Lu 1200, Pudong, Shanghai 201203, China³The Institute of Traditional Chinese Medicine Literature, Shanghai University of Traditional Chinese Medicine, Cai Lun Lu 1200, Pudong, Shanghai 201203, China⁴Evidence-Based Chinese Medicine Research Centre, Beijing University of Chinese Medicine, Beijing 100029, China

Abstract

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 hyperlipidemia. We included randomized controlled trials testing RYR preparation, compared with placebo, no treatment, statins, or other active lipid-lowering agents in people with hyperlipidemia through searching PubMed, CBMdisk, TCMLARS, the Cochrane Library, and AMED up to December 2004. Ninety-three randomized trials (9625 participants) were included and three RYR preparations (Cholestin, Xuezhikang and Zhibituo) were tested. The methodological quality of trial reports was generally low in terms of generation of the allocation sequence, allocation concealment, blinding, and intention-to-treat. The combined results showed significant reduction of serum total cholesterol levels (weighted mean difference -0.91 mmol/L, 95% confidence interval -1.12 to -0.71), triglycerides levels (-0.41 mmol/L, -0.6 to -0.22), and LDL-cholesterol levels (-0.73 mmol/L, -1.02 to -0.043), and increase of HDL-cholesterol levels (0.15 mmol/L, 0.09 to 0.22) by RYR treatment compared with placebo. The lipid modification effects appeared to be similar to pravastatin, simvastatin, lovastatin, atorvastatin, or fluvastatin. Compared with non-statin lipid lowering agents, RYR preparations appeared superior to nicotinate and fish oils, but equal to or less effective than fenofibrate and gemfibrozil. No significant difference in lipid profile was found between Xuezhikang and Zhibituo. RYR preparations were associated with non-serious adverse effects such as dizziness and gastrointestinal discomfort. Current evidence shows short-term beneficial effects of RYR preparations on lipid modification. More rigorous trials are needed, and long-term effects and safety should be investigated if RYR preparations are to be recommended as one of the alternative treatments for primary hyperlipidemia.

 Conclusion

Current evidence from randomized trials shows short-term beneficial effects of RYR preparations on lipid modification. More rigorous trials are needed, and long-term effects and safety should be investigated if RYR preparations are to be recommended as one of the alternative treatments for primary hyperlipidemia.

The electronic version of this article is the complete one and can be found online at: http://www.cmjournal.org/content/1/1/4