Cholesterol: Red Yeast Rice andd Omega-3s

Red yeast rice and omega-3s found in fish are two popular natural options. In fact, FDA approved a prescription form of omega-3s for the purpose of regulating lipid levels, with therapeutic dosages being 2 to 4 g/d of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), according to researchers at Virginia Commonwealth University in Richmond.² They added the treatment may also increase LDL levels, but the net effect is a reduction in non-HDL cholesterol.

One review examined the role of omega-3 and red yeast rice in preventing clinical cardiovascular events.³ Researchers found modest doses of omega-3 reduced cardiac deaths, and in high doses reduced nonfatal cardiovascular events, while red yeast rice reduced adverse cardiac events to a similar degree as the statins. Another study compared the lipid-lowering effects of an alternative treatment group (AG), i.e., lifestyle changes, red yeast rice and fish oil to a standard dose of a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, a statin.⁴ Seventy-four patients with hypercholesterolemia were randomized to an AG or to receive 40 mg/d of simvastatin for 12 weeks. There was a statistically significant reduction in LDL levels in both the AG and simvastatin group. The AG also showed significant reductions in triglycerides and weight compared with the simvastatin group.

Xuezhikang (XZK), a partially purified extract of red yeast rice, was examined in a multicenter, placebo-controlled study for its effects on lipoprotein and cardiovascular end points in Chinese patients (n=5,000) who experienced a previous myocardial infarction (MI).⁵ The primary end point was a major coronary event that included nonfatal MI and death from coronary heart disease. After 4.5 years, 10.4 percent of subjects in the placebo group experienced a major coronary event, including nonfatal MI or death, compared to 5.7 percent in the XZK-treated group. Treatment with XZK also significantly decreased cardiovascular events and total mortality by 30 percent and 33 percent, the need for coronary revascularization by one-third, and lowered total and LDL cholesterol and triglycerides; it did raise HDL levels.

According to a study of 923 pregnant women at the Swedish Medical Center in Seattle, the long-chain polyunsaturated fatty acids (LCPUFAs) found in fish improve cholesterol profiles.⁶ Women who reported eating fish twice or more per week had lower triglycerides and higher HDL than women who reported eating fish only once or less per week.

A policosanol omega-3 nanodispersion (as Nanocosanol®, from Valensa) may lower all parameters of cholesterol except HDL, which may increase slightly when taken in a twice-daily 690 mg capsule (containing 10 mg of policosanol and 100 mg of omega-3s), according to a company-sponsored trial reported in 2006.⁷ In a three-month, non-controlled, open-label trial, the most clearly established changes among the 11 subjects were in total cholesterol, and the LDL:HDL and total:HDL ratios.

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