A Meta-Analysis of Red Yeast Rice: An Effective and Relatively Safe Alternative Approach for Dyslipidemia

<div><p>Objective</p><p>To explore whether red yeast rice is a safe and effective alternative approach for dyslipidemia.</p><p>Methods</p><p>Pubmed, the Cochrane Library, EBSCO host, Chinese VIP Information (VIP), China National Knowledge Infrastructure (CNKI), Wanfang Databases were searched for appropriate articles. Randomized trials of RYR (not including Xuezhikang and Zhibituo) and placebo as control in patients with dyslipidemia were considered. Two authors read all papers and independently extracted all relevant information. The primary outcomes were serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), and high-density lipoprotein cholesterol (HDL-C). The secondary outcomes were increased levels of alanine transaminase, aspartate aminotransferase, creatine kinase, creatinine and fasting blood glucose.</p><p>Results</p><p>A total of 13 randomized, placebo-controlled trials containing 804 participants were analyzed. Red yeast rice exhibited significant lowering effects on serum TC [WMD = −0.97 (95% CI: −1.13, −0.80) mmol/L, P<0.001], TG [WMD = −0.23 (95% CI: −0.31, −0.14) mmol/L, P<0.001], and LDL-C [WMD = −0.87 (95% CI: −1.03, −0.71) mmol/L, P<0.001] but no significant increasing effect on HDL-C [WMD = 0.08 (95% CI: −0.02, 0.19) mmol/L, P = 0.11] compared with placebo. No serious side effects were reported in all trials.</p><p>Conclusions</p><p>The meta-analysis suggests that red yeast rice is an effective and relatively safe approach for dyslipidemia. However, further long-term, rigorously designed randomized controlled trials are still warranted before red yeast rice could be recommended to patients with dyslipidemia, especially as an alternative to statins.</p></div

Confocal laser images of wild-type, G615V and C201F LDLR activity in transfected HEK-293 cells.

<p>Cells were incubated with 1,1′-dioctadecyl-3,3,3′3′-tetramethylindocarbocyanine perchlorate (Dil)-conjugated LDL for 4 hours at 37°C. Overlays are shown in the right panels with co-localization appearing yellow. Similar results were obtained in 3 separate experiments.</p

The PRISMA flowchart of trial selection.

<p>The PRISMA flowchart of trial selection.</p

The DNA sequencing results of the two FH probands.

<p>(A) The <i>LDLR</i> gene of proband 1. The arrow indicates the G>T missense mutation at position 1907 of the thirteenth exon resulting in a glycine to valine substitution; (B) The <i>LDLR</i> gene of proband 2. The arrow indicates the G>T missense mutation at position 665 of the fourth exon resulting in a cysteine to phenylalanine substitution.</p

Meta-analysis of Red yeast rice on serum triglyceride (TG).

<p>Meta-analysis of Red yeast rice on serum triglyceride (TG).</p

Clinical features and gene identification results of the probands and their first relatives.

<p>Clinical features and gene identification results of the probands and their first relatives.</p

Flow cytometric measurements of wild-type and mutatant LDLR expression in transfected HEK-293 cells.

<p>The cells were incubated with phycoerythrin (PE)-conjugated mouse monoclonal anti-human LDLR antibody at room temperature for 30 minutes. The upper right area of the dot plots represents EGFP and LDLR double positive cells. (A) Transfected with wild-type; (B) Transfected with the G615V mutant LDLR; (C) Transfected with the C201F mutant LDLR; (D) The histogram shows the percentage of fluorescence for each of the mutations relative to wild-type. The results are representative of the means ± SD for three independent experiments.</p

Flow cytometric measurements of wild-type and mutant LDLR internalization activity in transfected HEK-293 cells.

<p>The transfected cells were incubated in serum-free media containing 20 μg/ml Dil-LDL at 37°C for 4 hours. The upper-right area of the dot plots represents EGFP and LDLR double positive cells. (A) Transfected with wild-type; (B) Transfected with the G615V mutant LDLR; (C) Transfected with the C201F mutant LDLR; (D) The histogram shows the percentage of fluorescence for each of the mutations relative to wild-type LDLR. The results are representative of the means ± SD for three independent experiments.</p

Confocal laser images of wild-type, G615V and C201F LDLR localization in transfected HEK-293 cells.

<p>Cells were incubated with tetramethylrhodamine-conjugated concanavalin A at room temperature for 1 hour. Overlays are shown in the right panels with co-localization appearing yellow. Similar results were obtained in 3 separate experiments.</p

Meta-analysis of Red yeast rice on serum low-density lipoprotein cholesterol (LDL-C).

<p>Meta-analysis of Red yeast rice on serum low-density lipoprotein cholesterol (LDL-C).</p