Red Yeast Rice for Hyperlipidemia: A Meta-Analysis of 15 High-Quality Randomized Controlled Trials

Abstract

Background: RYR is a commonly used lipid-lowering dietary supplements in Asian and European countries, showing considerable benefits and low toxicity. This quantitative study aims to present high-quality evidence regarding the efficacy and safety of RYR in treating hyperlipidemia, in order to promote its clinical application. Methods: PubMed, embase, and Cochrane Central Register of Controlled Trials databases were systematically searched, and high-quality randomized controlled trials comparing RYR with non-RYR interventions were included. RevMan5.3 software was used to conduct the meta-analysis. Results: A total of 1,012 individuals participated in this study (481 in the experimental and 531 in the control group). In comparison to statins, RYR was more effective in lowering TG (MD, -19.90; 95% CI, -32.22 to -7.58; p = 0.002), comparable in lowering LDL-C and elevating HDL-C, and less effective in lowering TC (MD, 12.24; 95% CI, 2.19 to 22.29; p = 0.02). Compared with nutraceutical, RYR significantly reduced TC (MD, -17.80; 95% CI, -27.12 to -8.48; p = 0.0002) and LDL-C (MD, -14.40; 95% CI, -22.71 to -6.09; p = 0.0007), and elevated HDL-C (MD, 7.60; 95% CI, 4.33 to 10.87; p < 0.00001). Moreover, RYR effectively synergized nutraceutical to further reduce TC (MD, -31.10; 95% CI, -38.83 to -23.36; p < 0.00001), LDL-C (MD, -27.91; 95% CI, -36.58 to -19.24; p < 0.00001), and TG (MD, -26.32; 95% CI, -34.05 to -18.59; p < 0.00001). Additionally, RYR significantly reduced apoB (MD, -27.98; 95% CI, -35.51 to -20.45; p < 0.00001) and, whether alone or in combination, did not increase the risk of adverse events in patients with hyperlipidemia. Conclusion: RYR at 200-4800 mg daily appears to be a safe and effective treatment for hyperlipidemia, effectively regulating blood lipid levels with an exceptional impact on TG. Looking forward, high-quality clinical trials with longer observation periods are required to evaluate the efficacy and safety of RYR as a long-term medication. Systematic Review Registration: (https://www.crd.york.ac.uk/PROSPERO/), identifier (CRD4202128450).

Keywords: RCTs; high-quality; hyperlipidemia; meta-analysis; red yeast rice.

FIGURE 1

Flowchart of search strategy and study selection, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.

FIGURE 2

(A) Forest plot of LDL-C between RYR alone and control groups. (B) Forest plot of LDL-C between RYR in combination and control groups. (RYR: red yeast rice; LDL-C: low density lipoprotein cholesterol).

FIGURE 3

(A) Forest plot of TC between RYR alone and control groups. (B) Forest plot of TC between RYR in combination and control groups. (RYR: red yeast rice; TC: total cholesterol).

FIGURE 4

(A) Forest plot of TG between RYR alone and control groups. (B) Forest plot of TG between RYR in combination and control groups. (RYR: red yeast rice; TG: triglyceride).

FIGURE 5

Mapping of adverse events between RYR and placebo groups. (RYR: red yeast rice; NA: nattokinase; NU: nutraceutical; XZK: xue-zhi-kang capsule; PT: phytosterols; ROS: rosuvastatin).