Treating CAD: A Focus on Red Yeast Rice Extract (RYR)

The Bullet Points:

• Red Yeast Rice Extract (RYR) is proven to reduce mortality 38% and Major Adverse Cardiovascular Events (MACEs) 46%.
• Safer than statin drugs in primary prevention as they lower the risk of metabolic syndrome with no adverse events compared with placebo.
• Designs For Health RYR 600mg caps - 2caps 2x/d (total 2400 mg/d), I have used successfully for decades.
• Statin drugs do have a role after MACEs as they are more powerful when more power is needed. Be careful of powerful drugs long term.
• I still only prescribe RYR when documented ASCVD/CAD exists. Always in combination with CoQ10 and the rest of our treating CAD routine and BNP.

When Big Pharma tries to harvest a drug from a known therapeutic herbal preparation, a classic saying within herbal medicine goes: “The pharmaceutical companies extract the intelligence while leaving the wisdom behind.” I find this particularly true when it comes to the functional food created by the fermentation of steamed rice with an edible fungus Monascus Purpureus Went (also known as Went yeast), known commonly as Red Yeast Rice (RYR).

The most famous component of RYR, monacolin K, became the first statin drug branded Mevacor (lovastatin). This birthed the most successful family of drugs, “statins”, that all derived from this component of RYR. However, actual RYR contains citrinin, terpenes, sterols, and more that added to its efficacy while dramatically lowering its toxicity. This is what we mean by "leaving the wisdom behind”, discarding the superior herb for drugs all in the name of profit, and not in service to humanity.

In PMID 35264949, published in Frontiers in Pharmacology February 2022, “Red Yeast Rice Preparations Reduce Mortality, Major Cardiovascular Adverse Events, and Risk Factors for Metabolic Syndrome: A Systematic Review and Meta-analysis”, Yuan, et al describe the extensive research on RYR. Of 921 articles reviewed, 30 met all stringent criteria for inclusion and were then discussed.

If you have ever been told “there is no research”, or “how do you know it’s safe” by any doctor or friend, here is your answer. In America, herb companies are not allowed to show the concentration of monacolin K on the label, or Big Pharma will get that preparation pulled off the shelves as an “unlicensed drug”. Oh the irony. This does allow less scrupulous companies to put out extracts of variable potency and efficacy. I am currently only recommending RYR from Designs For Health (DFH) as I have never had an issue with their product, and I test everyone for efficacy.

If your doctor has vast experience with another brand of RYR that they trust, please listen to them. Otherwise, when I recommend RYR I only mean DFH. I have no affiliation with this company. Whereas the doctors that follow the recommendations from the Cardiology organizations or Cholesterol organizations they simply act as mindless servants to Big Pharma.

The two trials within this analysis that included mortality data included 3297 participants, and the three trials with data on Major Adverse Cardiovascular Events (MACEs) included 3360 participants. Overall mortality was reduced 38% and MACEs reduced by 46%. Although not a lot of people, overall effects are far superior to statins and a clear effect that directly correlates with other RYR studies. Follow-up in these trials averaged 4-4.5 years, and participants had hypertension plus dyslipidemia or diabetes and dyslipidemia, but no previous cardiac events.

I find the data on fasting glucose and A1C to be hypervariable amongst the studies , but a clear trend towards improvement, completely unlike statin drugs, which especially favors RYR in primary prevention. Generally favorable effects on blood pressure, HDL and triglycerides make RYR a potential therapeutic option in anyone with metabolic syndrome. That being stated, I still only use RYR as an intervention in documented CAD. The data on lipids shows a very “statin-like” effect, not surprising since it is the original statin!

Twelve trials including 4164 participants assessed adverse events and showed no increased events compared with placebo, this fits the data on studies with thousands more participants, that even among people intolerant to statins, there is no increased rate of adverse events among people who take RYR in a blinded trial. I have only had one patient, ever, that had a clear muscle-related reaction to RYR with laboratory confirmation. Not once ever has it led to problems with the liver like you can see with the drugs, despite ongoing misinformation warfare stating the opposite.

Every Cardiologist, every doctor, knows that RYR and other statins do not work because they lower cholesterol. Benefits to statins can be seen within days of a MACE. These drugs, and one component of this herb, regulate inflammation and endothelial dysfunction that occurs in ASCVD/CAD. RYR’s primary role is that of an anti-inflammatory; the lab I follow most rigorously is LpPLA2.

There is a role for statin drugs in the acute treatment of MACEs, continuing for at least 12 months as secondary prevention. The statin drugs rosuvastatin and atorvastatin are my favorites in this setting and shooting for a higher dose, as reflected by a lower LDL, works better because they have more powerful anti-inflammatory properties, and not because the LDL is lower.

Aiming for lower and lower LDLs in primary prevention and for anything more than up to 24 months post-MACE is a criminal practice meant to spur on drug sales to the general population and not meant to improve your health.The fats, and the cholesterol, were never the enemy! You were sold this lie to sell drugs, and it was a good lie as there was a shred of truth in it. Furthermore statins and RYR prevent acute events (MACEs) but do not slow the progression of CAD!

The next few articles are about slowing the progression of CAD, the complementary approach necessary in addition to preventing MACEs.

In the meanwhile, Designs for Health Red Yeast Rice 1200mg 2x/d is a proven, safe intervention that saves lives without risking the high toxicity of the pharmaceutically corrupted version of what is really a functional food. I always recommend CoQ10 supplementation, especially in the setting of someone who takes RYR or statins. Shoot for a level above 2.0 on your lab test.