Nutraceutical alternatives to red yeast rice extract/monacolin K for moderate hypercholesterolaemia: Current evidence and knowledge gaps

Nutraceuticals and hypercholesterolaemia

Laura Comi
Department of Pharmacological and Biomolecular Sciences “Rodolfo Paoletti”, Università degli Studi di Milan, Milan, Italy
Claudia Giglione
Department of Pharmacological and Biomolecular Sciences “Rodolfo Paoletti”, Università degli Studi di Milan, Milan, Italy
Fationa Tolaj
Department of Pharmacological and Biomolecular Sciences “Rodolfo Paoletti”, Università degli Studi di Milan, Milan, Italy
Cinzia Parolini
Department of Pharmacological and Biomolecular Sciences “Rodolfo Paoletti”, Università degli Studi di Milan, Milan, Italy
Chiara Olivieri
Department of Pharmacological and Biomolecular Sciences “Rodolfo Paoletti”, Università degli Studi di Milan, Milan, Italy
Marco Ruzza
Department of Pharmacological and Biomolecular Sciences “Rodolfo Paoletti”, Università degli Studi di Milan, Milan, Italy
Valentina Tollemeto
Truffini & Reggè, Milan, Italy
Maria Zurlo
Truffini & Reggè, Milan, Italy
Federico Pialorsi
Truffini & Reggè, Milan, Italy
Antonio Seneci
Truffini & Reggè, Milan, Italy
Paolo Magni
Department of Pharmacological and Biomolecular Sciences “Rodolfo Paoletti”, Università degli Studi di Milan, Milan, Italy and IRCCS MultiMedica, Sesto S. Giovanni, Milan, Italy

Abstract

The nutraceutical approach to moderate hypercholesterolaemia is an interesting option in the context of appropriate conditions associated with low cardiovascular risk, and red yeast rice (RYR) extract is one of the most utilized products in this field. Monacolin k, its main active component, reduces serum LDL-C levels via inhibition of β-Hydroxy β-methylglutaryl-CoA reductase, similarly to statins. In 2011, EFSA approved the claim regarding monacolin k from RYR extract and maintenance of normal cholesterol levels. However, in 2018, EFSA issued a warning about potential adverse effects of this nutraceutical and, in 2022, the European Commission published a Regulation with several limitations of its use. Therefore, current research and development efforts are aiming at assessing efficacy and safety of other known and novel nutraceutical products which may benefit patients with moderate hypercholesterolaemia. These active agents range from phytosterols, probiotics and berberine to bergamot, cabbage and artichoke extracts and soy protein. Moreover, plant extracts from traditional medicine, for example from African countries, are also a subject of study in this direction. The full clinical exploitation of many of them, however, still requires robust clinical evidence, which should be the objective of future research.

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