Two better than one: plant sterols plus red yeast rice to achieve superior efficacy in patients with moderate hypercholesterolemia

The best LDL-cholesterol lowering can be achieved by inhibiting cholesterol absorption and cholesterol production. Plant sterols have been shown to inhibit the absorption of dietary and biliary cholesterol in the gut, while extracts of red yeast rice (a fungal fermentation product of Monascus purpureus contains several active ingredients including very low doses of lovastatin) inhibits cholesterol hepatic synthesis. The objective of this study, conducted in patients with mild moderate cardiovascular risk, was to assess the effect of 8 weeks of association of milkbased drink enriched with 2 g plant sterols (PS) (one mini-drink after dinner) plus a standardized formulation (SF) containing red yeast rice (Monascus purpureus 200 mg) and antioxidant substances (one tablet at bed-time). The association therapy was initiated in 20 patients (12 males, 8 females, age range 38 64 years) with moderate hypercholesterolemia (total cholesterol >239 mg/dL) in spite of treatment with 2 g of PS (10 patients) and the SF (10 patients) used in monotherapy for 8 weeks. Compared to monotherapy, TC, LDL-C and TC/HDL-C were significantly reduced with the combination therapy ( 13.8%, 17.4% and 14.3%, respectively, p < 0.001), while triglycerides and HDL-C did not vary significantly. In addition, the association therapy has allowed to reach the TC and LDL-C goals in the majority of these patients (<240 and <160 mg/dL, respectively, reached in 14/20 patients). No undesired effects were recorded. In conclusion, this association represents a non-pharmacological therapeutic approach in patients with mild moderate cardiovascular risk.