Red yeast rice, a fermented-rice supplement, is used to lower harmful cholesterol; its active compound is chemically identical to a prescription cholesterol-lowering medication. It reliably lowers cholesterol when products contain enough of that compound. Evidence for fewer heart attacks and deaths rests mainly on one long Chinese study. Risks mirror the prescription medication's: rare muscle and liver injury, drug interactions. Product strength varies enormously; contamination has caused kidney injury. (Full Review)
| Marker | Target | Why |
|---|---|---|
| LDL cholesterol | 50–99 mg/dL (Life Extension) | Main efficacy marker |
| Apolipoprotein B (ApoB) | 66–133 mg/dL (men), 60–117 mg/dL (women) | Counts artery-clogging particles |
| Triglycerides | Under 80 mg/dL (Life Extension) | Possible modest fall |
| HDL cholesterol | 50–60 mg/dL and higher (Life Extension) | Small rise possible |
| ALT (alanine aminotransferase, liver enzyme) | 7–56 U/L | Safety check; liver injury |
| Creatine kinase (CK) | 30–200 U/L | Safety check; muscle injury |
| Serum creatinine with eGFR (kidney filtering capacity) | Creatinine 0.6–1.3 mg/dL | Safety check; contaminant kidney injury |
| HbA1c (three-month blood sugar average) | 4.0–5.6% | Modest fall in pooled trials |
Cadence: Baseline lipid panel, liver and kidney function, CK and glucose markers before starting; repeat lipid panel, ALT and CK at 6–8 weeks after starting or changing products, then every 6–12 months; CK after unexplained muscle pain; kidney function after new fatigue, swelling or urinary change