Coenzyme Q10 and Red Yeast Rice  supplements can lower plasma cholesterol levels. Arguably, red yeast rice extracts are the most effective nutritional supplement for the lowering of cholesterol concentrations in the blood.

CoQ10 biosynthesis slide from Dr. Judy

This slide provided by Dr. William Judy shows that Coenzyme Q10 and cholesterol are synthesized in the same biological pathway. The inhibition of this pathway by statin medications and by red yeast rice supplements will affect the biosynthesis of both substances.

Monacolin K in red yeast rice is the primary cause of this cholesterol lowering effect. Monacolin K inhibits the activity of the enzyme 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase, which is necessary for the body’s bio-synthesis of cholesterol [Cicero 2021].

Red Yeast Rice Lowers Plasma Cholesterol Levels

Daily consumption of a red yeast rice supplement containing monacolin K is expected to reduce plasma LDL-cholesterol levels by 15% to 25% within six to eight weeks. There should also be a proportional decrease in total cholesterol and in high-sensitivity C-reactive protein, a blood biomarker for inflammation in the body and a useful indicator of the risk of heart attack [Cicero 2021].

Red yeast rice supplements consist of fermented rice that has been grown on the yeast Monascus purpureus. This process gives the red yeast rice its distinctive reddish-purple color. The red yeast rice contains numerous substances called monacolins. It is the monacolin K that has the ability to inhibit the biosynthesis of cholesterol.

Red Yeast Rice and Improved Endothelial Function

Data from some clinical trials suggest that the use of red yeast rice supplements will lead to an improvement in endothelial function and a reduction of arterial stiffness [Cicero 2021].

Note: The endothelium consists of a single layer of cells on the surface of the inside of blood vessels and lymph vessels. These cells are instrumental in the control of the contraction and relaxation of the blood vessels, i.e., blood flow regulation. Damage to endothelial cells increases the risk of atherosclerosis and heart attack.

Safety of Red Yeast Rice Supplements

Research studies show red yeast rice supplements to be safe and well-tolerated. Although red yeast rice supplements are not regulated by the U.S. Food and Drug Administration, the guidelines of the European Cardiology Society and the European Atherosclerosis Society have suggested the use of red yeast rice as an inhibitor of endogenous cholesterol synthesis for the management of mild hypercholesterolemia since 2011 [Cicero 2021].

The safety of red yeast rice supplements depends primarily upon the following factors:

  • the quality of the red yeast rice supplement
  • the frailty of the patient taking the red yeast rice supplement
  • the risk of pharmacological interactions with other medications

Researchers at a 2021 Journal of the American College of Cardiology Focus Seminar concluded as follows [Cicero 2021]:

  • The risk related to a daily intake of 3 to 10 mg of monacolin K, the key ingredient in the red yeast rice, is minimal.
  • Red yeast rice supplements represent a therapeutic tool to support the management of mild to moderate hypercholesterolemia in low-risk patients, especially those patients who cannot be treated with statin medications or other LDL-cholesterol–lowering therapies.

Combined Coenzyme Q10 and Red Yeast Rice Supplementation

Remember, in inhibiting the body’s synthesis of cholesterol, statins and red yeast rice supplements will also inhibit the synthesis of Coenzyme Q10. Therefore, it is especially important to take CoQ10 supplements in the period in which you are taking a red yeast rice supplement or a statin medication [Okuyama 2015].

A further bonus of taking daily CoQ10 supplements is that randomized controlled studies show that Coenzyme Q10 also has a beneficial effect on cholesterol levels [Liu 2022].

Beware of Citrinin in Red Yeast Rice Supplements

During the fermentation of the rice, there could be a dangerous byproduct of the process called citrinin. In preclinical studies, citrinin has been associated with toxic effects on the kidneys, with increased risk of cancer, and with reproductive toxicity [Cicero 2021].

Users of red yeast rice products should insist on a certified absence of citrinin as well as a documented absence of aflatoxin, dioxins and heavy metals.

Conclusion: Red Yeast Rice Safe for Lowering Cholesterol

A 2023 review of relevant research literature has revealed that red yeast rice supplementation reduces low-density lipoprotein cholesterol levels by approximately 15–34% versus placebo [Cicero 2023].

Red yeast rice has demonstrated beneficial reductions of up to 45% versus placebo in the risk of atherosclerotic cardiovascular disease events in secondary prevention studies [Cicero 2023].

Red yeast rice supplements at a dose that provides about 3 mg/day of monacolin K are well tolerated [Cicero 2023].


Cicero AFG, Fogacci F, Zambon A. Red yeast rice for hypercholesterolemia: JACC Focus Seminar. J Am Coll Cardiol. 2021 Feb 9;77(5):620-628.

Cicero AFG, Fogacci F, Stoian AP, Toth PP. Red Yeast Rice for the Improvement of Lipid Profiles in Mild-to-Moderate Hypercholesterolemia: A Narrative Review. Nutrients. 2023 May 12;15(10):2288.

Liu Z, Tian Z, Zhao D, Liang Y, Dai S, Liu M, Hou S, Dong X, Zhaxinima, Yang Y. Effects of Coenzyme Q10 supplementation on lipid profiles in adults: A Meta-analysis of randomized controlled trials. J Clin Endocrinol Metab. 2022 Dec 17;108(1):232-249.

Okuyama H, Langsjoen PH, Hamazaki T, Ogushi Y, Hama R, Kobayashi T, Uchino H. Statins stimulate atherosclerosis and heart failure: pharmacological mechanisms. Expert Rev Clin Pharmacol. 2015 Mar;8(2):189-99.

The information presented in this review article is not intended as medical advice and should not be used as such.