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Does red yeast rice lower cholesterol?

Trials show red yeast rice lowers LDL cholesterol by roughly 20 to 40 mg/dL. It contains a statin-like compound, so side effects and product quality matter.

Published October 2026

Short answer

Yes. In trials, red yeast rice lowered LDL ('bad') cholesterol by roughly 20 to 40 mg/dL because it contains monacolin K, the same compound as the statin drug lovastatin. Products vary in strength and can cause statin-like side effects. Evidence grade B (Moderate). Several meta-analyses of randomised trials and a large 2026 trial consistently show LDL and total cholesterol reductions; downgraded once because cholesterol is a surrogate marker rather than heart attacks or deaths, and some older trials were small or lower quality.

Key takeaways

  • Pooled results from many trials show red yeast rice lowers LDL ('bad') cholesterol by about 20 to 40 mg/dL [1][2][3].
  • Its active compound, monacolin K, is chemically the same as lovastatin, a prescription statin [4].
  • In a 2026 trial of 1,110 adults, a natto plus red yeast rice supplement lowered LDL cholesterol by about 21 mg/dL (13%) over 3 months [5].
  • In people who had already had a heart attack, a specific 1,200 mg/day red yeast rice extract reduced repeat heart attacks and sudden death [6].
  • Trials report few serious side effects, but muscle aches happen and product quality varies; one small 28-day trial found no significant LDL change [7][8][9].

The short version

Yes — red yeast rice lowers cholesterol. Across many trials, it cut LDL ("bad") cholesterol by roughly 20 to 40 mg/dL, about as much as a low-dose statin [1][2][3]. It works because it naturally contains monacolin K, a compound chemically identical to the prescription drug lovastatin [4]. The catch: it is sold as a supplement, so how much monacolin K you get varies by product, and it can cause the same muscle and liver effects as statin drugs [8][7].

What the studies show

A 2015 review of 20 trials found LDL cholesterol fell by 1.02 mmol/L (about 40 mg/dL) with red yeast rice compared with placebo, and the drop was no different from statin treatment [3]. A 2023 meta-analysis (a study that pools several trials) of 24 treatment arms reported average falls of about 33 mg/dL in total cholesterol and 29 mg/dL in LDL cholesterol [2]. A 2024 review of 14 double-blind trials found similar reductions in total and LDL cholesterol, but no clear effect on HDL cholesterol or triglycerides [1].

The largest trial yet, published in 2026, gave 1,110 adults with raised cholesterol a natto plus red yeast rice supplement (1,950 mg a day) or a placebo for 3 months. LDL cholesterol fell by 21 mg/dL, or 13%, compared with placebo; a simvastatin 20 mg group fell 26 mg/dL, and side effects were similar across the groups [5].

Smaller trials point the same way. In 142 adults, a daily dose providing just 3 mg of monacolin K lowered LDL cholesterol by 14.8% over 12 weeks [10]. A review of 10 small trials in 905 people found red yeast rice and simvastatin changed cholesterol by similar amounts [11]. In a 60-person pilot, people taking red yeast rice reported less muscle fatigue than those taking simvastatin, with similar cholesterol changes [12].

Heart outcomes matter most. Among 10,699 people who had already had a heart attack, a meta-analysis of 7 trials found a 1,200 mg/day red yeast rice extract lowered the risk of a repeat non-fatal heart attack by 58%, revascularisation (a stent or bypass procedure) by 42% and sudden death by 29% [6]. A wider 2022 review of 30 trials also found lower death and cardiovascular event rates, though results varied between the included studies [13].

Not every trial agrees. In a 28-day study of 190 adults, none of six supplements tested — including red yeast rice — lowered LDL cholesterol significantly compared with placebo, while rosuvastatin 5 mg did [9].

The nuances

Most trials lasted 4 to 24 weeks and mostly recruited adults with mildly to moderately raised cholesterol, so little is known about longer-term use [1]. Daily doses in the trials supplied about 2 to 10 mg of monacolin K [4]; LDL cholesterol fell even with 2–3 mg a day [10][14].

Because red yeast rice is sold as a supplement, strength varies from product to product. When researchers tested 35 supplements bought online, about 11% had too much monacolin K or bacterial contamination, and about a third had incomplete labels [8]. The European Union caps these supplements at 3 mg of monacolins per day, and in 2007 the FDA warned that some products contain lovastatin, an unauthorised drug [8][15]. Tests of other European products found no citrinin, a mould contaminant, in the samples checked [16][17].

In pooled trials, muscle problems and serious side effects were no more common with red yeast rice than with placebo: 53 trials, 8,535 people [7]. Still, some users report mild muscle aches [18], and one 50-person trial saw two cases of raised liver enzymes [19]. In Japan in 2024, specific beni-koji (red yeast rice) tablets were linked to kidney injury in 192 people; most improved after stopping the tablets, but 87% still had reduced kidney function at their last check, and the exact cause has not been established [20]. Because it works like a statin, red yeast rice may interact with other medicines, and one review warns of serious risks in pregnancy; we found no breastfeeding data [21].

What this means for you

For adults with mildly raised cholesterol, trials suggest red yeast rice can lower LDL cholesterol by roughly as much as a low-dose statin [3][4]. The heart-attack and death benefits, however, come from one specific 1,200 mg/day extract in people who had already had a heart attack, so they may not apply to every consumer product [6]. Because the active compound works like a statin, it is worth telling a doctor or pharmacist if you use it, especially if you take other cholesterol or heart medicines; ask first if you are pregnant or have kidney or liver problems [21][20][3].

Go deeper

  • Red Yeast Rice — Red yeast rice lowers LDL ('bad') cholesterol in trials, by roughly 20 to 40 mg/dL, because it naturally contains monacolin K — the same compound as the prescr…

References

  1. Safety and Efficacy of the Consumption of the Nutraceutical "Red Yeast Rice Extract" for the Reduction of Hypercholesterolemia in Humans: A Systematic Review and Meta-Analysis.. Nutrients, 2024.
  2. Impact of red yeast rice supplementation on lipid profile: a systematic review and meta-analysis of randomized-controlled trials.. Expert Rev Clin Pharmacol, 2023.
  3. Traditional Chinese lipid-lowering agent red yeast rice results in significant LDL reduction but safety is uncertain - a systematic review and meta-analysis.. Atherosclerosis, 2015.
  4. Monacolin K supplementation in patients with hypercholesterolemia: A systematic review of clinical trials.. Semergen, 2024.
  5. Natto Red Yeast Rice Supplement Regulates Lipid Profiles: A Multicenter, Double-Placebo, Double-Blinded, Randomized Controlled Trial.. JACC Asia, 2026.
  6. Efficacy of red yeast rice extract on myocardial infarction patients with borderline hypercholesterolemia: A meta-analysis of randomized controlled trials.. Sci Rep, 2020.
  7. Safety of red yeast rice supplementation: A systematic review and meta-analysis of randomized controlled trials.. Pharmacol Res, 2019.
  8. Quality Control and Safety Assessment of Online-Purchased Food Supplements Containing Red Yeast Rice (RYR).. Foods, 2024.
  9. Comparative Effects of Low-Dose Rosuvastatin, Placebo, and Dietary Supplements on Lipids and Inflammatory Biomarkers.. J Am Coll Cardiol, 2023.
  10. Low daily dose of 3 mg monacolin K from RYR reduces the concentration of LDL-C in a randomized, placebo-controlled intervention.. Nutr Res, 2016.
  11. Systematic review of red yeast rice compared with simvastatin in dyslipidaemia.. J Clin Pharm Ther, 2016.
  12. Red yeast rice induces less muscle fatigue symptom than simvastatin in dyslipidemic patients: a single center randomized pilot trial.. BMC Cardiovasc Disord, 2017.
  13. Red Yeast Rice Preparations Reduce Mortality, Major Cardiovascular Adverse Events, and Risk Factors for Metabolic Syndrome: A Systematic Review and Meta-analysis.. Front Pharmacol, 2022.
  14. Low dose red yeast rice with monacolin K lowers LDL cholesterol and blood pressure in Japanese with mild dyslipidemia: A multicenter, randomized trial.. Asia Pac J Clin Nutr, 2021.
  15. Review of red yeast rice content and current Food and Drug Administration oversight.. J Clin Lipidol, 2013.
  16. The Questionable Quality Profile of Food Supplements: The Case of Red Yeast Rice Marketed Products.. Foods, 2023.
  17. Dietary Supplements Based on Red Yeast Rice-A Source of Citrinin?. Toxins (Basel), 2021.
  18. Red Yeast Rice for Hypercholesterolemia.. Methodist Debakey Cardiovasc J, 2019.
  19. A Randomized Clinical Efficacy Trial of Red Yeast Rice (Monascus pilosus) Against Hyperlipidemia.. Am J Chin Med, 2019.
  20. A nationwide questionnaire study evaluated kidney injury associated with Beni-koji tablets in Japan.. Kidney Int, 2025.
  21. ['Red yeast rice' as a cholesterol-lowering substance?Caution is warranted].. Ned Tijdschr Geneeskd, 2016.