From Geriatric Pharmacy Intern Yariagna Rollan Pharm.D(c) University of Florida College of Pharmacy
Statins (3-hydroxy-3-methylglutaryl coenzyme A or HMG- CoA reductase inhibitors) are the most effective medications to lower low-density lipoprotein (LDL) cholesterol or bad cholesterol and the risk of cardiovascular events. Although generally well tolerated, many patients taking statins may experience adverse effects including statin-associated myopathy and rhabdomyolysis, elevated liver enzyme levels, and gastrointestinal symptoms. In older adults there is a higher risk of cardiovascular events due to accumulated coronary atherosclerosis and also an increased risk for severe myopathy not only from statins but from fibrates as well.
Statin-associated rhabdomyolysis is a rare, life-threatening condition, with a rapid breakdown of skeletal muscle that leads to the release of muscle fiber contents (myoglobin) into the bloodstream causing weakness and diffuse muscle pain. Myoglobin is a protein that is harmful to the kidneys and may result in Acute Kidney Failure. Rhabdomyolysis is dose related and there is no alternative treatment for patients who still require management for hyperlipidemia. In some cases is possible to reduce the dose of the statin or completely discontinue the medication. However, each patient needs to be treated as an individual, considering the necessary goals in order to continue to reduce the risk of cardiovascular events.
Red yeast rice is the fermented product of the yeast species Monascus purpureus that grows on rice. It could be used as an alternative treatment for patients with statin associated myopathy. It is a readily available dietary supplement that has been used for centuries in China and helps decrease LDL cholesterol levels. Red yeast rice contains monacolin K, a strong HMG-CoA reductase inhibitor. Recent studies have reviewed the effectiveness, safety, and tolerability of red yeast rice in patients with ages ranging from 21 to 80 years of age and with a history of myopathy related to the use of statins.
The studies have shown reductions of approximately 18% of total cholesterol, 22% of LDL cholesterol, and 7% reduction of serum triglyceride levels. No significant effect was seen on high-density lipoprotein (HDL) cholesterol levels or good cholesterol. Most importantly there was no significant difference found between the red yeast rice and placebo groups in adverse events and muscle pain. Further studies are required in order to recommend this treatment as an alternative. There are still concerns with toxicity and the ability of red yeast rice to lower cardiovascular related events effectively. Consult your pharmacist before starting any supplement.