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The Role of Red Yeast Rice Based Preparations for Non-Pharmacological Correction of Dyslipidemia in Patients with Low and Moderate Cardiovascular Risk (Expert Opinion)

https://doi.org/10.20996/1819-6446-2020-02-04

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Abstract

The Russian Federation is among countries with high cardiovascular risk. Hypercholesterolemia is a leading risk factor for the development of atherosclerotic cardiovascular diseases. To achieve low-density lipoprotein cholesterol (LDL-C) targets, such approaches as lifestyle changes and pharmacological correction, based on the use of statins, are applied. At the same time, a significant proportion of the population has moderate hypercholesterolemia and is characterized by low or moderate cardiovascular risk. Although first-line recommendations should be followed, a healthy lifestyle alone is not enough to achieve target levels of LDL-C, which means that even people with low to moderate risk may end up with the prospect of lifelong therapy with lipid-lowering drugs. These individuals do not have an indication for lipid-lowering therapy, and they are usually recommended a change in diet and supplementation. Innovative nutritional strategies have been developed to manage dyslipidemia. They were based either on changing some “risky” food components or on encouraging the consumption of “healthy” functional foods and/or nutraceuticals. Nutraceuticals (registered as food supplements in Russia) is an innovative way to help control LDL-C at low and moderate risk individuals without lipid-lowering drugs and as nutritive support for the cholesterol-lowering diet. Red yeast rice (RYR) based preparations have been already developed and available at the moment. RYR based preparations can be considered in patients with low and moderate cardiovascular risk, who have not reached the target level of LDL-C and have no indications for statin therapy or have statin intolerance. RYR based preparations contains a statin-like substance monacolin K in a dose of 3 mg. In randomized clinical trials, it was proved that the use of high-quality RYR nutraceutical leads to a decrease in LDL-C by an average of 20% without increasing the risk of side effects like for statins. Evaluation of dietary supplements and functional foods should necessarily include not only evidence of beneficial effects with respect to effects on the lipid profile and atherosclerosis, but also proven good tolerability. The manufacturing standard for these products is also important, guaranteeing component standardization and quality. RYR analogues should guarantee the absence of mycotoxin in their composition. In Russia, programs are needed for the primary prevention of atherosclerotic cardiovascular diseases with effects on hypercholesterolemia at the population level.

About the Authors

M. V. Ezhov
National Medical Research Center of Cardiology
Russian Federation

Marat V. Ezhov – MD, PhD, Professor, Chief Researcher, Department of Atherosclerosis, National Medical Research Center of Cardiology; President of the National Society for the Study of Atherosclerosis

Tretya Cherepkovskaya ul. 15A, Moscow, 121552



A. Catapano
University of Milan
Italy

Alberico Catapano – MD, PhD, Professor of Pharmacology, Director of Center of Epidemiology and Preventive Pharmacology, University of Milano; Director of the Laboratory for the Study of Lipoproteins and Atherosclerosis and of the Center for the Study of Atherosclerosis, Italian Society of Atherosclerosis, “Bassini” Hospital; the Chairman of European Atherosclerosis Society (EAS) Educational, Guidelines & Corporate Activities Committees and the Chairman of the EAS and European Society of Cardiology (ESC) Guidelines for the Treatment of Dyslipoproteinemias

Via Balzaretti 9, Milano, 20133



C. Escobar
University Hospital La Paz
Spain

Carlos Escobar – MD, PhD, Consultant Cardiologist, Hospital La Paz; President of the Clinical Cardiology Group of the Spanish Society of Cardiology; Member of the Cardiovascular Pharmacology and Drug Therapy Working Group, European Society of Cardiology

Paseo de la Castellana 261, Madrid, 28046



V. V. Kukharchuk
National Medical Research Center of Cardiology
Russian Federation

Valery V. Kukharchuk – MD, PhD, Corresponding Member of the Russian Academy of Sciences, Chief Researcher, Head of Department of Atherosclerosis Problems, National Medical Research Center of Cardiology

Tretya Cherepkovskaya ul. 15A, Moscow, 121552



M. I. Voevoda
Federal Research Center, Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences, Institute of Internal and Preventive Medicine
Russian Federation

Mikhail I. Voevoda – MD, PhD, Professor, Corresponding Member of the Russian Academy of Sciences, Director of the Institute of Internal and Preventive Medicine, Branch of the Federal Research Center – Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences; Vice President of the National Society for the Study of Atherosclerosis.

B. Bogatkova ul. 175/1, Novosibirsk, 630089



O. M. Drapkina
National Medical Research Center for Preventive Medicine
Russian Federation

Oxana M. Drapkina – MD, PhD, Professor, Corresponding Member of the Russian Academy of Sciences, Director of National Medical Research Center for Preventive Medicine; Chief Freelance Specialist in Therapy and General Medical Practice of the Ministry of Health of Russia

Petroverigsky per. 10, Moscow, 101990



S. A. Shalnova
National Medical Research Center for Preventive Medicine
Russian Federation

Svetlana A. Shalnova – MD, PhD, Professor, Head of Department of Epidemiology of Chronic Non-Communicable Diseases

Petroverigsky per. 10, Moscow, 101990



A. V. Starodubova
National Research Center of Nutrition, Biotechnology and Food Safety
Russian Federation

Antonina V. Starodubova – MD, PhD, Professor, Deputy Director for Scientific and Medical Work

Ustinsky pr. 2/14, Moscow, 109240



V. S. Gurevich
St. Petersburg State University
Russian Federation

Viсtor S. Gurevich – MD, PhD, Professor, Chair of Cardiology, Faculty of Postgraduate Education, St. Petersburg State University; Head of the Center for the Treatment of Atherosclerosis and Lipid Metabolism Disorders; Vice President of the National Society for the Study of Atherosclerosis

21-linia V.O. 8a, St. Petersburg, 199106



I. I. Shaposhnik
South-Ural State Medical University; City Clinical Hospital №1
Russian Federation

Igor I. Shaposhnik – MD, PhD, Professor, Head of the Chair of Propaedeutics of Internal Diseases, South Ural State Medical University; Scientific and Practical Head of the Therapeutic Service, City Clinical Hospital №1

Vorovskogo ul. 64, Chelyabinsk, 454092, 

Vorovskogo ul. 16, Chelyabinsk, 454048



O. O. Bolshakova
Almazov National Medical Research Center
Russian Federation

Olga O. Bolshakova – MD, PhD, Professor, Head of the Research Laboratory of Clinical Research and Evidence-Based Medicine; Professor, Chair of Internal Medicine, Institute of Medical Education

Akkuratova ul. 2, St. Petersburg, 197341



O. S. Oynotkinova
Pirogov Russian National Research Medical University
Russian Federation

Olga S. Oynotkinova – MD, PhD, Professor, Chair of Propaedeutics of Internal Diseases and Radiation Diagnostics, Pirogov Russian National Research Medical University; President of the National Society for the Study of Lipidology and Associated Metabolic Diseases

Ostrovityanova ul. 1, Moscow, 117997



A. S. Alieva
Almazov National Medical Research Center
Russian Federation

Asiiat S. Alieva – MD, PhD, Head of the Center of Atherosclerosis and Lipid Metabolism

Akkuratova ul. 2, St. Petersburg, 197341



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For citation:


Ezhov M.V., Catapano A., Escobar C., Kukharchuk V.V., Voevoda M.I., Drapkina O.M., Shalnova S.A., Starodubova A.V., Gurevich V.S., Shaposhnik I.I., Bolshakova O.O., Oynotkinova O.S., Alieva A.S. The Role of Red Yeast Rice Based Preparations for Non-Pharmacological Correction of Dyslipidemia in Patients with Low and Moderate Cardiovascular Risk (Expert Opinion). Rational Pharmacotherapy in Cardiology. 2020;16(1):147-155. (In Russ.) https://doi.org/10.20996/1819-6446-2020-02-04

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ISSN 1819-6446 (Print)
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