Red Yeast Rice Preparations Reduce Mortality, Major Cardiovascular Adverse Events, and Risk Factors for Metabolic Syndrome: A Systematic Review and Meta−analysis

Systematic review and meta-analysis of randomized trials in participants with metabolic syndrome or related cardiometabolic conditions such as diabetes, dyslipidaemia, and hypertension. Most studies were conducted in China, with one trial from Italy.

Oral red yeast rice preparations, mainly Xuezhikang or related red yeast rice products, were evaluated across randomized trials. The included regimens varied by study and sometimes were used as add-ons to conventional therapy; exact doses, frequency, and duration were not consistently reported in the provided material.

Red yeast rice preparations were associated with lower mortality and fewer major cardiovascular adverse events, along with improvements in glucose, lipid, and blood pressure measures. In the pooled analysis, mortality was reduced (RR 0.62) and MACEs were reduced (RR 0.54); adverse reactions were not increased (RR 1.00, 95% CI [0.69, 1.43]). Metabolic outcomes also favored red yeast rice, including lower fasting plasma glucose (MD -0.46 mmol/L), HbA1c (-0.49), HOMA-IR (-0.93), total cholesterol (-1.55), triglycerides (-0.70), LDL-C (-0.42), and mean arterial pressure (-3.79), with higher HDL-C (+0.14). Overall, the evidence suggests benefit for preventing progression of metabolic syndrome and reducing cardiovascular risk, but certainty varied by outcome and some estimates were based on heterogeneous, lower-quality evidence.

Substantial heterogeneity was present across outcomes, with varied certainty of evidence and some outcomes rated low or very low. The review also relied largely on trials from China, with variable reporting of dose and regimen details, which limits generalizability and precise intervention characterization. Methodological limitations of the underlying studies support cautious interpretation.