The role of monacolin in the treatment of dyslipidaemia

Dyslipidaemia is one of the major modifiable risk factors for cardiovascular diseases. According to the current epidemiological data, excessively high serum cholesterol levels are found in 64% of women and 70% of men aged ≥20 years in Poland. Statins are the treatment of choice in patients with high-to-very high cardiovascular risk and high low-density lipoprotein (LDL) cholesterol levels. At the other end of the spectrum, there is a group of patients with low-to-moderate cardiovascular risk and low or moderate LDL cholesterol levels, who should be put on well-planned and appropriately adjusted therapy involving lifestyle modification and, if needed, pharmacotherapy. In such cases, the current guidelines of the European Society of Cardiology make it possible to use monacolin, a nutraceutical which is a natural statin (chemically identical to lovastatin). Monacolin is found in red yeast rice and its action is based on the known mechanism of inhibition of HMG-CoA reductase, a key enzyme in endogenous cholesterol synthesis. Data on the efficacy and safety of monacolin come from many clinical trials showing a significant decrease in triglycerides, total and LDL cholesterol, resulting in a reduced number of cardiovascular events in the absence of significant adverse effects. Monacolin is likely to become an effective pharmaceutical to combat dyslipidaemia in the growing group of (relatively young) patients with low-to-moderate baseline cardiovascular risk and lowto- moderate LDL cholesterol levels, without concomitant indications for statins. This paper summarises the current knowledge on the efficacy, safety and potential indications for the use of monacolin in the treatment of dyslipidaemia.