Red Yeast Rice for Cardiovascular Disease
Red yeast rice has genuine, high-quality evidence for reducing heart attacks and cardiovascular death, but only in the form of one standardized prescription-grade Chinese extract (Xuezhikang) tested in heart-attack survivors; that benefit cannot be assumed for the ordinary over-the-counter supplements most consumers buy, whose active-ingredient content is unregulated and wildly variable.
Why this grade7-layer evidence engine
The grade reflects a striking split between strong data and narrow scope. The landmark China Coronary Secondary Prevention Study (PMID 18549841, n=4870, 4.5 years) cut major coronary events by 45% (10.4% to 5.7%) and lowered cardiovascular and total mortality by 30-33%, with a prespecified elderly subgroup showing similar gains (PMID 19602720). Two pooled analyses agreed: a 2022 meta-analysis of 30 trials (PMID 35264949) found all-cause mortality RR 0.62 and MACE RR 0.54, and a 2012 review of 22 trials (PMID 22567033) reported myocardial-infarction RR 0.39.
However, nearly all of this hard-outcome evidence comes from a single standardized extract, Xuezhikang, in a single population (Chinese post-MI patients), and the trial pools overlap heavily rather than independently confirming each other. The 2022 meta-analysis was government-funded. None of it tests the typical Western OTC product.
Regulators and clinicians sharpen the caution. The US FDA treats red yeast rice with more than trace monacolin K as an unapproved drug, and EFSA could identify no safe intake (the EU bars >=3 mg/day). Mayo and Cleveland Clinic acknowledge LDL lowering but warn that unregulated products vary enormously in content and carry statin-like liver and muscle risks. Hence a disputed B: real benefit, but only for a specific extract and population.
Scoring transparency
All scores computed by a 7-layer evidence engine — fully auditable▸View the full decision path (audit trail)
- compute_raw_score — 加權公式: L2×0.30 + L3×0.25 + L5×0.25 + L11×0.10 + L1×0.10 = 0.574
- tier_from_score — 依分數區間映射至 tier letter
- apply_hec_rules — 高品質 SR/MA 顯示 positive (2 篇 > 0 negative)
- tier_strict_requirement_check — Tier 條件達標，未降階
- detect_disputes — 偵測到 1 個 hard + 0 個 soft dispute
- decide_status — 依 tier + dispute 結果決定 status