Life Extension Magazine®

Issue: Mar 2010

Lower Cholesterol Safely

Many individuals believe they must rely solely on drugs to attain healthy cholesterol levels. The truth is that certain natural agents are just as effective. Substantiating research details how these natural lipid-lowering nutrients also reduce triglycerides and increase beneficial HDL.

By Robert Haas, MS

Are statin drugs right for you?

At Life Extension®, we have long maintained that one’s decision to take a particular drug should be based on individual blood test findings.

For blood lipids, we recommend members seek to achieve the following optimal ranges:

Total cholesterol 160-180 mg/dL
LDL 50-99 mg/dL
HDL 50-60 mg/dL (and higher)
Triglycerides Under 80 mg/dL

Statin drugs lower LDL and total cholesterol, but have only a modest effect on boosting artery-cleansing HDL. Statin drugs do not lower triglycerides.

Physicians often rely solely on high-dose statin drug therapy to achieve desired blood lipid readings. One problem with this approach is that side effects elevate markedly as the dose of the statin drug is increased.

While you should take all necessary steps to protect heart health—which may include cholesterol-lowering medications—high-dose statins are often unnecessary. They should not be considered the only approach, given their considerable risks at high doses. The side effects of sustained statin use are well documented—muscle wasting, cognitive impairment, blurred vision, and nerve damage, among others.

Lower Cholesterol Safely

The encouraging news is that safe, low-cost, broad-spectrum interventions exist right now, especially for individuals with elevated cholesterol, LDL, and triglyceride levels (and low HDL) who do not have other risk factors for vascular disease.

In this article, we explore a novel set of natural lipid-lowering compounds shown to support healthy cholesterol levels. Monacolin-K, a compound found in standardized red yeast rice extract, is a naturally occurring statin. It may surprise you to learn that in clinical studies, red yeast rice along with healthy lifestyle practices lowers cholesterol as effectively as the prescription drug simvastatin.1

A substantial body of supportive research further indicates that monacolin-K also reduces triglycerides and boosts HDL, thus offering a safer and broader spectrum alternative to taking synthetic prescription statins.2-8

You will also discover the clinically demonstrated heart-protective benefits of other natural compounds that can bring your blood lipids into healthy balance, lower C-reactive protein (CRP) in the blood, quell chronic system-wide inflammation, and support healthy endothelial function.

Together they provide a potent, complementary alternative to prescription statin drugs.

Why So Many Doctors Advocate Statin Use

The simple answer is: many of them have been misled by Big Pharma. It’s no exaggeration to say that statins have become the new aspirin in mainstream medicine’s war on cardiovascular disease. They’re considered wonder drugs by many in the medical community. As one leading cardiologist observed, “You can’t go to a cardiology conference and ask who’s on statins without everyone’s hand going up.”9

Why So Many Doctors Advocate Statin Use

This almost casual attitude toward statin drug use largely stems from industry influence. Not content with letting doctors decide whether or not to prescribe statins on the merits of questionably favorable research data, some drug companies have apparently taken to bribing physcians to push statins on their patients. A 2009 investigative report disclosed that Pfizer and AstraZeneca, pharmaceutical giants that make the two best-selling statins—Lipitor® and Crestor®, respectively—offered Canadian doctors $100 for every new patient they put on the cholesterol-lowering drugs.10 This outrageous marketing ploy is nothing new. In 2003, when AstraZeneca was poised to launch Crestor®, which was already known to have twice the adverse side effects of other statins, another unethical deceit was discovered. Dr. Bryan Brewer, a highly influential cholesterol researcher, raved about the drug, telling attendants at a seminar at an American Health Association convention that the drug was safe and effective. His comments were conveniently published in a “special supplement” of the American Journal of Cardiology, timed perfectly with the release of Crestor® to the US market.11

An investigation later revealed that Dr. Brewer had financial ties to AstraZeneca as a paid speaker. It also revealed that AstraZeneca directly financed Dr. Brewer’s American Health Association seminar and Circulation’s special supplement. Dr. Brewer’s monetary ties to the drug maker were not disclosed in his article.

Red Yeast Rice: A Better Alternative to Statins

Red yeast rice (RYR), a staple of Chinese medicine and a traditional Asian seasoning, is made by fermenting polished rice with various strains of the yeast monacus purpureus. It contains a naturally occurring statin called monacolin-K.

High-dose statins are often unnecessary, and may not be the right choice for millions of people, given their side effect profile.

Monacolin-K effectively lowers cholesterol by acting as an HMG-CoA reductase inhibitor—the same mode of action as synthetic statin drugs. Bioactive compounds found in RYR complement monacolin-K’s lipid-lowering effects, including unsaturated fats.12 These act both as cholesterol-lowering and anti-inflammatory agents.13

Pantethine: A Lipid-Lowering Vitamin

Mainstream medicine has been slow to embrace red yeast rice (RYR) as an alternative treatment therapy because the FDA does not regulate the supplement—and because many doctors remain unaware of its lipid-lowering ability and safety profile. This constitutes a great disservice to the millions of Americans now taking synthetic statin drugs. There is a wealth of compelling evidence indicating RYR’s power to lower low-density lipoprotein (LDL) and triglyceride levels and raise high-density lipoprotein (HDL)—without unwanted and sometimes dangerous side effects.

In one of the largest studies of its kind, a meta-analysis of 93 randomized controlled trials involving almost 10,000 Chinese patients found that RYR could significantly lower levels of total cholesterol, LDL, and triglycerides, and raise levels of HDL compared with placebo.14

In a study specifically designed to determine if RYR could lower lipid levels without causing myalgias (muscle pain), researchers conducted a randomized, double-blind, placebo-controlled trial in patients with high cholesterol.15 Study participants were randomly assigned to take either 1,800 mg of red yeast rice or placebo twice daily for 24 weeks. All participants were also enrolled in a 12-week therapeutic lifestyle change program during the study.

What You Need to Know: Red Yeast Rice
  • Cholesterol-lowering statin drugs are one of the most widely prescribed classes of drugs.
  • While protecting heart health is an important lifelong habit, the long-term effects of high-dose statin drugs carry considerable risks and should not be taken without thoughtful consideration.
  • Safe, low-cost interventions are available now for those seeking to safeguard heart health.
  • Red yeast rice contains monacolin-K, which works by the same mechanism as statin drugs to lower cholesterol.
  • Red yeast rice has been shown to lower LDL, total cholesterol, and triglycerides while raising HDL. Red yeast rice has even benefitted individuals who could not tolerate the side effects of statin drugs.
  • Since red yeast rice works similarly to statin drugs, practitioners recommend consuming extra CoQ10 while using it.
  • Other therapies that support healthy cholesterol levels include beta-sitosterol, pantethine, policosanol, and niacin.

LDL levels decreased more in the RYR treatment group (average decrease of 35 mg/dL) than in participants receiving the placebo (average placebo decrease was 15 mg/dL). The RYR treatment achieved these results without increasing muscle pain or CPK (creatine phosphokinase)—an enzyme in the blood that indicates muscle damage.

RYR has been shown in some studies to perform as well or better than some widely used synthetic statins. In one randomized, open-label clinical trial, investigators looked at 74 individuals with high cholesterol, dividing them between a simvastatin treatment group (40 mg/day) and an alternative treatment (AT) group.1

Risks of Statin Drugs

The alternative treatment included lifestyle changes and ingestion of RYR and fish oil supplements for 12 weeks; the statin group received their medication and traditional counseling. Both groups achieved a statistically significant reduction in LDL levels (AT group –42.4% and the simvastatin group –39.6%). But the AT group also achieved significant reductions in triglycerides (–29% in the AT group vs. –9.3% in the statin group) and weight loss (–5.5% vs. –0.4% of body weight in the statin group). The data showed that lifestyle changes (i.e., diet, exercise, relaxation techniques) combined with ingestion of RYR and fish oil reduced LDL in proportions similar to standard therapy with simvastatin. Investigators concluded that, “This multifactorial, alternative approach to lipid lowering has promise for a subset of patients unwilling or unable to take statins.”

Individuals already suffering from coronary heart disease (CHD) may also benefit from RYR as it has been shown to blunt the increase in triglycerides following a meal in patients with clinically documented coronary heart disease (CHD).16 After a high-fat meal, RYR significantly reduced fasting serum lipids while increasing fasting HDL. Post-meal triglyceride levels fell by 43% after 6 hours in the treatment group—but not in the control group.

Pantethine: A Lipid-Lowering Vitamin

Pantethine is the active form of vitamin B5 (or pantothenic acid), the molecule used to make coenzyme A (CoA). CoA is involved in the transport, synthesis, and oxidation of fatty acids to and from the cells, and into the mitochondria. As a member of the B-complex family of vitamins, pantothenic acid is essential to numerous bodily functions, including

synthesis of neurotransmitters, hormones, and hemoglobin. Studies have shown that pantethine can reduce serum triglycerides and cholesterol levels while increasing HDL levels. This is true across a broad range of at-risk populations.

Cardiovascular diseases are the main cause of death in women, especially post-menopause. In a 16-week study of 24 menopausal women with high cholesterol (total cholesterol greater than or equal to 240 mg/dL), pantethine yielded significant reductions of total cholesterol, LDL, and LDL/HDL ratio.17

Another study of pantethine in 7 children and 65 adults with high cholesterol and/or high triglycerides showed a significant reduction in total cholesterol, LDL, and triglycerides—as well as a substantial increase in HDL.18

RISKS OF STATIN DRUGS

Using prescription statins is not without serious health risks and no one knows the long-term effects of living on them for life, which is how they must be taken. People who use them and then quit a year later face elevated risk levels of stroke and heart attack.34,35 Many people who take statins have to stop because of muscle pain, the most commonly reported side effect.36,37 A serious and potentially fatal type of rhabdomyolysis (muscle breakdown) has also been reported in statin users.38-41

Numerous published studies have documented other hazards of taking statin drugs that afflict an untold number of users, including muscle damage,42 cognitive impairment,43 vision problems,44 peripheral neuropathy,45-47 and tendonopathy.48

Published surveys reveal that doctors tend to deny or to minimize statin risks to their patients. These denials occur even when patients present with symptoms that are well-documented adverse reactions to statin drugs, such as muscle pain and detrimental changes in memory, concentration, and mood.49

In another illustrative clinical trial, researchers examined the effect of oral treatment with pantethine on 20 patients with elevated cholesterol and triglycerides.19 They found significant decreases of total cholesterol, LDL, and triglycerides, with increased levels of HDL.

Beta-Sitosterol: An Anti-Inflammatory and Anti-Cholesterol Plant Extract

Beta-Sitosterol: An Anti-Inflammatory and Anti-Cholesterol Plant Extract

Beta-sitosterol is a primary plant sterol. This class of compounds is molecularly similar to cholesterol and may inhibit cholesterol’s absorption in the lower intestine and reduce levels of cholesterol in the blood. Phytosterols have also been shown to act in synergy with red yeast rice by achieving a therapeutic effect at a lower dose.

In effect, beta-sitosterol acts as a potent dietary cholesterol blocker. A significant body of clinical evidence has demonstrated its cholesterol-lowering effects. In a 2005 study, researchers gave 29 individuals with high cholesterol (40-80 years old, average age = 55; 14 with type 2 diabetes) an edible beta-sitosterol spread.20 Both diabetic and non-diabetic patients experienced a greater reduction in LDL—27% and 15% respectively—than controls.

A meta-analysis of 14 randomized controlled trials investigated the effects of plant sterols added to margarine on cholesterol levels.21 The sterol-fortified margarine caused a reduction in the mean concentration of LDL, an effect that tended to increase with age.

The results of two older beta-sitosterol studies further indicate it can decrease systemic inflammation. In one meta-analysis, the lead investigator noted that beta-sitosterol appears to support proliferation of peripheral blood lymphocytes and enhance the cytotoxic effect of natural killer cells.22 Another study that measured inflammation and immune suppression in marathon runners found that beta-sitosterol could help prevent immune system suppression and could reduce bodily inflammation.23 Together, these anti-inflammatory properties led researchers to suggest that beta-sitosterol might be of clinical use in treating a number of chronic inflammatory conditions that could lead to cancers of the breast and colon.

Policosanol

Policosanol is a naturally occurring component of beeswax and whole sugar cane. More than 80 studies performed mostly by a single research institute suggest that policosanol obtained from Cuban sugar cane at doses of 5-40 mg/dL exerts cholesterol-lowering effects equivalent to that of statin drugs.24,25 (It should be noted that other research groups using policosanol from alternative sources have failed to reproduce the efficacy of these alcohols observed in earlier studies.)26

Numerous animal models studies have been conducted using policosanol. One study found that pretreatment with policosanol and omega-3 fatty acids prevented arterial wall thickening and endothelial damage in animals whose arteries had been damaged artificially.27

Some research suggests that policosanol is effective in lowering cholesterol in patients with progressive atherosclerosis and diabetes. One study tested policosanol in patients suffering ischemic stroke who were also treated with aspirin and vitamins. They achieved substantially positive results, with improvements in neurological outcomes and recurrent events.28

Niacin

Niacin’s ability to lower LDL, raise HDL, and lower triglyceride levels has been conclusively established by a wealth of clinical research.29 It is one of the best-known and most widely used vitamins for lowering blood cholesterol levels. It has also been shown in multiple studies to provide better heart health protection than some statins. A widely publicized study appearing last November in the New England Journal of Medicine found that niacin was more effective at shrinking artery plaque than a billion-dollar blockbuster called ezetimibe, the active ingredient in the cholesterol drugs Zetia® and Vytorin®.30

RED YEAST RICE PRECAUTIONS

Let your doctor know if you decide to take red yeast rice extract. Use it only under the guidance and supervision of your doctor or a healthcare practitioner. Pregnant or breast-feeding women should check with a health care provider before using products that contain red yeast rice extract.

Due to the relative lack of regulation of supplement manufacture, the stated content of red yeast rice products is unpredictable unless you use a product with certified concentrations of standardized monacolin-K content.

We strongly recommend using only standardized red yeast rice extract from reputable manufacturers who routinely test their products for purity.

As with prescription statins, people who ingest high doses of red yeast rice extract can experience muscle pain.50-52

As is also the case with statins, use of red yeast rice products may also deplete tissue levels of CoQ10.53 Life Extension® recommends taking additional CoQ10 for those people who take statins and red yeast rice-containing products.

Recent studies further indicate that niacin reduces oxidative stress and inhibits vascular inflammatory genes, including key cytokines involved in atherosclerosis.29,31,32 Until recently, niacin’s general use and widespread patient tolerability have been impeded by the need to take it 4 times a day and by the high incidence of skin flushing, gastric problems, and other adverse events.

CoQ10 may boost heart health of diabetics on statins CoQ10 may boost heart health of diabetics on statins

A form of “no-flush” niacin has emerged, called inositol hexaniacinate (IHN).33 It consists of six molecules of nicotinic acid (niacin) and one molecule of inositol. It is metabolized in the body into its component parts, niacin and inositol, and does not reach maximum blood levels for approximately 10 hours after ingestion. This form of the vitamin has not been linked with the skin “flushing” or other typical niacin reactions, even when ingested in amounts typically associated with skin flushing, nausea, vomiting, and agitation. Regrettably, it also does not work as well as niacin in reducing LDL and triglycerides and boosting HDL.

Summary

Statin drugs are heavily used and over-prescribed, owing to industry influence and misinformation. High-dose statins are often unnecessary, and may not be the right choice for millions of people, given their side effect profile. Studies indicate that any reduced cardiovascular risk from taking statins may be offset by other serious side effects, from sexual, visual, hepatic, renal, and cognitive dysfunction to disability and death. Aging individuals who want to lower their blood lipid levels and C-reactive protein (CRP) number may be able to achieve similar benefits with standardized red yeast rice extract, beta-sitosterol, pantethine, policosanol, and niacin. These synergistic ingredients have been shown to reduce blood lipid levels while promoting healthy endothelial function and reducing CRP and systemic inflammation. They offer a safer alternative to taking synthetic prescription statins.

If you have any questions on the scientific content of this article, please call a Life Extension® Wellness Specialist at 1-866-864-3027.

CoQ10 may boost heart health of diabetics on statins

Coenzyme Q10 supplements may increase the vascular health of diabetics receiving statins, according to a new study from Australia.

Following 12 weeks of supplementation with CoQ10 (200 mg per day), an improvement in the blood flow was observed, according to findings published in the journal Diabetes Care.54

It is well known that statins deplete the body’s natural stores of CoQ10, and this has boosted use of CoQ10, particularly in the US, where the popularity of statins has increased.55

The new findings indicate that, in addition to redressing the balance of CoQ10, supplementation may also improve endothelial dysfunction in statin-treated type 2 diabetic patients.

“The patients in our study had endothelial dysfunction despite satisfactory control of blood pressure, glycaemia and lipids, which may represent the proportion of statin-treated patients at increased residual risk of cardiovascular disease,” wrote the researchers, led by Professor Gerald Watts from the University of Western Australia.

“Our absolute improvement in [blood flow in the arm] of 1% with CoQ10 supplementation may potentially translate to a 10-25% reduction in residual cardiovascular risk in these patients.”

According to the International Diabetes Federation, there are over 245 million people with diabetes worldwide. If current trends continue, this number will rise to a staggering 380 million by 2030. Current costs of diabetic complications are estimated to account for 5 to 10% of total global healthcare spending.56

Study details

In order to test their hypothesis that oral CoQ10 supplementation would improve the vascular health in statin-treated diabetics, Professor Watts and his co-workers recruited 23 statin-treated type 2 diabetic patients with endothelial dysfunction (and LDL-cholesterol levels less than 97.5 mg/dL). The volunteers were randomly assigned to receive either CoQ10 or placebo for 12 weeks.

The randomised, double-blind, crossover study analysed by brachial artery flow-mediated dilatation (FMD), a measure of endothelial dysfunction since a low value is indicative of a blood vessel’s inability to relax, and nitrate-mediated dilation (NMD), which relates to nitric oxide, a potent endothelium-derived relaxing factor.

The researchers report a 2.7-fold increase in blood levels of CoQ10 following supplementation, and an increase in FMD of 1%. However, no changes in NMD were recorded, nor were any changes in levels of oxidative stress observed, assessed by measuring levels of compounds called F2-isoprostanes in the blood and urine.

“Impaired FMD is a consistent predictor of adverse cardiovascular events,” wrote the researchers. “Several interventions that improve FMD also improve cardiovascular outcomes.”

“The significance of the findings in our report, however, require further investigation in a clinical endpoint trial,” they added.

The CoQ10 used in this study was provided by Blackmores (Balgowlah, Australia), and the study was funded by a CardioVascular Lipid Research grant from Pfizer.

References
  1. Becker DJ, Gordon RY, Morris PB, et al. Simvastatin vs therapeutic lifestyle changes and supplements: randomized primary prevention trial. Mayo Clin Proc. 2008 Jul;83(7):758-64.
  2. Li JJ, Lu ZL, Kou WR, et al. Beneficial Impact of Xuezhikang on Cardiovascular Events and Mortality in Elderly Hypertensive Patients With Previous Myocardial Infarction From the China Coronary Secondary Prevention Study (CCSPS). J Clin Pharmacol. 2009;49:947-56.
  3. Lu Z, Kou W, Du B, et al. Effect of Xuezhikang, an extract from red yeast Chinese rice, on coronary events in a Chinese population with previous myocardial infarction. Am J Cardiol. 2008;101:1689-93.
  4. Zhao SP, Lu ZL, Du BM, et al. Xuezhikang, an extract of cholestin, reduces cardiovascular events in type 2 diabetes patients with coronary heart disease: subgroup analysis of patients with type 2 diabetes from China coronary secondary prevention study (CCSPS). J Cardiovasc Pharmacol. 2007;49:81-4.
  5. Keithley JK, Swanson B, Sha BE, Zeller JM, Kessler HA, Smith KY. A pilot study of the safety and efficacy of cholestin in treating HIV-related dyslipidemia. Nutrition. 2002;18:201-4.
  6. Journoud M, Jones PJH. Red yeast rice: A new hypolipidemic drug. Life Sciences. 2004;74:2675-83.
  7. Heber D, Yip I, Ashley JM, Elashoff DA, Go VLW. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr. 1999;69:231-6.
  8. Wang J, Lu Z, Chi J, et al. Multicenter clinical trial of serum lipid-lowering effects of a Monascus purpureus (red yeast) rice preparation from traditional Chinese medicine. Curr Ther Res. 1997;58(12):964-78.
  9. Available at: http://www.courant.com/news/politics/ny-hs-statin3,0,5977685.story. Accessed November 30, 2009.
  10. Available at: http://www.yorku.ca/yfile/archive/index.asp?Article=12368. Accessed November 30, 2009.
  11. Brewer HB. Benefit-risk assessment of Rosuvastatin 10 to 40 milligrams. Am J Cardiol. 2003;92:23-9K.
  12. Ma J, Li Y, Ye Q, Li J, Hua Y, Ju D, et al. Constituents of red yeast rice, a traditional Chinese food and medicine. J Agric Food Chem. 2000;48:5220-5.
  13. Man RY, Lynn Eg, Cheung F, Tsang PS. Cholestin inhibits cholesterol synthesis and secretion in hepatic cells (HepG2). Mol Cell Biochem. 2002 Apr;233(1-2):153-8.
  14. Liu J, Zhang J, Shi Y, et al. Chinese red yeast rice (Monascus purpureus) for primary hyperlipidemia: a meta-analysis of randomized controlled trials. Chin Med. 2006;1:4.
  15. Becker DJ, Gordon RY, et al. Red yeast rice for dyslipidemia in statin-intolerant patients. Annals Int Med. 2009 Jun;150(16):830-9.
  16. Zhao SP, Liu L, Cheng YC, Li YL. Effect of xuezhikang, a cholestin extract, on reflecting postprandial triglyceridemia after a high-fat meal in patients with coronary heart disease. Atherosclerosis. 2003;168:375-80.
  17. Binaghi P, Cellina G, Lo Cicero G, Bruschi F, Porcaro E, Penotti M. Evaluation of the cholesterol-lowering effectiveness of pantethine in women in perimenopausal age. Minerva Med. 1990;81:475-9.
  18. Bertolini S, Donati C, Elicio N, et al. Lipoprotein changes induced by pantethine in hyperlipoproteinemic patients: adults and children. Int J Clin Pharmacol Ther Toxicol. 1986;24:630-7.
  19. Gensini GF, Prisco D, Rogasi PG, Matucci M, Neri Serneri GG. Changes in fatty acid composition of the single platelet phospholipids induced by pantethine treatment. Int J Clin Pharmacol Res. 1985;5:309-18.
  20. Lau VW, Journoud M, Jones PJ. Plant sterols are efficacious in lowering plasma LDL and non-HDL cholesterol in hypercholesterolemic type 2 diabetic and nondiabetic persons. Am J Clin Nutr. 2005 Jun;81(6):1351-8.
  21. Law MR. Plant sterol and stanol margarines and health. West J Med. 2000 Jul;173(1):43-7.
  22. Bouic PJ. The role of phytosterols and phytosterolins in immune modulation: a review of the past 10 years. Curr Opin Clin Nutr Metab Care. 2001 Nov;4(6):471-5.
  23. Bouic PJ, Clark A, Lamprecht J, et al. The effects of β-sitosterol (BSS) and—sitosterol glucoside (BSSG) mixture on selected immune parameters of marathon runners: inhibition of post marathon immune suppression and inflammation. Int J Sports Med. 1999;20:258-62.
  24. Castaño G, Fernández L, Mas R, et al. Effects of addition of policosanol to omega-3 fatty acid therapy on the lipid profile of patients with type II hypercholesterolaemia. Drugs R D. 2005;6(4):207-19.
  25. Castaño G, Fernández L, Mas R, Illnait J, Mesa M, Fernández JC. Comparison of the effects of policosanol and atorvastatin on lipid profile and platelet aggregation in patients with dyslipidaemia and type 2 diabetes mellitus. Clin Drug Investig. 2003;23(10):639-50.
  26. Kassis AN, Marinangeli CP, Jain D, Ebine N, Jones PJ. Lack of effect of sugar cane policosanol on plasma cholesterol in Golden Syrian hamsters. Atherosclerosis. 2007;194:153-8.
  27. Gamez R, Maz, R, Arruzazabala ML, Mendoza S, Castano G. Effects of concurrent therapy with policosanol and omega-3 fatty acids on lipid profile and platelet aggregation in rabbits. Drugs R D. 2005;6(1):11-9.
  28. Ortega LL, Sánchez J, Más R, et al. Effects of policosanol on patients with ischemic stroke: a pilot open study. J Med Food. 2006 Fall;9 (3):378-85.
  29. Kamanna VS, Kashyap ML. Mechanism of action of niacin. Am J Cardiol. 2008;101:20-6B.
  30. Kastelein JJP, Bots ML. Statin ezetimibe or niacin in high-risk patients. NEJM. 2009 Nov 26;361(22):2180-3.
  31. Kamanna VS, Vo A, Kashyap ML. Nicotinic acid: recent developments. Curr Opin Cardiol. 2008;23:393-8.
  32. Kamanna VS, Ganji SH, Kashyap ML. Niacin: an old drug rejuvenated. Curr Atheroscler Rep. 2009;11:45-51.
  33. No authors listed. Inositol hexaniacinate. Altern Med Rev. 1998 Jun;3(3):222-3.
  34. Blanco M, Nombela F, Castellanos M, et al. Statin treatment withdrawal in ischemic stroke: a controlled randomized study. Neurology. 2007;69:904-910.
  35. Heeschen C, Hamm CW, Laufs U, et al. Withdrawal of statins increases event rates in patients with acute coronary syndromes. Circulation. 2002;105:1446-52.
  36. Brown WV. Safety of statins. Curr Opin Lipidol. 2008;19:558-62.
  37. Ahn SC. Neuromuscular complications of statins. Phys Med Rehabil Clin N Am. 2008;19:47-59, vi.
  38. Oldemeyer JB, Lund RJ, Koch M, Meares AJ, Dunlay R. Rhabdomyolysis and acute renal failure after changing statin-fibrate combinations. Cardiology. 2000;94:127-8.
  39. Omar MA, Wilson JP. FDA adverse event reports on statin-associated rhabdomyolysis. Ann Pharmacother. 2002;36:288-95.
  40. Schech S, Graham D, Staffa J, et al. Risk factors for statin-associated rhabdomyolysis. Pharmacoepidemiol Drug Saf. 2007;16:352-8.
  41. Staffa JA, Chang J, Green L. Cerivastatin and reports of fatal rhabdomyolysis. N Engl J Med. 2002;346:539-40.
  42. Hanai J, Cao P, Tanksale P, et al. The muscle-specific ubiquitin ligase atrogin-1/MAFbx mediates statin-induced muscle toxicity. J Clin Invest. 2007 Dec;117(12):3940-51.
  43. King DS, Wilburn AJ, Wofford MR, Harrell TK, Lindley BJ, Jones DW. Cognitive impairment associated with atorvastatin and simvastatin. Pharmacotherapy. 2003;23:1663-7.
  44. Fraunfelder FW, Richards AB. Diplopia, blepharoptosis, and ophthalmoplegia and 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitor use. Ophthalmology. 2008;115:2282-5.
  45. Gaist D, García Rodríguez LA, Huerta C, Hallas J, Sindrup SH. Are users of lipid-lowering drugs at increased risk of peripheral neuropathy? Eur J Clin Pharmacol. 2001;56:931-3.
  46. de Langen JJ, van Puijenbroek EP. HMG-CoA-reductase inhibitors and neuropathy: reports to the Netherlands Pharmacovigilance Centre. Neth J Med. 2006;64:334-8.
  47. Chong PH, Boskovich A, Stevkovic N, Bartt RE. Statin-associated peripheral neuropathy: review of the literature. Pharmacotherapy. 2004;24:1194-203.
  48. Chazerain P, Hayem G, Hamza S, Best C, Ziza JM. Four cases of tendinopathy in patients on statin therapy. Joint Bone Spine. 2001;68:430-3.
  49. Golomb BA, McGraw JJ, Evans MA, Dimsdale JE. Physician response to patient reports of adverse drug effects: implications for patient-targeted adverse effect surveillance. Drug Saf. 2007;30:669-75.
  50. Smith DJ, Olive KE. Chinese red rice-induced myopathy. South Med J. 2003;96:1265-7.
  51. Yang HT, Lin SH, Huang SY, Chou HJ. Acute administration of red yeast rice (Monascus purpureus) depletes tissue coenzyme Q(10) levels in ICR mice. Br J Nutr. 2005;93:131-5.
  52. Prasad GV, Wong T, Meliton G, et al. Rhabdomyolysis due to red yeast rice (Monascus purpureus) in a renal transplant recipient. Transplantation. 2002;74:1200-1.
  53. Yang HT, Lin SH, Huang SY, et al. Acute administration of red yeast rice (Monascus purpureus) depletes tissue coenzyme Q(10) levels in ICR mice. Br J Nutr. 2005;93:131-5.
  54. Available at: www.nutraingredients-usa.com/content/search?SearchText=CoQ10. Accessed December 29, 2009.
  55. Available at: www.nutraingredients-usa.com/content/search?SearchText=statins. Accessed December 29, 2009.
  56. Available at: www.nutraingredients-usa.com/content/search?SearchText=diabetes. Accessed December 29, 2009.

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