Red Yeast Rice for Dyslipidemia in Statin-Intolerant Patients

Red yeast rice (RYR) dapat digunakan untuk menurunkan kadar kolesterol LDL pada pasien yang tidak bisa diberikan preparat statin

 

Annals of Internal Medicine 150(12):830-839, 16 June 2009 © 2009 to the American College of Physicians
Red Yeast Rice for Dyslipidemia in Statin-Intolerant Patients-A Randomized Trial. David J. Becker, Ram Y. Gordon, Steven C. Halbert, Benjamin French, Patti B. Morris, and Daniel J. Rader.

 

16 June 2009 | Volume 150 Issue 12 | Pages 830-839

Background: Red yeast rice is an herbal supplement that decreases low-density lipoprotein (LDL) cholesterol level.

Objective: To evaluate the effectiveness and tolerability of red yeast rice and therapeutic lifestyle change to treat dyslipidemia in patients who cannot tolerate statin therapy.

Design: Randomized, controlled trial.

Setting: Community-based cardiology practice.

Patients: 62 patients with dyslipidemia and history of discontinuation of statin therapy due to myalgias.

Intervention: Patients were assigned by random allocation software to receive red yeast rice, 1800 mg (31 patients), or placebo (31 patients) twice daily for 24 weeks. All patients were concomitantly enrolled in a 12-week therapeutic lifestyle change program.

Measurements: Primary outcome was LDL cholesterol level, measured at baseline, week 12, and week 24. Secondary outcomes included total cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride, liver enzyme, and creatinine phosphokinase (CPK) levels; weight; and Brief Pain Inventory score.

Results: In the red yeast rice group, LDL cholesterol decreased by 1.11 mmol/L (43 mg/dL) from baseline at week 12 and by 0.90 mmol/L (35 mg/dL) at week 24. In the placebo group, LDL cholesterol decreased by 0.28 mmol/L (11 mg/dL) at week 12 and by 0.39 mmol/L (15 mg/dL) at week 24. Low-density lipoprotein cholesterol level was significantly lower in the red yeast rice group than in the placebo group at both weeks 12 (P < 0.001) and 24 (P = 0.011). Significant treatment effects were also observed for total cholesterol level at weeks 12 (P < 0.001) and 24 (P = 0.016). Levels of HDL cholesterol, triglyceride, liver enzyme, or CPK; weight loss; and pain severity scores did not significantly differ between groups at either week 12 or week 24.

Limitation: The study was small, was single-site, was of short duration, and focused on laboratory measures.

Conclusion: Red yeast rice and therapeutic lifestyle change decrease LDL cholesterol level without increasing CPK or pain levels and may be a treatment option for dyslipidemic patients who cannot tolerate statin therapy.

Determining optimal approaches for weight maintenance

Penelitian ini menilai efektivitas 2 program pendukung dan dua jenis diet dalam mempertahankan penurunan berat badan.

 

Diikuti oleh 200 wanita yang telah berhasil turun >5% BB, desain randomized controlled, 2x2 faktorial. Dibandingkan antara program pendukung intensif terhadap program pendukung sederhana. Dan dibandingkan antara diet tinggi karbohidrat terhadap diet tinggi mono-unsaturated fatty acid (MUFA)

 

Setelah 2 tahun didapatkan tidak ada beda signifikan antara kedua program pendukung.

Sedangkan diet tinggi MUFA menyebabkan kadar kolesterol total dan LDL lebih tinggi signifikan dibanding konsumsi diet tinggi karbohidrat.

 

Kesimpulan setelah berhasil mencapai penurunan BB sebaiknya diikuti dengan program pendukung, meskipun sederhana (dan murah) namun terbukti dapat mempertahankan penurunan BB.

 

Research

CMAJ. May 12, 2009; 180 (10). doi:10.1503/cmaj.080974. © 2009 Canadian Medical Association or its licensors

Determining optimal approaches for weight maintenance: a randomized controlled trial

Kelly S. Dale, PhD MSc, Kirsten A. McAuley, MBChB PhD, Rachael W. Taylor, PhD BSc, Sheila M. Williams, DSc BSc, Victoria L. Farmer, MSc, Paul Hansen, PhD MEc, Sue M. Vorgers, RN, Alexandra W. Chisholm, MCApSc PhD and Jim I. Mann, DM PhD

From the Departments of Human Nutrition (Dale, McAuley, Taylor, Vorgers, Chisholm, Mann), Preventive and Social Medicine (Williams), and Economics (Hansen), University of Otago; and the Edgar National Centre for Diabetes Research (McAuley, Taylor, Farmer, Mann), Dunedin, New Zealand

Background: Weight regain often occurs after weight loss in overweight individuals. We aimed to compare the effectiveness of 2 support programs and 2 diets of different macronutrient compositions intended to facilitate long-term weight maintenance.

Methods: Using a 2 x 2 factorial design, we randomly assigned 200 women who had lost 5% or more of their initial body weight to an intensive support program (implemented by nutrition and activity specialists) or to an inexpensive nurse-led program (involving "weigh-ins" and encouragement) that included advice about high-carbohydrate diets or relatively high-monounsaturated-fat diets.

Results: In total, 174 (87%) participants were followed-up for 2 years. The average weight loss (about 2 kg) did not differ between those in the support programs (0.1 kg, 95% confidence interval [CI] –1.8 to 1.9, p = 0.95) or diets (0.7 kg, 95% CI –1.1 to 2.4, p = 0.46). Total and low-density lipoprotein (LDL) cholesterol levels were significantly higher among those on the high-monounsaturated-fat diet (total cholesterol: 0.17 mmol/L, 95% CI 0.01 to 0.33; p = 0.040; LDL cholesterol: 0.16 mmol/L, 95% CI 0.01 to 0.31; p = 0.039) than among those on the high-carbohydrate diet. Those on the high-monounsaturated-fat diet also had significantly higher intakes of total fat (5% total energy, 95% CI 3% to 6%, p < 0.001) and saturated fat (2% total energy, 95% CI 1% to 2%, p < 0.001). All of the other clinical and laboratory measures were similar among those in the support programs and diets.

Interpretation: A relatively inexpensive program involving nurse support is as effective as a more resource-intensive program for weight maintenance over a 2-year period. Diets of different macronutrient composition produced comparable beneficial effects in terms of weight loss maintenance.

Indeks massa tubuh sebagai prediktor mortalitas

Hubungan antara indeks massa tubuh (IMT) dan mortalitas terlihat dalam penelitian prospektif berikut yang melibatkan 900 ribu subyek dewasa.

 

Kematian terendah adalah pada IMT 22,5 - 25 kg/m2.

 

Setiap peningkatan IMT 5 kg/m2 meningkatkan kematian (overall mortality) 30%.

Untuk kematian akibat penyakit vaskuler meningkat 40%.

Untuk kematian akibat diabetik, penyakit ginjal, dan penyakit hati meningkat 60-120%.

Untuk kematian akibat penyakit keganasan meningkat 10%.

Untuk penyakit pernapasan meningkat 20%.

 

IMT <22,5 kg/m2 terjadi peningkatan kematian akibat penyakit pernapasan dan kanker paru, terutama bagi perokok.

 

IMT 30-35 kg/m2 angka survival berkurang 2-4 tahun. IMT 40-45 kg/m2 angka survival berkurang 8-10 tahun (setara efek merokok)

 

 

The Lancet, Volume 373, Issue 9669, Pages 1083 - 1096, 28 March 2009

 

Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies

 

Background

The main associations of body-mass index (BMI) with overall and cause-specific mortality can best be assessed by long-term prospective follow-up of large numbers of people. The Prospective Studies Collaboration aimed to investigate these associations by sharing data from many studies.

Methods

Collaborative analyses were undertaken of baseline BMI versus mortality in 57 prospective studies with 894 576 participants, mostly in western Europe and North America (61% [n=541 452] male, mean recruitment age 46 [SD 11] years, median recruitment year 1979 [IQR 1975—85], mean BMI 25 [SD 4] kg/m2). The analyses were adjusted for age, sex, smoking status, and study. To limit reverse causality, the first 5 years of follow-up were excluded, leaving 66 552 deaths of known cause during a mean of 8 (SD 6) further years of follow-up (mean age at death 67 [SD 10] years): 30 416 vascular; 2070 diabetic, renal or hepatic; 22 592 neoplastic; 3770 respiratory; 7704 other.

Findings

In both sexes, mortality was lowest at about 22·5—25 kg/m2. Above this range, positive associations were recorded for several specific causes and inverse associations for none, the absolute excess risks for higher BMI and smoking were roughly additive, and each 5 kg/m2 higher BMI was on average associated with about 30% higher overall mortality (hazard ratio per 5 kg/m2 [HR] 1·29 [95% CI 1·27—1·32]): 40% for vascular mortality (HR 1·41 [1·37—1·45]); 60—120% for diabetic, renal, and hepatic mortality (HRs 2·16 [1·89—2·46], 1·59 [1·27—1·99], and 1·82 [1·59—2·09], respectively); 10% for neoplastic mortality (HR 1·10 [1·06—1·15]); and 20% for respiratory and for all other mortality (HRs 1·20 [1·07—1·34] and 1·20 [1·16—1·25], respectively). Below the range 22·5—25 kg/m2, BMI was associated inversely with overall mortality, mainly because of strong inverse associations with respiratory disease and lung cancer. These inverse associations were much stronger for smokers than for non-smokers, despite cigarette consumption per smoker varying little with BMI.

Interpretation

Although other anthropometric measures (eg, waist circumference, waist-to-hip ratio) could well add extra information to BMI, and BMI to them, BMI is in itself a strong predictor of overall mortality both above and below the apparent optimum of about 22·5—25 kg/m2. The progressive excess mortality above this range is due mainly to vascular disease and is probably largely causal. At 30—35 kg/m2, median survival is reduced by 2—4 years; at 40—45 kg/m2, it is reduced by 8—10 years (which is comparable with the effects of smoking). The definite excess mortality below 22·5 kg/m2 is due mainly to smoking-related diseases, and is not fully explained.