Effects of monacolin K-containing nutraceutical on cholesterol homeostasis re- establishment and CVD risk reduction in hypercholesterolemic subjects

OBJECTIVE: Hypercholesterolemia is caused by cholesterol homeostasis (CH) disruption, and it contributes to cardiovascular diseases pathogenesis and progression. Status of CH can be assessed by measuring serum concentrations of non-cholesterol sterols (NCS) which serve as cholesterol synthesis and absorption surrogate markers. Monacolin K, isolated from red yeast rice, influences cholesterol synthesis by inhibiting HMG-CoA reductase activity and reduces serum total cholesterol (TC) concentration. PATIENTS AND METHODS: This longitudinal study included 30 hypercholesterolemic patients, with systematic coronary risk estimation (SCORE) values <10%, who received 3-monthslong supplementation with nutraceutical mixture containing monacolin K, and vitamins C, B1 and K2. Serum NCS were quantified by HPLCMS/MS method. Atherogenic indexes were calculated from lipid status parameters concentrations. Albumin degradation inhibition test was conducted to estimate in vitro anti-inflammatory activity of the nutraceutical mixture, whereas in vitro antioxidant activity was measured in serum enriched with prooxidants and antioxidants. RESULTS: TC, LDL-cholesterol (LDL-C), and triglycerides (TG) concentrations (p<0.001), as well as atherogenic indexes and SCORE values (p<0.001, p< 0.01, respectively) were lowered following the supplementation. Concentrations of cholesterol synthesis markers were decreased (p<0.001), whereas levels of cholesterol absorption markers remained unchanged after the supplementation. Reduction in cholesterol synthesis went alongside reductions in lipid status parameters and atherogenic indexes. In vitro analyses showed certain anti-inflammatory and antioxidant activity of the nutraceutical. CONCLUSIONS: These results suggest that supplementation with monacolin K containing nutraceutical favorably influences lipid status parameters and atherogenic indexes by acting on cholesterol synthesis. Anti-inflammatory and antioxidant effects of this unique nutraceutical mixture may exhibit beneficial pleiotropic effects.