Pravastatin is the lowest potency statin that is widely used in the US to lower LDL cholesterol. It is often tolerated even in patients where other statins cause muscle pain. Red Yeast Rice extract is a well tolerated supplement that has been touted to lower LDL cholesterol. A study published in the Jan 15th issue of Am. Journal of Cardiology compares 2400 mg twice daily Red Yeast Rice extract with 20 mg twice daily pravastatin in a small group of patients who did not tolerate more potent statins. It turns out that both regimens are equally well tolerated and equally effective. Both reduce LDL levels by about 30%, and both are not tolerated by <10% of patients in this difficult population where another statin was already not tolerated. One unusual thing about this study is that the pravastatin was used as 20 mg twice daily, whereas statins are essentially always clinically dosed as a once daily evening dose when statins are more effective. It may be that if the whole pravastatin dose was used in the evening it may have been somewhat more effective. Both of these are similarly priced, If you buy the least expensive on-line brands of Red Yeast Rice this dose can be found for less than $8./ month. Pravastatin is available as a generic from the large chain stores at $4./month. The disadvantage of the Red Yeast Rice is that it may involve taking 4 large capsules twice a day, vs. a single smaller pill of pravastatin in the evening.
Important to note is that simvastatin, another generic statin, and several brand name statins lower LDL cholesterol by closer to 50%, and in order to get to their goal LDL (sorry about this link, it is very detailed and complicated, it’s probably better to just ask your physician what your LDL goal should be) many patients will need a more potent statin than pravastatin or Red Yeast Rice.
Of note some Red Yeast Rice extracts that are cultivated with the mold Monascus purpureus contain lovastatin (the first statin marketed in the US).