Protective Effects of Red Yeast Rice and the Associated Preparations on Gut Microbiota Against Atherosclerosis

Currently, atherosclerotic cardiovascular disease (ASCVD) is the primary cause of mortality globally. Meanwhile, accumulating evidence continues to implicate gut microbiota and the associated metabolites in the pathogenesis and progression of atherosclerosis. Red yeast rice (RYR), a traditional functional food, contains monacolin K as the primary bioactive component, which exerts statin-like lipid-lowering effects. Thus, RYR plays a protective role in regulating lipid metabolism and preventing ASCVD through multiple pathways, including improving endothelial dysfunction, attenuating oxidative stress, and inhibiting inflammatory responses. Therefore, this review summarizes current evidence regarding the regulatory effects of RYR and the associated preparations on hyperlipidemia and ASCVD. Furthermore, we highlight the protective role of RYR in the management of hyperlipidemia, with particular emphasis on the capacity of RYR to modulate the gut microbiota and the associated metabolites, thereby exerting anti-atherosclerotic effects. By elucidating the intricate interactions between RYR and the gut microbiota, this review provides novel insights into the therapeutic potential of RYR and reveals possible roles for the gut microbiota in ASCVD prevention.