HDL biology
Red yeast rice supplement linked to extreme HDL cholesterol via apparent CETP downregulation in a case report (Lab Med 2020)
Original title: Paradoxical Hypercholesterolemia in an Otherwise Healthy Adult Man
A 23-year-old otherwise healthy man was found on routine screening to have a total cholesterol of 7.6 mmol per L, driven not by high LDL as in familial hypercholesterolaemia but by an HDL cholesterol level of 5.6 mmol per L, consistent with hyperalphalipoproteinaemia. The clinical picture was complicated by his use of red yeast rice extract, a popular hypolipidaemic supplement. The case author attributes the paradoxical hyperlipidaemic state to downregulation of cholesteryl ester transfer protein by the supplement, illustrating an unusual mechanism by which a commonly used over-the-counter product can markedly elevate HDL cholesterol and complicate the diagnostic picture in the laboratory.
Original abstract
Hypercholesterolemia is characterized by serum cholesterol levels greater than 5 mmol per L. However, the distribution of cholesterol among lipoprotein classes has a significant bearing on diagnosis: high-low-density lipoprotein (LDL) cholesterol suggests familial hypercholesterolemia, whereas high-high-density lipoprotein (HDL) cholesterol is associated with hyperalphalipoproteinemia. On routine screening, a 23-year-old man presented with a total cholesterol level of 7.6 mmol per L but was subsequently found to have an HDL cholesterol level of 5.6 mmol per L. The clinical picture was confounded by his use of red yeast rice extract, a popular health supplement with hypolipidemic effects. In this case individual, the use of red yeast rice extract caused a hyperlipidemic state, ostensibly through downregulation of cholesteryl ester transfer protein. This case emphasizes the extended role of laboratory medicine in complex cases of hyperlipidemia.
Summary written by cetpinhibition.org from the published abstract; figures as published. Page updated 19 August 2026. Methods.