Hypercholesterolemia, a risk factor for atherosclerosis and associated cardiovascular diseases is currently widely treated with statins, potent inhibitors of HMO-CoA reductase the rate-limiting enzyme in cholesterol synthesis. Despite the proven benefits on the prevention of heart disease, the high cost of statin treatment, in addition to side effects on liver function resulted in the search for a more natural therapy. The finding was Cholestin, a red yeast rice dietary supplement prepared from rice fermented with red yeast (Monascus purpureus). Dating back to 800 AD during the Tang Dynasty in China this fermentation product has been used to make rice wine, maintain food color and taste, and serve as a medicine. Studies show that red yeast rice preparations significantly decrease total cholesterol levels in hyperlipidemic subjects (11). However, despite its promise as an alternative to conventional statin therapy, as a dietary supplement it is not restricted to standardized manufacturing guidelines and the contents of preparations vary widely between manufacturers. As a result, the beneficial findings found by some studies with Cholestin may not apply to the preparations available in stores. Thus, the full potential of Chinese red yeast rice will not be realized until standards of production and labeling are established (7).