Patients frequently ask for complementary therapy since nutraceuticals are being actively promoted as a way to help control LDL cholesterol levels in patients with low to moderate cardiovascular disease risk. Since people do not want to resort to lipid-lowering drugs, they decide to take various biologically active supplements as nutritional support for a cholesterol-lowering diet (Banach et al., 2019). I agree that nowadays red yeast rice (RYR) has become popular. It contains more than 10 types of monacolins and the greatest amount of monacolin K, which in the dose range of 3-11.4 mg causes a dose-dependent decrease in LDL cholesterol from 14.8% to 26.3%.
The enzymes of cytochrome P450 (CYP450) and P-glycoprotein are involved in the metabolism of monacolin K, which indicates a potential interaction with drugs that are mainly metabolized by these same pathways. RYR contains additional compounds with potential lipid-lowering properties, such as plant sterols, isoflavones, monounsaturated fatty acids, and other components, including fatty acids, pigments, and citrinin (Banach et al., 2019). However, despite being relatively safe and well-tolerated, patients should know that red yeast rice (RYR) also has side effects. The prevalence of severe side effects is less than 0.1%.
Taking everything into consideration, the use of nutraceuticals containing purified red yeast rice (RYR) can be considered in patients with a low risk of CVD. They should have no indication for statin therapy or statin intolerance (Banach et al., 2019). Thus, it can be concluded that nutraceuticals are also not completely safe and cannot replace drug therapy if there are indications for it. In addition, some patients with hypercholesterolemia may have statin intolerance, which reduces adherence to therapy, limits treatment efficacy, and increases the risk of CVD. Patients need to know all these details when prescribing any nutraceuticals.
Gestational diabetes mellitus (GDM) is a violation of carbohydrate metabolism that was first detected during pregnancy. So I agree that the GDM screening must be carried out between 24 to 28 weeks of gestation taking into account the high prevalence of carbohydrate metabolic disorders during pregnancy and the negative effects of hyperglycemia on mother and fetus (Maesa et al., 2019). Screening for GDM will reduce the number of gestosis, miscarriage, and the development of fetopathy.
The process of detecting carbohydrate metabolism violation by a doctor during pregnancy must include the following stages:
- identification of risk factors for GDM;
- determination of the level of glycemia;
- assessment of the level of glycemia, determination of the indication and timing of the oral glucose tolerance test (OGTT);
- carrying out a retest and assessing the level of glycemia;
- in 6 weeks after childbirth, determination of the fasting blood glucose level with the help of OGTT;
- in 6-12 months after childbirth, determination of fasting glycemia level using OGTT);
- once a year in case of impaired glucose tolerance and once in 3 years with normal glycemia, determination of the fasting blood glucose level (Banach et al., 2019).
I may add that all pregnant women need glucose level testing. At a normal level of glycemia, observation by an endocrinologist is required and OGTT is performed every three years. With an increased level of glycemia, constant observation by an endocrinologist is needed. Moreover, women with a history of GDM are advised to plan a subsequent pregnancy. Contraception is mandatory for 1.0–1.5 years and must be assigned individually by an obstetrician-gynecologist.
References
Banach, M., Bruckert, E., Descamps, O. S., Ellegård, L., Ezhov, M., Föger, B.,… & Catapano, A. L. (2019). The role of red yeast rice (RYR) supplementation in plasma cholesterol control: A review and expert opinion. Atherosclerosis Supplements, 39, 1-8.
Maesa, J. M., Fernandez-Riejos, P., Gonzalez-Rodriguez, C., & Sanchez-Margalet, V. (2019). Screening for gestational diabetes mellitus by measuring glycated hemoglobin can reduce the use of the glucose challenge test. Annals of Laboratory Medicine, 39(6), 524-529.