[104] Green Tea There is no evidence of a patient-oriented benefit from green tea supplements. The systematic review by Onakpoya et al. (2014) reviewed 20 RCTs and assessed the effectiveness of green tea supplements on blood pressure and lipid parameters.[105] The evidence demonstrated no increased adverse events. The Work Group s confidence in the quality of the evidence for green tea supplements was very low.[105] Red Yeast Rice There is no evidence of a patient-oriented benefit from red yeast rice supplements. A systematic review by Fogacci et al. (2019) reviewed 53 RCTs and assessed the safety of red yeast rice supplements.[106] These supplements were compared to either a statin or placebo and the follow-up ranged from 1 month 4.5 years. The authors concluded red rice yeast supplements were safe for use but caution is recommended when used with other medications, especially other cholesterol-lowering agents, due to possible interactions.[107] The Work Group s confidence in the quality of the evidence for red yeast rice was low. Summary The National Institutes of Health s Office of Dietary Supplements states that dietary supplements are products intended to supplement the diet. They are not drugs and therefore are not intended to treat, diagnose, mitigate, prevent, or cure diseases. [108] Dietary supplements do not require FDA premarket review or approval. As this is a Reviewed, New-added recommendation, the Work Group systematically reviewed evidence related to this recommendation.[101-106] The Work Group s confidence in the quality of the evidence was very low. The body of evidence did not yield results on the outcomes of CV mortality, all-cause mortality, or CV events. Most studies were short term (i.e., 1 6 months). Safety data for fiber, garlic, ginger, and green tea was inconclusive.