Vol.1 Issue 1
Dyslipidemia

I’m a family practice physician and I generally recommend statins for dyslipidemia that’s unresponsive to dietary and physical activity modifications. Recently, a few of my patients have declined statin therapy in favor of policosanol, which they believe to be a more natural approach. What evidence is there to support the safety and efficacy of policosanol?

Policosanol is a natural cholesterol-lowering supplement that has been extensively studied in Cuba (1). Derived from sugar cane wax, beeswax, or rice bran wax, policosanol consists of a mixture of higher primary aliphatic alcohols. Major alcohol components are octacosanol, triacontanol, and hexacosanol; tetracosanol and heptacosanol are minor components (2). Policosanol is postulated to lower cholesterol by inhibiting lipid synthesis and enhancing lipid clearance (3). Other purported policosanol benefits are that it inhibits platelet aggregation, prevents LDL peroxidation, and blocks smooth muscle proliferation, all of which may be important in reducing atherosclerotic risk (3-5).

In over twenty clinical trials, policosanol was consistently associated with normalization of dyslipidemic profiles, with reductions in total cholesterol and LDL cholesterol reaching as high as 21% and 29%, respectively, and increases in HDL cholesterol reaching 15% (1). In these trials, as well as animal studies, policosanol was well-tolerated and associated with few adverse effects. There have been no reports of drug interactions, however, formal studies are lacking. Policosanol should be avoided by persons taking anticoagulants.

Policosanol is widely available in health food stores under brand names such as Lesstanol Policosanol, Cholestin, PoliChol, and CholesOutII. Some of these products contain active ingredients other than policosanol. Policosanol is sold in soft-gel capsule, film-coated tablet, and bulk powder forms and generally costs less than $40.00 for a one month’s supply. The typical recommended dose is 5 — 20 mg once daily taken with the evening meal since the majority of the body’s cholesterol is produced at night.

2. Mas R, Castano G, Illnait J, Fernandez L, Fernandez J, Aleman C, Pontigas V, Lescay M. Effects of policosanol in patients with type II hypercholesterolemia and additional coronary risk factors. Clin Pharmacol Ther 1999;65:439-437.

3. Menendez R, Fernandez SI, Del Rio A, Gonzalez RM, Fraga V, Amor AM, Mas RM. Policosanol inhibits cholesterol biosynthesis and enhances low density lipoprotein processing in cultured human fibroblasts. Biol Res 1994;27: 199-203.

4. Menendez R, Mas R, Amor AM, Gonzalez RM, Fernandez JC, Rodeiro I, Zayas M, Jimenez S. Effects of policosanol treatment on the susceptibility of low density lipoprotein (LDL) isolated from healthy volunteers to oxidative modification in vitro. Br J Clin Pharmacol 2000;50:255-262.

5. Noa M, Mas R, Mesa R. Effect of policosanol on intimal thickening in rabbit cuffed carotid artery. Int J Cardiol 1998;67:124-32.