Policosanol Helps Protect Your Heart

September 10, 2008

It’s hard to not be frightened. Heart disease kills or cripples more people than any other cause. Cardiovascular disease (CVD) affects over 60 million Americans with heart disease and stroke, causing almost half of all deaths.[1] CVDs include problems not only with the heart but also high blood pressure and the much-feared “brain attack” we call stroke.[2]

Fortunately, researchers have demonstrated that Policosanol, a dietary supplement extracted from the wax that covers sugar cane stems, may help. Policosanol has been shown to lower LDL cholesterol and raise HDL cholesterol as well as or better than drugs, and without the serious side-effects of pharmaceuticals. Preliminary research suggests it may help reduce abnormal clotting as well.

Cholesterol problems often run in families. The defect appears to be a lack of liver receptor cells that bind to LDL, thereby removing it from the blood. The result: LDL–cholesterol levels 2-1/2 times normal.[3] Because the liver manufactures most of this cholesterol internally,[4] adopting a low-cholesterol diet may not bring the level down much. Obviously, adjusting liver function is a key to health.

Many people with heart disease deny their symptoms and risks, even to themselves. However, all adults should know their cholesterol levels, and everyone should realize that lowering LDL cholesterol and raising HDL cholesterol can substantially reduce the risk of having a second or even a first heart attack. Experts recommend keeping total cholesterol levels below 200 to reduce heart attack risk.[19]

For every 1% increase in total cholesterol over 200mg/dL, a person’s risk of heart attack rises 2%, according to the Framingham Heart Study.[20]  An especially bad factor is LDL cholesterol, but even this isn’t the whole story.

Even people with low LDL still die from heart attack. Raising HDL appears to be an even more important protection than lowering LDL. This may result in part from HDL’s function as a “vacuum cleaner” that removes LDL. An analysis of four major heart studies,21 including Framingham, shows that each 1mg/dL increase in HDL reduces risk of cardiovascular disease by 2%-3%. This same 1 point increase in HDL concentration also cuts risk of dying from cardiovascular disease by 3.7%-4.7%. Interestingly, the higher benefits occurred for women.

• Down-regulates cholesterol synthesis in the liver.[6]

• Increases LDL receptors to speed removal from blood.[6]

• Increases HDL levels.[7,8,9,10]

• Does not inhibit synthesis of enzymes essential for CoQ10 synthesis.[6]

• Reduces oxidation of cholesterol, reducing plaque formation in the arteries.[11]

• Has a synergistic effect with aspirin to reduce blood “stickiness.” [12,13]

• Reduces proliferation of smooth muscle cells within blood vessel walls.[14]

• Works synergistically with fibrate medications.[6]

• Reduces claudication (leg pain).[15]

• Prevents injury to arteries’ inner walls.[16,17]

• May ease carotid artery blockages in the neck.[18]

In repeated, well-controlled trials, Policosanol showed consistent improvement in blood cholesterol profiles.[7,9,10,22,23] Decreases in total cholesterol ranged from 14.7%-17.4%. Decreases in LDL cholesterol ranged from 15.6%-29%. And increases in HDL ranged from 15%-29.1%. In one large open label study, more than 3000 people took Policosanol for an average of 2.5 years24 and only 26 dropped out because of side effects. By chance, the Policosanol group reported more hypertension, ischemic cardiovascular disease and vascular events before the study began. However, after treatment the Policosanol group had significantly fewer hospitalizations and fewer coronary events than those on placebo.[24]

American doctors write 30 million prescriptions each year for drugs that lower blood fats, including the popular statins.[25] Although the statins do lower cholesterol, they are also expensive, can cause liver and muscle toxicity, and interfere with the body’s production of CoenzymeQ10.

Luckily, Policosanol has been shown to work as well as or better than statin drugs.[26,27,28,29] Both lower LDL and total cholesterol, and Policosanol performs significantly better at elevating HDL.

In an 8-week randomized study of women aged 60-80 with high blood cholesterol levels, Policosanol yielded significantly better results than the prescription drug fluvastatin with fewer side effects.[26] Another randomized, double-blind study compared policosanol and lovastatin in patients with high cholesterol and noninsulin dependent diabetes mellitus. Both treatments lowered LDL, but Policosanol yielded significantly better changes in HDL, and researchers noted it had a better safety and tolerability profile.[27] Similar results have been obtained for lovastatin and simvastatin, and pravastatin.[29] Blood vessels are subject to damage, and a rabbit study showed Policosanol stopped the proliferation of smooth muscle cells in the walls of blood vessels.[14,16] This indicates Policosanol may reduce formation of scar tissue that can narrow the arteries, a finding in keeping with effects reported for other lipid lowering drugs, such as most of the statins.[6]

• Cardiovascular disease is the Number 1 killer in the United States,[5] claiming 950,000 lives in the United States in 1998. That includes 459,841 from coronary heart disease and 158,448 from stroke.[2]

• 1 in 3 men can expect to develop major cardiovascular disease before the age of 60; the odds for women are 1 in 10.5

Although Policosanol does not itself consistently affect triglyceride levels, it does appear to have a synergistic effect with fibrate medications, which lower triglycerides and raise HDL.[6] Although studies have been small, the results have been consistent. In all but one study, both policosanol and fibrate medications significantly increased HDL values. A combination of policosanol and gemfibrozil worked better than either by itself. In addition, Policosanol dramatically enhanced the ability of bezafibrate to lower LDL and total cholesterol.[6]

In addition to helping the body remove LDL from the blood stream, Policosanol protects LDL against the oxidation that contributes to artery-clogging plaque. In laboratory conditions that mimic what goes on within arteries, 10mg/day of Policosanol significantly reduced the oxidation of blood cholesterol by 32.2%30 confirming results of animal studies.[11] Also, Policosanol reduced foam cell formation in rats,[14] indicating a reduced inflammatory response and less blood vessel destruction.

1. Start exercising

2. Quit smoking

3. Adopt a healthy diet

4. Check cholesterol level

5. Keep LDL below 18019

Policosanol also seems to work synergistically with aspirin to reduce abnormal blood clotting. In healthy subjects, a daily dose of 20 mg of Policosanol reduced platelet aggregation (i.e., decreased their stickiness) as effectively as 100 mg of aspirin.[13] A comparison showed that aspirin was better at reducing one type of platelet aggregation but Policosanol was better at inhibiting another type. Together, Policosanol and aspirin worked better than either alone.[13] Policosanol’s ability to reduce aggregation may stem in part from its inhibiting effect on thromboxane, a chemical produced by blood cells that promotes clotting and constricts blood vessels.[12] Fortunately, it does this without inhibiting the production of beneficial prostacyclin, which relaxes blood vessel walls and promotes free flow of blood.[12] 

In a long-term study, heart disease patients who took Policosanol with aspirin had significantly fewer cardiac events, improved exercise function and better ECG responses than those who took either Policosanol or aspirin alone.[31] These results suggest Policosanol might become as important as aspirin for reducing heart attack risk.

In a placebo-controlled study, patients with intermittent leg pain took 20 mg of Policosanol daily. After six months of treatment, the patients who took Policosanol were able to walk an average of about 70 meters farther without pain.[15] This 50% improvement in performance was statistically significant.

In a double-blind trial, healthy subjects who took octacosanol, the primary ingredient of Policosanol, experienced a significant increase in grip strength and reaction time.[32] In a double-blind placebo controlled trial, healthy subjects also experienced improved reaction time and brain activity after taking Policosanol for one week. A small one-year pilot study suggested that Policosanol may also help atherosclerosis that affects arteries of the neck, and more research is needed. Animal studies also show that Policosanol helps stop the formation of artery lesions in rats and rabbits.

Policosanol is a purified mixture of molecules known as “long chain alcohols,” (without intoxicating effects). With its wide range of protective actions, Policosanol shows great promise for people who want to reduce their cardiovascular risk. Policosanol has been extensively studied at medical facilities in other countries, notably Cuba, a nation that has few financial resources for treating heart patients, yet has an abundance of sugar cane fields.

Policosanol appears to work through several mechanisms. It inhibits the liver’s production of LDL cholesterol,[6] but unlike statins, it inhibits neither the HMG-CoA reductase enzyme[6] nor the production of CoQ10. Also, animal studies have shown that Policosanol does not interfere with the liver’s cytochrome P450 enzyme system that is responsible for the metabolism of many widely used drugs.[6] Policosanol also increases receptors that help remove LDL from the body,[6] further contributing to the drop in circulating LDL levels.

Animal studies show that octacosanol, the primary component of Policosanol, is initially taken up rapidly by the liver, which may relate to its beneficial cholesterol effects. It also accumulates in muscles, which may relate to its ability to increase muscle endurance.[34]

In short-term placebo-controlled trials, more people complained about side effects of placebo than of policosanol in every category except abdominal pain (which was reported equally in both). Policosanol has shown no toxicity and no carcinogenity.[36]

Typical recommended dosage is 10-20 mg daily. People taking blood thinners or anti-platelet medications should talk with their health care advisor before taking Policosanol.

References 

1. Preventing Heart Disease and Stroke: Addressing the Nation’s Leading Killers, At A Glance 2001, Centers for Disease Control and Prevention.
2. Deaths from heart disease and stroke down, but not enough, American Heart Association, Stroke News, 12/28/2000, http://216.185.112.5/presenter.jhtml identifier=2687.
3. The Cholesterol Quartet, Goldstein J and Brown M, Science Magazine, 292(5520):1310-12, 2001.
4. Chinese condiment cuts blood cholesterol, American Heart Association meeting report, March 25, 1999.
5. 1999 heart and stroke statistical update, American Heart Association, Dallas, 1998.
6. Policosanol: Hypolipidemic antioxidant, treatment of atherosclerosis. Mas R, Drugs of the Future, 25(6):569-86, 2000.
7. Effects of policosanol in patients with type II hypercholesterolemia and additional coronary risk factor. Mas R, Castano G, Illnait J, et al, Clin Pharm Ther, 65:439-47, 1999.
8. Efficacy and tolerability of policosanol in elderly patients with type II hypercholesterolemia: A
12-month study. Castano G, Canetti M, Moreira M, et al, Curr Ther Res, 56:819-28, 1995.
9. Effects of policosanol on postmenopausal women with type II hypercholesterolemia. Castano G, Mas R, Fernandez L, et al, Gynecol Endocrinol, 14(3):187-95, Jun 2000.
10. Effects of policosanol in older patients with type II hypercholesterolemia and high coronary risk. Castano G, Mas R, Fernandez JC, et al, J Gerontol, Series A, M186, March 2001.
11. Oral administration of policosanol inhibits in vitro copper ion-induced rat lipoprotein peroxidation. Menendez, R., et al, Physiol Behav,67:1-7, 1999.
12. Effect of policosanol on platelet aggregation and serum levels of arachidonic acid metabolites in healthy volunteers. Carbajal D, Arruzazabala ML, Valdes S, Mas R, Prostaglandins Leukot Essent Fatty Acids, 58(1):61-4, Jan 1998.
13. Comparative study of policosanol, aspirin, and the combination therapy policosanol-aspirin on platelet aggregation in healthy volunteers. Arruzazabala ML, Valdes S, Mas R, et al, Pharm Res, 36:293-97, 1997.
14. Effect of policosanol on damaged arterial wall induced by forceps in rabbits. Noa M, Mas R, Aguilar C, et al, J Electron Microsc, 4:629-30,1998.
15. A double-blind, placebo-controlled study of the effects of policosanol in patients with intermitent claudication. Castano G, Mas R, Roca J,et al, Angiology, 50:123-30, 1999.
16. Effect of policosanol on foam-cell formation in carrageenan-induced granulomas in rats. Noa, M., et al, J Pharm Pharmacol, 48:282-5, 1996.17. Protective effect of policosanol on atherosclerotic lesions in rabbits with exogenous hypercholesterolemia. Arruzazabala, M.L., et al, Braz J Med Biol Res, 33:835-40, 2000.
18. Doppler-ultrasound pilot study of the effects of long-term policosanol therapy on carotid-vertebral atherosclerosis. Batista J, Stusser R, Penichet M, Uguet E, Curr Ther Res, 56:906-8, 1995.
19. Lininger SW, Jr, DC Ed, The Natural Pharmacy, 2nd edition, Rocklin, CA: Prima Publishing, 79-84, 1999.
20. Prediction of coronary heart disease using risk factor categories. (Framingham Heart Study) Wilson PWF, D’Agostino RB, Levy D, et al, Circulation, 97:1837-47, 1998.
21. High-density lipoprotein cholesterol and cardiovascular disease. Four propsective American studies. Gordon DJ, Probstfield JL, Garrison RJ, et al, Circulation, 79(1)8-15, Jan 1989.
22. Effect of policosanol on hyperlipidemia and coronary heart disease in middle-aged patient. A 14 month pilot study. Batista J, Stusser R, Saez, F, et al, Int J Clin Pharm Res, 34:134-37, 1996.
23. A comparative study of policosanol versus simvastatin in elderly patients with hypercholesterolemia. Ortensi G, Gladstein J, Valli H, Tesone PA, Curr Ther Res, 58:390-40,1 1997.
24. Pharmacoepidemiologic study of policosanol. Mas R, Rivas P, Izquierdo JE, et al, Cur Ther Res, 60(8), pp 458-67, 1999.
25. Policosanol: The cholesterol-lowering breakthrough. Rountree R, MD, Let’s Live, March 2001.
26. Comparison of the efficacy, safety and tolerability of policosanol versus fluvastatin in elderly hypercholesterolaemic women. Fernandez JC, Mas R, Castano G, et al, Clin Drug Invest, 21:103-13, 2001.
27. Comparative study of the efficacy and tolerability of policosanol and lovastatin in patients with hypercholesterolemia and noninsulindependent diabetes mellitus. Crespo N, Illnait J, Max R,et al, Int J Clin Pharm Res, 19:117-27, 1999.
28. Comparative effects of policosanol and two HMG-CoA reductase inhibitors on type II hypercholesterolemia. [Spanish] Prat H, Roman O, Pino E, Rev Med Chil, 127(3):286-94, Mar 1999.29. Effects of policosanol and pravastatin on lipid profile, platelet aggregation and endothelia in older hypercholesterolemic patients. Castano G, Mas R, Arruzazabala ML, et al, Int J Clin Pharmacol Res, 19(4):105-16, 1999.
30.Effects of policosanol treatment on the susceptibility of low-density lipoprotein (LDL) isolated from healthy volunteers to oxidative modification in vitro. Menendez R, Mas R, Amor AMA, et al, Br J Clin Pharmacol, 50:255-62, 2000.
31.Long-term therapy with policosanol improves treadmill exercise-ECG testing performance of coronary heart disease patients. Stusser R, Batista J, Padron R, et al, Int J Clin Pharmacol Ther, 36(9):469-73, Sep 1998.
32.Octacosanol ingestion and its effects on meta- bolic responses to submaximal cycle ergometry, reaction time and chest and grip strength. Saint- John M and McNaughton L, Int Clin Nutr Rev, 6(2):81-87, 1986.
33.Policosanol, reaction time and event-related potentials. Fontani G, Maffei D, Lodi L, Neuropsychobiology, 41:158-65, 2000.
34.Tissue distribution of (8-14C)-octacosanol in liver and muscle of rats after serial administration. Kabir Y, et al, Ann Nutr Metab, 39:279-84, 1995.
35.A 12-month study of policosanol oral toxicity in Sprague Dawley rats. Aleman CL, Mas R, Hernandez C, et al, Toxicol Lett, 70(1):77-87, Jan 1994.
36.Carcinogenicity of policosanol in mice: An 18- month study. Aleman CL, Puig MN, Elias EC, et al, Food and Chemical Toxicology, 33(7), p 573-78, 1995.

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