Policosanol & Omega-3 Fish Oils Are Good for the Heart

Policosanol & Omega-3 Fish Oils—A Dynamic Duo

Policosanol & Omega-3 Fish Oils
Are Good for the Heart

When taken concurrently, they provide complementary and additive cardiovascular benefits
By Dr. Edward R. Rosick

ew would argue that we live in an age of relentless advertising, 24/7. It is estimated that, worldwide, corporations will spend around 400 billion dollars this year on advertisements for everything from condoms to cars. In the United States, pharmaceutical companies spend between 2 and 3 billion dollars a year on direct-to-consumer advertising (DTCA)—that is, ads that are placed on TV, radio, newspapers, and magazines, hawking the supposedly latest and greatest prescription medications.

As a proud capitalist, I have no objection to any corporation, no matter how large or small, using its own money to advertise its products. With pharmaceuticals, however, DTCAs can get a little tricky for consumers, especially for those who don’t know how (or don’t make the effort) to research what’s being advertised.

Statins Are Not the Only Game in Town

Take the statin drugs, for instance. They were developed to combat high cholesterol levels, which are thought to contribute to the epidemic of heart disease, and they generate billions in profits for their manufacturers. (Not coincidentally, they’re quite expensive, as many consumers who lack health insurance find out the hard way.) Although many studies have demonstrated the value of statins in reducing the risk for heart disease, it takes an astute consumer to read the fine print and realize that these drugs are not without their drawbacks.


Policosanol was as or more effective
than the statin drugs in lowering
LDL-cholesterol levels—and it was
shown to be extremely safe.


For example, although the statins are quite safe, as synthetic drugs go, they can cause abnormalities in liver function. They’re contraindicated in patients with known liver disease or in the elderly who have liver problems, even if the patient has high levels of LDL-cholesterol (the “bad cholesterol”). Other side effects that have been seen with statin drugs are polyneuropathy and myopathy (a weakness or wasting of the muscles), including rhabdomyolysis, a severe form of myopathy that can be fatal. In fact, the statin drug cerivastatin was withdrawn from the market in 2001 owing to an unusually high incidence of this condition.

Policosanol Is Often Better

Thanks to incessant advertising, you might think that statins are the only effective way to combat your high cholesterol levels and heart disease, but this is not true at all. In fact, there are several safe, natural, and inexpensive supplements that can significantly lower your cholesterol and triglyceride levels and, in so doing, reduce your risk for heart disease. Two of the most widely studied of these supplements are policosanol and the omega-3 fatty acids from fish oil.

Policosanol is a mixture of eight closely related waxy compounds that are derived from sugar cane (but they are not sugars, so they do not raise blood sugar levels). In numerous studies, policosanol has been shown to be remarkably safe and effective. Some of these studies were head-to-head comparisons between policosanol and various statin drugs, and it was found that the supplement was as or more effective than the drugs in lowering LDL-cholesterol levels.1 Moreover, policosanol was shown to be extremely safe, displaying none of the liver toxicity that occasionally results from the use of statins.


The effects of policosanol and
omega-3 fatty acids tended to be
additive. Since both have proven
cardiovascular benefits in humans,
this study suggests the potential
value of using both concurrently.


With its proven cholesterol-fighting ability, it’s no wonder that policosanol, like the statins, has been shown to reduce the risk of heart disease in people with high levels of LDL-cholesterol. In a comparison trial with atorvastatin (Lipitor®), policosanol was shown to be superior in increasing levels of HDL-cholesterol (the “good cholesterol”), and it was almost as effective in reducing LDL-cholesterol levels.2

Omega-3 Fatty Acids Have an Outstanding Track Record

Another safe and effective supplement in the battle against heart disease is fish oil, or, more precisely, the omega-3 fatty acids found in fish oil (from coldwater fish). The two omega-3s of greatest value are DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid). They are called essential fatty acids, meaning that they’re necessary for various functions of the human body, including lipid metabolism, blood pressure regulation, immune system modulation, and brain development. If we did not consume foods or supplements containing omega-3 fatty acids, optimal health would be impossible.

As with policosanol, numerous studies have demonstrated the heart-protective benefits that fish oil confers. Some studies have shown that a diet high in omega-3 fatty acids can significantly reduce triglycerides (fats), which are implicated in heart disease.3,4 And a study published in 2000 looked at the effects of omega-3s on patients who had a history of heart attacks and coronary artery bypass surgery.5 In those who had had a heart attack, the omega-3s appeared to reduce significantly the chances of dying from a second heart attack.

A more recent review study examined 11 previous studies on omega-3 fatty acids (which are also known as n-3 fatty acids), and the authors concluded that “… n-3 polyunsaturated fatty acids may decrease mortality due to myocardial reinfarction [heart attack], sudden death, and overall mortality in patients with coronary heart disease.”6

Policosanol and Omega-3s Provide Complementary Benefits

Since both policosanol and the omega-3 fatty acids can decrease cholesterol and triglyceride levels, and thus your risk for heart disease, it stands to reason that the two together might be a winning combination. Indeed, researchers in Cuba (where policosanol was discovered) have investigated that idea by studying the effects of policosanol plus omega-3 fatty acids on lipid profile and platelet aggregation (the tendency to form blood clots) in rabbits.7

Male rabbits were randomly placed in one of four groups: (1) a control group; (2) a group receiving only policosanol; (3) a group receiving only omega-3 fatty acids; or (4) a group receiving both policosanol and omega-3 fatty acids. The supplements were given orally, and the trial lasted 60 days.

For the two single-supplement groups, at least, the results were not surprising: the rabbits on policosanol showed significant reductions in their total cholesterol and LDL-cholesterol levels, with an increase in their HDL-cholesterol levels; their triglyceride levels remained unchanged. In the group that was given omega-3 fatty acids, triglyceride levels were significantly reduced, but there were no changes in cholesterol levels. Inhibition of platelet aggregation was observed in both of these groups. Clearly, their benefits were complementary.

Policosanol + Omega-3s = Additive Benefits

But what about the group that received both policosanol and omega-3 fatty acids? In this group, both total cholesterol and LDL-cholesterol levels declined significantly, and HDL-cholesterol levels increased. In addition, as was seen in the omega-3 fatty acid group, triglyceride levels also declined significantly. Finally, inhibition of platelet aggregation was observed at a higher level than was seen in either of the single-supplement groups.

What can we deduce from this study? As in earlier studies, this one showed the effectiveness of policosanol in decreasing total cholesterol and LDL-cholesterol levels and in increasing HDL-cholesterol levels, as well as the ability of omega-3 fatty acids to reduce triglyceride levels. Although no synergistic effects were noted with the combination of these two supplements, the effects tended to be additive. Since both agents have proven cardiovascular benefits in humans, this study suggests the potential value of using both concurrently.

Sudden Death Can Ruin Your Day

It has been estimated that sudden death accounts for at least 50% of all deaths attributed to heart disease. The majority of these deaths are thought to be caused by the heart’s going into some type of arrhythmia, or abnormal heart rhythm (see the sidebar).There is now evidence that omega-3 fatty acids may reduce the risk of sudden death from cardiac arrhythmias. In a study published in 2002, researchers concluded that the ability of omega-3 fatty acids to prevent sudden cardiac death is related to the way in which they protect the heart from going into arrhythmia, even in patients with severe heart disease.8

Cardiac Arrhythmias—From Benign to Deadly

Your heart normally beats in a regular, rhythmic fashion. This rhythm is controlled by bioelectrical impulses that cause the heart’s four chambers (two atria and two ventricles) to pump blood out in a coordinated fashion. However, cardiac arrhythmias—irregularities in the force or the rhythm of the heartbeat—turn this order to chaos. They can range from benign to deadly.

ECG of PVC
Premature ventricular complex, or PVC (not to be confused with polyvinyl chloride!), is a common type of cardiac arrhythmia. It’s due to an “extra” electrical impulse originating in one of the heart’s ventricles, usually the left one. PVCs have a classic signature on an electrocardiogram (ECG), so they are easily identified by physicians. For patients who complain of skipped heartbeats, an office ECG will very often show some PVCs.

In and of themselves, PVCs are not dangerous, and most people with this condition have no symptoms at all. If they do not have heart disease, their PVCs do not signal an increased risk for it. Research has shown, however, that PVCs in people who do have heart disease are at increased risk for more serious problems, including ventricular fibrillation. In this devastating arrhythmia, the heart doesn’t actually beat, but undulates erratically, like a bag of worms. No blood is pumped, and if the arrhythmia isn’t corrected immediately, the person will die.

Although all cardiac arrhythmias can be treated when they occur, preventing their occurrence can be difficult or even impossible. Some types can be readily prevented through the use of prescription drugs or surgical interventions (such as coronary artery bypass surgery, catheter ablation, or implanted pacemakers), but others are resistant to such treatments.

In another study, also published in 2002, researchers examined 278 healthy men to test the hypothesis that omega-3 fatty acids would provide protection for people without known heart disease.9 From the results of this study, the authors concluded, “The n-3 fatty acids found in fish are strongly associated with a reduced risk of sudden death among men without evidence of prior cardiovascular disease.”

Omega-3s May Inhibit Cardiac Arrhythmias

Two more recent studies have also examined the effects of omega-3 fatty acids on cardiac arrhythmias. The first one, a randomized, double-blind, placebo-controlled trial published in 2004, investigated the effects of fish oil (3 g/day) or placebo in patients with cardiac arrhythmias.10 In the group given the fish oil, a statistically significant decrease was seen in various arrhythmias, including atrial and ventricular premature complexes, couplets, and triplets. No similar improvements were noted in the placebo group.

The second study, published in 2005, investigated the effects of 3.5 g/day of fish oil in patients with confirmed cardiac arrhythmias, especially premature ventricular complexes (PVCs).11 Here, in contrast to the earlier studies, fish-oil supplementation did not significantly affect the number of PVCs. It did, however, seem to decrease heart rate somewhat, and the authors stated that this alone foretold a lower risk of sudden cardiac death.

What should we make of these conflicting studies? At this point, all we can say for sure is that omega-3 fatty acids do confer cardiovascular health benefits—the evidence for that is indisputable (even the FDA acknowledges it). And even if it should turn out, from the results of larger studies, that these benefits are not mediated by antiarrhythmic effects, omega-3 fatty acids should definitely be high on your list of heart-healthy supplements.

Lower Your Cholesterol Levels—for Life

There is now solid scientific evidence for the health benefits of lowering your cholesterol levels—regardless of the levels you’re starting from (really!)—especially if you have other risk factors for heart disease. If you accept this challenge, you might at first think that prescription drugs are the only way to go. However, policosanol and omega-3 fatty acids—two safe, effective supplements that don’t get the advertising dollars that prescription drugs do—can lower both your cholesterol and triglyceride levels and may even help protect you against sudden cardiac death.

References

  1. Gouni-Berthold I, Berthold HK. Policosanol: clinical pharmacology and therapeutic significance of a new lipid-lowering agent. Am Heart J 2002;143(2):356-65.
  2. Castano G, Fernandez L, Mas R, et al. Comparison of the efficacy, safety, and tolerability of original policosanol versus other mixtures of higher aliphatic primary alcohols in patients with type II hypercholesterolemia. Int J Clin Pharm Res 2002;22(2):55-66.
  3. Miller M. Current perspectives on the management of hypertriglyceridemia. Am Heart J 2000;140(2):232-40.
  4. Durrington PN, Bhatnager D, Mackness, MI, et al. Omega-3 fatty acid concentrate decreased triglycerides in coronary heart disease patients treated with simvastatin. Heart 2001;85:544-8.
  5. von Schacky C. n-3 Fatty acids and the prevention of coronary atherosclerosis. Am J Clin Nutr 2000;71(1):224-7.
  6. Bucher H, Hengstler P, Schindler C, Meir G. n-3 Polyunsaturated fatty acids in coronary heart disease: a meta-analysis of randomized controlled trials. Am J Med 2002;112:298-304.
  7. Gomez R, Mas R, Arruzazabala ML, et al. Effects of concurrent therapy with policosanol and omega-3 fatty acids on lipid profile and platelet aggregation in rabbits. Drugs 2005;6(1):11-9.
  8. Rosenberg I. Fish food to calm the heart. New Engl J Med 2002;346(15): 1102-3.
  9. Albert C, Campos H, Stampfer M, et al. Blood levels of long-chain n-3 fatty acids and the risk of sudden death. New Engl J Med 2002;346(15): 1113-8.
  10. Singer P, Wirth M. Can n-3 PUFA reduce cardiac arrhythmias? Results of a clinical trial. Prostogland Leuk Essen Fatty Acids 2004;71:153-9.
  11. Geelen A, Brouwer IA, Schouten EG, et al. Effects of n-3 fatty acids from fish on premature ventricular complexes and heart rate in humans. Am J Clin Nutr 2005;81:416-20.


Dr. Rosick is an attending physician and clinical assistant professor of medicine at Pennsylvania State University, where he specializes in preventive and alternative medicine. He also holds a master’s degree in healthcare administration.

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