Policosanol Has Benefits for Your Health

Policosanol Lowers Cholesterol
Better Than Prescription Drugs

Sugar cane extract also protects arteries by reducing lipid oxidation

ave you ever wondered what the difference between "good" and "bad" cholesterol is? Well, you're certainly not alone. Many people want to know why low-density lipoprotein (LDL, or "bad" cholesterol) is bad, while high-density lipoprotein (HDL, or "good" cholesterol) is good. We will see in a moment. Lipoproteins are molecular aggregates of lipids (which are fat-soluble molecules) and proteins. Cholesterol is a lipid and therefore does not dissolve in blood, which is mostly water. To be transported throughout the body from its source in the liver, it must be incorporated into lipoproteins, which do dissolve in blood. Thus, all the cholesterol in your bloodstream is a component of one kind of lipoprotein or another.

Sugar cane, the source of policosanol. 

Lipoproteins contain cholesterol, triglycerides (fats), and protein. Protein is denser than cholesterol and fats, so the higher the protein content of the lipoprotein, the greater its density. It should not surprise you, therefore, that HDLs have relatively more protein than LDLs, which means that they have relatively less cholesterol than LDLs. Because LDLs have a high cholesterol content, they are capable of donating this molecule to cells that require it for their normal function. This, in fact, is LDL's designated - and highly beneficial - role in human physiology. Unfortunately, however, LDLs can also donate cholesterol elsewhere, such as the inner walls of blood vessels, especially when the LDLs have become oxidized by free radicals in the blood. This destructive process accelerates the development of atherosclerosis, which is the buildup of cholesterol-laden arterial plaque.

HDLs, on the other hand, because they are cholesterol-poor, can absorb small amounts of cholesterol from undesirable locations (such as the walls of blood vessels), thereby decreasing the damage caused by LDLs. They transport the cholesterol back to the liver for storage or for ultimate excretion via the bile. This explains why it is beneficial to your cardiovascular health to reduce your LDL levels and increase your HDL levels.

Abundant research indicates that elevated LDL levels are a major cause of coronary heart disease (CHD) and that cholesterol-lowering therapy greatly reduces the risk of CHD. It should be reassuring to know that there are several options available for reducing high LDL levels. Changes in lifestyle (such as decreasing dietary fat and cholesterol intake, increasing physical activity, not smoking, and losing weight if you are obese) are beneficial but are difficult for many people to implement and maintain. A viable alternative for such people is to use lipid-lowering agents, such as policosanol. Policosanol is an extract of chemically related compounds from sugar cane. It can significantly reduce blood cholesterol levels by interfering with cholesterol synthesis in the liver. Statistically, this means a corresponding decrease in the risk of CHD.

The ability of policosanol to lower blood cholesterol levels has been compared with that of a number of highly effective pharmaceutical compounds called statins, and the results are compelling. The most recent of these studies, published in the journal Clinical Drug Investigations, demonstrates that policosanol treatment is superior to treatment with the prescription drug fluvastatin.1 In this study, 70 women, aged 60-80 years, with high LDL levels were initially placed on a "diet stabilization plan" for 4 weeks. The women were then randomized to receive either 10 mg of policosanol or 20 mg of fluvastatin daily for 8 weeks. Blood samples were drawn at the beginning of the treatment period and again 4 weeks and 8 weeks later.

After the first 4 weeks of treatment, the effects of policosanol and fluvastatin were essentially the same: they reduced total cholesterol by about 10% and LDL by about 13-14%, and increased HDL by 5.0-5.5%. After 8 weeks of treatment, however, the results with policosanol were clearly better than those with fluvastatin. Total cholesterol decreased by 19.3% (policosanol) vs. 16.7% (fluvastatin), LDL decreased by 29.2% vs. 22.9%, and HDL increased by 19.8% vs. 9.2%. These differences were judged to be statistically significant. An additional advantage of policosanol is that it was better tolerated than fluvastatin. For example, three patients withdrew from fluvastatin treatment because of adverse events, whereas no patients discontinued the policosanol treatment.

Finally, the policosanol/fluvastatin study demonstrated that policosanol provides superior protection against LDL oxidation compared with fluvastatin. By one measure - increase in the "lag time" for oxidation (the time required before oxidation becomes apparent) - policosanol was better, with a 36.5% increase, than fluvastatin (6.6% increase). By another measure - reduction of the oxidation rate - policosanol was again better, with a 15.5% reduction, than fluvastatin (7.6% reduction). Since oxidation of the lipids in LDL promotes the formation of atherosclerotic plaque, reducing lipid oxidation is an important step in reducing the risk of heart disease.

An Unexpected Benefit of Policosanol

Recent research has demonstrated that supplementation with octacosanol (the major component of policosanol) improves one's ability to react to a visual stimulus.1 The participants (20-21 years old) in this study took 3.6 g per day of octacosanol or a placebo for 7 days. Then their reaction time to a visual image flashed on a computer screen was monitored and compared with their reaction time before the supplementation began. Three separate tests of this kind demonstrated that the participants reacted more quickly to visual stimuli after the policosanol treatment.

Scientists aren't sure how to explain this, but two theories have been put forth. One suggests that specific circuits in the cholinergic system in the brain may be involved, while the other suggests that muscle activity may be heightened. Whichever theory (if either) turns out to be correct, it's pretty amazing that something that can be so good for your cardiovascular system can also improve your reaction time.

  1. Fontani G, Maffei D, Lodi L. Policosanol, reaction time and event-related potentials. Neuropsychobiology 2000;41:158-65.

A more detailed analysis of the role that policosanol plays in reducing lipid oxidation was reported recently in the British Journal of Clinical Pharmacology.2 Healthy volunteers with an average total cholesterol level of 178 mg/dL (less than 200 is considered good) were given placebo or policosanol at either 5 mg/day or 10 mg/day for 8 weeks. As predicted, LDL levels decreased (by 20.2%, with 10 mg/day), and HDL levels increased (by 15.2%) in these subjects. (These percentage changes are not as great as those seen in patients with high cholesterol levels, because the healthy volunteers had low to moderate cholesterol levels to begin with.)

After 8 weeks of treatment,
the results with policosanol
were clearly better than
those with fluvastatin.

At the beginning and end of the study, LDL was isolated from the patients' blood samples, and the researchers induced oxidation under controlled laboratory conditions that are believed to mimic those occurring in our arteries. With placebo, the amount of LDL oxidation increased slightly (7.9%), whereas it decreased significantly with policosanol: treatment with 5 mg/day and 10 mg/day of policosanol led to reductions of 12.4% and 32.2%, respectively. In addition, the oxidation products accumulated faster in the control group than in the treatment groups. Thus, not only is more LDL oxidized in the absence of policosanol, it also occurs at a faster rate.

These results indicate that policosanol acts as an antioxidant in the laboratory and may perform the same function in the bloodstream to reduce the level of oxidized LDL, a result that could significantly decrease the risk of atherosclerosis.* And since atherosclerosis leads to CHD, even a small change in LDL levels is something to get excited about. Data compiled by the long-running Framingham Heart Study suggest that for every 1% drop in total cholesterol level, there is a 2% drop in the risk of fatal or nonfatal heart attack.3

*Atherosclerosis is a special type of arteriosclerosis (a thickening and hardening of the arteries that often occurs as we grow older). Atherosclerotic plaque consists not just of cholesterol but also of other fatty substances and cellular waste products, which in time attract calcium deposits as well. The buildup of plaque reduces blood flow to important organs, such as the heart, brain, kidneys, and genitals, with consequences that range from annoying to fatal.

Many medical researchers today believe that the best predictor of future cardiovascular disease is not the total amount of cholesterol in the blood, nor even the amount of LDL (bad cholesterol) in the blood. Rather, they believe that the ratio between LDL and HDL is the best indicator of future problems. The lower the LDL/HDL ratio, the better the chance of enjoying good cardiovascular health; ideally, it should be less than 3.5. The way to reduce this ratio, of course, is to decrease your LDL level or increase your HDL level, or both.

Recently, much medical research has been conducted on the lipid-lowering benefits of policosanol in individuals with high LDL levels. In addition to comparing policosanol and fluvastatin in the study described above, direct head-to-head trials have been performed with lovastatin, pravastatin, and simvastatin as well. In all cases, policosanol performed as well as, or better than, these high-priced prescription drugs.

Direct head-to-head trials have
been performed with lovastatin,
pravastatin,and simvastatin. In
all cases, policosanol performed
as well as, or better than, these
high-priced prescription drugs.

For example, when policosanol was compared to simvastatin, the LDL/HDL ratio decreased by 15.4% with policosanol and by 16.6% with simvastatin.4 In a comparison with lovastatin, the difference was more pronounced: policosanol reduced the LDL/HDL ratio by 23.7%, but lovastatin reduced it by only 14.9%.5 The results with pravastatin were also impressive: policosanol reduced LDL/HDL by 28.3%, but pravastatin reduced it by only 18.9%.6 Finally, policosanol outperformed fluvastatin as well: policosanol reduced LDL/HDL by 39.8 %, whereas fluvastatin reduced it by 28.4%.1 In all four studies, policosanol was administered at 10 mg/day; simvastatin and pravastatin were administered at 10 mg/day, and lovastatin and fluvastatin at 20 mg/day. All the studies were conducted for 8 weeks except the lovastatin study, which ran for 12 weeks.

Lipid Oxidation vs. Peroxidation

In the context of cholesterol and the role it plays in the development of atherosclerosis, one often sees the term "lipid peroxidation" rather than "lipid oxidation." This can be confusing. So, what is peroxidation, and how does it differ from plain old oxidation? Peroxidation is just oxidation that produces compounds called peroxides - in this case, organic peroxides, which have a characteristic, unstable molecular structure that causes them to react to form other, more stable oxidation products. The initial process is often triggered by free radicals - molecules that have an unpaired electron, which makes them highly reactive and usually harmful to our health.

Thus, peroxidation is simply a special case of oxidation, and for all practical purposes, the two terms are equivalent where lipids are concerned. "Plain old" oxidation, by the way, is a chemical process that occurs in many different ways (many of which do not involve oxygen at all!) and that produces many different kinds of products - some harmful, some beneficial. The technicalities are of little concern except to chemists. But now you know a little bit about it.

Don't be concerned that the reduction achieved with policosanol treatment was different in each of these trials. Although researchers try to control each experiment as much as possible by administering the same dose of policosanol over the same time period, the studies are bound to differ in some ways. For example, the overall patient profiles may vary in terms such as age range, genetic background, cholesterol levels, lifestyle choices (diet, exercise, smoking, drinking), and medical history. All such factors can influence the manner in which the patients respond to policosanol treatment - or any treatment. More important than a comparison of policosanol between studies is how policosanol performed within each study in comparison with a statin drug being administered in the same way. Those results speak for themselves.

As you can see, research continues to roll in regarding the benefits of policosanol in lowering LDL levels and raising HDL levels.

In 1998 (the latest year for which statistics are available), coronary heart disease was the leading cause of death in the United States, accounting for 459,841 fatalities.7 Many of these deaths could undoubtedly have been prevented by wise lifestyle choices (increased exercise, healthy eating, not smoking) and by improving the LDL/HDL ratio in the blood. Recently, an Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults made just these recommendations for reducing the risk of heart disease in the United States.8 Make sure you do your part to ensure that heart disease doesn't claim you as one of its victims.


  1. Fernandez JC, Mas R, Castano G, et al. Comparison of the efficacy, safety and tolerability of policosanol versus fluvastatin in elderly hypercholesterolaemic women. Clin Drug Invest 2001;21:103-13.
  2. Menendez R, Mas R, Amor AMA, et al. 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;50:255-62.
  3. Wilson PWF, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation 1998;97:1837-47.
  4. Ortensi G, Gladstein J, Valli H, Tesone PA. A comparative study of policosanol versus simvastatin in elderly patients with hypercholesterolemia. Curr Ther Res 1997;58:390-401.
  5. Crespo N, Illnait J, Max R, et al. Comparative study of the efficacy and tolerability of policosanol and lovastatin in patients with hypercholesterolemia and noninsulin-dependent diabetes mellitus. Int J Clin Pharm Res 1999;19:117-27.
  6. Castona G, Mas R, Arruzazabala M, et al. Effects of policosanol and pravastatin on lipid profile, platelet aggregation and endothelemia in older hypercholesterolemic patients. Int J Clin Pharm Res 1999;19:105-16.
  7. American Heart Association. www.americanheart.org/Heart_and_Stroke_A_Z_Guide/cvds.html.
  8. Expert Panel. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). J Am Med Assoc 2001;285:2486-96.

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