You Can - and Ought to - Lower Your Cholesterol

Policosanol Gets the Job Done

You Can - and Ought to - Lower Your Cholesterol
The payoff from more aggressive efforts is a longer, healthier life
By Will Block

ou’re in your cardiologist’s office for a regular checkup, because you had some warning signs of heart problems last year, and your risk factors need to be controlled. You know what they are: your weight, your blood pressure, your cholesterol levels, your inadequate exercise, etc. The doctor enters the examination room. After the initial pleasantries, he opens your file and checks the weight and blood pressure figures just recorded by the technician. They’re both good—lower than on the last visit. He’s pleased, and says so. You feel a slight flush of pride, because your efforts to improve your cardiovascular health seem to be paying off.

Then he checks the results from your most recent lab tests: lipid panel, liver function, glucose tolerance, etc. He reviews the data—and frowns. Uh-oh, that can’t be good. Your heart (which is why you’re there in the first place) sinks a little. You know you’re not going to like what he says next, and you brace yourself. He looks you straight in the eye and says, “I’m concerned about your LDL-cholesterol level—it’s too low.”

Low Cholesterol Is No Joke

What? Too low? Is this some kind of joke? You mentally check the calendar, and today is not April 1. What’s up, doc? He says it’s no joke, and proceeds to explain. He starts by congratulating you for having done such a good job—“fantastic” is the word—at getting your cholesterol levels down: total cholesterol 109 mg/dL (milligrams per deciliter) and LDL-cholesterol 44 mg/dL.* The latter is commonly called “bad cholesterol” because it’s particularly harmful when there’s too much of it—as is the case with most people in our overfed and underexercised society.


*Doctors consider values of less than 200 mg/dL for total cholesterol, and less than 100 mg/dL for LDL-cholesterol, to be desirable for high-risk patients.


In your case, however, the doctor says there may be too little LDL-cholesterol in your bloodstream for optimal health, and your level ought to be raised somewhat. Cholesterol is, after all, essential for life, because it serves as a component of your cell membranes and as the ultimate steroid precursor for your sex hormones, adrenocortical hormones, and bile acids. Most of your cholesterol comes from your liver, which normally produces about 600 mg of it daily.

Life Is Unfair—But It’s Life

Anyhow, you feel pretty pleased with yourself for having a cholesterol “problem” such as this. Obviously (to you) it’s the result of your having successfully resisted the siren calls of sugar and fat for the past year. You start fantasizing about all the cheeseburgers and ice cream you’ll now have to eat to get those darned cholesterol levels back up to where they belong.

Fat chance! Your killjoy doctor says that the obvious remedy for your unusual problem is to reduce the dosage of the cholesterol-lowering drug—atorvastatin—he had prescribed for you last year. Get this: he actually believes that it was more the drug than it was your saintlike devotion to dietary deprivation that had done the trick. And he reminds you that good diet and regular exercise will always be vitally important for your health, no matter what. Your little bubble bursts. Life is so unfair! But hey—life is, after all, life, which beats the alternative any day.

Aggressiveness Pays

Stories such as the one above are true. Although few people get to experience this odd situation, it illustrates that cholesterol levels can be reduced dramatically—and not just with statin drugs, but also with nutritional supplements such as policosanol. For most people with cardiovascular risk factors (one of which is, of course, high cholesterol), aggressive cholesterol reduction is a very good thing.

Just how good a thing it is has become clearer than ever recently, with the publication of five major studies on statins, reviewed in a recent issue of Circulation.1 Two of these studies2,3 were discussed recently in Life Enhancement (“Got Cholesterol? Lower It!” and “A Sea Change in Cholesterol Thinking,” in the May and June 2004 issues, respectively). In case you missed them, following is a synopsis.

British Study: Starting Point Doesn’t Matter

A British research group studied the effects of cholesterol-lowering therapy—40 mg/day of simvastatin (Zocor®) for 5 years—on cardiovascular risk factors in 20,536 men and women at high risk for a cardiovascular disease-related event, such as unstable angina pectoris, heart attack, or death.2 The results showed—with extremely high statistical significance—that, compared with placebo, the drug reduced the overall event rate from all vascular causes by 24%. Further analysis indicated that, with perfect patient compliance throughout the 5-year period (an unrealistic prospect in such a large study), the reduction in the event rate would have been about one-third rather than one-fourth.

The researchers came to the startling conclusion that the cardiovascular health benefits of this therapy did not depend on the patients’ initial cholesterol levels. In other words, the benefits were essentially the same whether their cholesterol levels were initially high, normal, or low! Furthermore, the results showed that the benefits applied similarly to all the participants in the study, regardless of their sex, age, or disease status. The authors described the evidence as “unequivocal.”

International Study: Intensive Therapy Is Better

In a major breakthrough, an international research team has discovered that intensive, high-dosage therapy with cholesterol-lowering drugs produces much greater benefits in cardiac patients (there were 4162 in this study) than those achieved with standard, normal-dosage therapy.3 Half the patients were given a standard therapy, 40 mg/day of pravastatin (Pravachol®), while the other half were given an intensive therapy, 80 mg/day of atorvastatin (Lipitor®).

Within 1 month, the standard therapy produced a 10% drop in LDL-cholesterol levels, whereas the intensive therapy produced a 42% drop. Even more impressive, however, was the dramatic improvement, within 2 years, in the patients’ long-term prospects for staying alive and healthy as a result of the intensive therapy. By comparison with the standard therapy (which is itself very effective in reducing cardiovascular risk factors), the intensive therapy produced a 16% reduction in the overall risk for a major cardiac event or death from any cause.

Better Walking with Policosanol

Intermittent claudication (IC) sounds like some kind of weird weather forecast, but it’s just a fancy way of saying “painful walking.” It results not from a torn muscle or ligament, but from something much more serious: peripheral arterial disease (PAD), which is usually the result of atherosclerotic plaque deposits in the arteries of the legs (the disease is common in diabetics). These deposits obstruct blood flow, sometimes so severely that the demands of the leg-muscle cells for increased oxygen and glucose during exercise, such as walking, cannot be met. The cells complain by crying “pain” to the brain (hmm, perhaps there’s a tune that line could be sung to …).

The pain usually occurs in the calves and is typically described as being like muscle cramps or fatigue. Upon starting a walk, a patient with IC can go a certain distance (which depends on the severity of the condition) before the pain sets in, and a somewhat greater distance before it becomes disabling. When the patient stops walking, the pain subsides within a few minutes; but soon after the walking resumes, so does the pain.

Intermittent claudication affects about 12% of the adult population. One avenue for treating this condition is with agents that inhibit platelet aggregation, a process involved in the formation of blood clots. Such clots often become incorporated into plaque deposits (thereby worsening the obstruction of blood flow) and can be very dangerous if they break free. Policosanol, a powerful natural anticholesterol agent, has significant antiplatelet activity (i.e., it’s a kind of anticoagulant) and is therefore potentially effective for treating IC.

Researchers in Cuba recently studied the effects of policosanol (10 mg twice daily) vs. those of an antiplatelet drug, ticlopidine (250 mg twice daily), which has been used for treating IC.1* In a randomized, double-blind, placebo-controlled pilot study, they measured the improvements in walking distances in 28 IC patients (average age 60) over a 20-week period. The results showed that policosanol was as effective as ticlopidine: both agents increased the walking distances by about 60%.


*Ticlopidine is not commonly used anymore, however, owing to the widespread use of a newer antiplatelet drug, clopidogrel. Other types of drugs, such as vasodilators, are also used in treating IC.


In addition, policosanol produced a modest but significant improvement (+9%) in the ankle/arm blood pressure ratio, which is a measure of the severity of the disease, whereas ticlopidine did not (–3%). Furthermore, whereas ticlopidine had no effect on the patients’ cholesterol levels, policosanol produced the significant improvements that are characteristic of this remarkable supplement. Total cholesterol was reduced by 17%; LDL-cholesterol (“bad cholesterol”) was reduced by 30%; and HDL-cholesterol (“good cholesterol”) was increased by 32%. The important ratio of total cholesterol to HDL-cholesterol was reduced (i.e., improved) by 34%.

Such improvements in cholesterol levels are important in the long run because atherosclerosis is the principal cause of PAD (smoking is another major cause). Numerous studies have shown that policosanol is often equivalent, and sometimes superior, to the widely prescribed statin drugs for cholesterol reduction. A previous study on IC patients by the Cuban research team showed that policosanol was equivalent to lovastatin in reducing cholesterol levels, and it was much better in improving walking distancesmainly because of its antiplatelet activity, which the statins do not possess.2 (For a broader discussion of intermittent claudication and policosanol’s role in treating it, see “Policosanol Helps with Painful Walking” in the August 2003 issue.)

  1. Castaño G, Más R, Gámez R, Fernández L, Illnait J. Effects of policosanol and ticlopidine in patients with intermittent claudication: a double-blinded pilot comparative study. Angiology 2004;55(4):361-71.
  2. Castaño G, Más R, Fernández L, Gámez R, Illnait J. Effects of policosanol and lovastatin in patients with intermittent claudication: a double-blind comparative pilot study. Angiology 2003;54:25-38.

As in the British study, the benefits of the intensive therapy were strikingly consistent throughout the study population: the results were largely independent of the patients’ sex or age, the nature of their heart condition, their initial cholesterol levels, their prior history of statin use, and whether or not they had diabetes or had been smokers.

Set Your Goals Low

These studies, and three others discussed in the Circulation paper, have sharpened the medical profession’s focus on cholesterol-lowering therapy, especially for LDL-cholesterol. Although the goal for high-risk individuals is still “officially” less than 100 mg/dL, a more aggressive goal of less than 70 is recommended as a therapeutic option—one that seems to be increasingly favored by doctors. For individuals at moderate risk, the goal is less than 130 mg/dL, with a therapeutic option of less than 100. And for those fortunate few (among older people) who are at low risk, the goal is less than 160 mg/dL, period.

Even if these goals may not be achievable in every case, it is currently recommended that, for high-risk and moderate-risk individuals, the therapeutic intensity be sufficient to reduce LDL-cholesterol levels by at least 30–40%. Doctors also strongly recommend TLC (which in this case means therapeutic lifestyle changes, but the traditional kind couldn’t hurt), especially when the patient has risk factors such as obesity or inadequate exercise.

Policosanol—A Good Alternative to Statins

For cholesterol reduction, the statin drugs, as effective as they are, are not the only game in town—which is a good thing, because they’re very expensive. Far less costly, yet also highly effective, is the natural nutritional supplement policosanol, a sugar-cane extract that has been found in numerous studies to rival—and sometimes exceed—the statins in its ability to reduce total cholesterol and LDL-cholesterol levels (as well as triglycerides), while substantially increasing levels of HDL-cholesterol (“good cholesterol”).* These studies have shown that the optimal amount of policosanol is 20 mg/day and that this amount is very safe to use, with virtually no adverse effects. (Policosanol is not a sugar, by the way, and has no effect on blood sugar levels.)


*Some recent Life Enhancement articles on policosanol’s role in heart health include: “Policosanol—Nature’s Remedy for High Cholesterol” (February 2002), “Policosanol—A Better Alternative to Statin Drugs” (May 2002), “Policosanol Improves Every Measure of Blood Cholesterol” (October 2002), “Policosanol Keeps Your Arteries Healthy” (November 2002), “Policosanol Improves Cardiovascular Health” (December 2002), and “Our Cholesterol Levels Are Still Too High” (October 2003).


Music to Your Ears

The authors of the British study outlined above had this to say about their findings:2

. . . these findings suggest that, other things being equal, a downward shift of the whole LDL-cholesterol distribution typically found in Western populations would lead to reductions in the incidence of vascular disease (and there was no evidence in the present trial that such a change would be associated with any material adverse effects).

Considering the great health rewards that are attainable through cholesterol reduction, with virtually no risk attached, one would almost have to be crazy not to go for it. You may never hear your doctor say that your cholesterol levels are too low, but wouldn’t it be nice if he said they were good and low? That could happen—it’s up to you.

References

  1. Grundy SM, Cleeman JI, Merz CNB, Brewer HB Jr, Clark LT, Hunninghake DB, Pasternak RC, Smith SC Jr, Stone NJ, for the Coordinating Committee of the National Cholesterol Education Program. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004;110:227-39.
  2. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet 2002; 360(9326):7-22.
  3. Cannon CP, Braunwald E, McCabe CH, Rader DJ, Rouleau JL, Belder R, Joyal SV, Hill KA, Pfeffer MA, Skene AM, for the Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction 22 Investigators. Comparison of intensive and moderate lipid lowering with statins after acute coronary syndromes. New Engl J Med 2004;350:1495-1504.


Will Block is the publisher and editorial director of Life Enhancement magazine.

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