Meta-analysis of natural therapies for hyperlipidemia: plant sterols and stanols versus policosanol.

Abstract

STUDY OBJECTIVE:

To compare the efficacy and safety of plant sterols and stanols as well as policosanol in the treatment of coronary heart disease, as measured by a reduction in low-density lipoprotein cholesterol (LDL) levels.

DESIGN:

Systematic review and meta-analysis of randomized controlled trials.

PATIENTS:

A total of 4596 patients from 52 eligible studies.

MEASUREMENTS AND MAIN RESULTS:

We searched MEDLINE, EMBASE, the Web of Science, and the Cochrane Library from January 1967-June 2003 to identify pertinent studies. Reduction of LDL levels was the primary end point; effects on other lipid parameters and withdrawal of study patients due to adverse effects were the secondary end points. Weighted estimates of percent change in LDL were -11.0% for plant sterol and stanol esters 3.4 g/day (range 2-9 g/day [893 patients]) versus -2.3% for placebo (769 patients) in 23 eligible studies, compared with -23.7% for policosanol 12 mg/day (range 5-40 mg/day [1528 patients]) versus -0.11% for placebo (1406 patients) in 29 eligible studies. Cumulative p values were significantly different from placebo for both (p<0.0001). The net LDL reduction in the treatment groups minus that in the placebo groups was greater with policosanol than plant sterols and stanols (-24% versus -10%, p<0.0001). Policosanol also affected total cholesterol, high-density lipoprotein cholesterol (HDL), and triglyceride levels more favorably than plant sterols and stanols. Policosanol caused a clinically significant decrease in the LDL:HDL ratio. Pooled withdrawal rate due to adverse effects and combined relative risk for patients who withdrew were 0% and 0.84, respectively (95% confidence interval [CI] 0.36-1.95, p=0.69), for plant sterols and stanols across 20 studies versus 0.86% and 0.31, respectively (95% CI 0.20-0.48, p<0.0001), for policosanol across 28 studies.

CONCLUSION:

Plant sterols and stanols and policosanol are well tolerated and safe; however, policosanol is more effective than plant sterols and stanols for LDL level reduction and more favorably alters the lipid profile, approaching antilipemic drug efficacy.

• Authors: Judy T Chen, Robert Wesley, Robert D Shamburek, Frank Pucino, Gyorgy Csako
• Journal: Pharmacotherapy (Pharmacotherapy) Vol. 25 Issue 2 Pg. 171-83 (Feb 2005) ISSN: 0277-0008 [Print] United States
• PMID: 15767233 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)

Chemical References

• Anticholesteremic Agents
• Fatty Alcohols
• Phytosterols
• Sitosterols
• plant stanol ester
• policosanol

Topics

• Anticholesteremic Agents (therapeutic use)
• Coronary Disease (drug therapy)
• Fatty Alcohols (therapeutic use)
• Humans
• Hyperlipidemias (drug therapy)
• Phytosterols (therapeutic use)
• Randomized Controlled Trials as Topic
• Sitosterols (therapeutic use)