Meta-analysis of natural therapies for hyperlipidemia: plant sterols

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Meta-analysis of natural therapies for hyperlipidemia: plant sterols

and stanols versus policosanol.

 

Author:

 

Chen JT, Wesley R, Shamburek RD, Pucino F, Csako G.

 

Source:

 

Pharmacotherapy. 2005 Feb;25(2):171-83.

http://www.enzy.com/abstracts/display.asp?id=4515

Abstract:

 

Pharmacotherapy. 2005 Feb;25(2):171-83. Related Articles, Links Meta-

analysis of natural therapies for hyperlipidemia: plant sterols and

stanols versus policosanol.

 

Chen JT, Wesley R, Shamburek RD, Pucino

F, Csako G. School of Pharmacy and Pharmacal Sciences, Purdue

University, West Lafayette, Indiana 47907-2091, USA.

jtchen

 

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.