Effects of policosanol on lipid profile and cardiac events in older hypercholesterolaemic patients with coronary disease

Objective: This study was undertaken to investigate the effects of policosa nol administered for 1 year on the lipid profile and cardiac events of olde r hypercholesterolaemic patients with coronary heart disease (CHD). Patients: 280 older patients of both sexes with type II hypercholesterolaem ia and CHD were included. Methods: Patients were randomised after 6 weeks of a standard step I choles terol-lowering diet to treatment with policosanol (5mg) or placebo tablets once daily for I year. The starting dose was 5 mg/day, which was doubled to 10 mg/day if predefined goals were not reached after 6 months on therapy. Cardiac events were defined as death from cardiovascular causes [fatal myoc ardial infarction (MI), sudden cardiac death] and nonfatal Ml, unstable ang ina pectoris or coronary surgery. Results: Policosanol significantly (p < 0.00001) lowered serum low-density lipoprotein-cholesterol (LDL-C) [21.3%], total cholesterol (TC) [15.9%], TC to high-density lipoprotein-cholesterol (HDL-C) ratio [22.7%] and LDL-C/HD L-C ratio (26.1%), as well as triglycerides (7.8%, p < 0.001). HDL-C was si gnificantly increased (18.2%, p < 0.001). The frequency of cardiac events w as lower (p < 0.001) in policosanol (1 event, 0.7%) than in placebo (11 eve nts, 7.9%) recipients. Likewise, the frequency of all vascular serious adve rse events (four events, 2.9%) and all-cause hospitalisations in the polico sanol group (five events, 3.6%) was lower (p < 0.001) than in the placebo g roup (15 and 20 events, 10.7 and 14.3%, respectively). No patient died duri ng the study. Policosanol was well tolerated. Conclusions: Long-term policosanol is effective in lowering LDL-C and TC an d in increasing HDL-C levels in older patients with CHD, and also showed be nefits in the occurrence of cardiac events and overall frequency of serious adverse events of vascular aetiology.