policosanol: updating and perspectives

Abstract Different mixtures of higher aliphatic alcohols are on the market under the name “policosanol” claiming, without the support of independent data, the therapeutic efficacy and tolerability that former studies had demonstrated for the original policosanol. This name originally referred to a mixture of eight higher aliphatic primary alcohols obtained at the beginning of the 1990s from sugar-cane wax, and patented by Cuban researchers for its ability to lower blood cholesterol, and its antiplatelet and antioxidant properties. Analysis by GC-MS shows qualitative/ quantitative differences in policosanol-like preparations from different plant sources and origins. The anticholesterolaemic activity and some desirable pleiotropic effects (decreased platelet aggregation, LDL oxidation, thromboxane production and foam-cell production) of the original policosanol have been confirmed by more than 50 clinical studies. However these results have recently been questioned by a few authors who have reported a modest or negligible activity of policosanol, whether from sugar cane or from other plant sources. A review of this important issue is therefore in order. Although the mechanism involved in the anticholesterolaemic effect has not been fully elucidated, there is clear evidence that policosanol induces AMP kinase phosphorylation and inhibits HMG-CoA reductase