title: Meta-analysis of natural therapies for hyperlipidemia: plant sterols and stanols versus policosanol.
abstract: 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.
  
  
  METHODS
  Systematic review and meta-analysis of randomized controlled trials.
  
  
  METHODS
  A total of 4596 patients from 52 eligible studies.
  
  
  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.
  
  
  CONCLUSIONS
  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.affiliation: School of Pharmacy and Pharmacal Sciences, Purdue University, West Lafayette, Indiana 47907-2091, USA. jtchen@pharmacy.purdue.edu
authors.forename: Judy T
authors.initials: JT
authors.lastname: Chen
authors.forename: Robert
authors.initials: R
authors.lastname: Wesley
authors.forename: Robert D
authors.initials: RD
authors.lastname: Shamburek
authors.forename: Frank
authors.initials: F
authors.lastname: Pucino
authors.forename: Gyorgy
authors.initials: G
authors.lastname: Csako
mesh_terms: D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D003327:Coronary Disease / Q000188:drug therapy*; D005233:Fatty Alcohols / Q000627:therapeutic use*; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy*; D010840:Phytosterols / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012855:Sitosterols / Q000627:therapeutic use*
chemical_list: D000924:Anticholesteremic Agents; D005233:Fatty Alcohols; D010840:Phytosterols; D012855:Sitosterols; C407042:plant stanol ester; C080710:policosanol