Effects of Policosanol and Lovastatin in Patients with Intermittent Claudication: A Double-Blind Comparative Pilot Study

Abstract

Policosanol is a cholesterol-lowering drug with concomitant antiplatelet effects. The present study was undertaken to compare the effects of policosanol and lovastatin on patients with moderately severe intermittent claudication. The study had a 4-week baseline step, followed by a 20-week double blinded, randomized treatment period. Twenty-eight patients who met study entry criteria were randomized to policosanol 10 mg or lovastatin 20 mg tablets once daily. Walking distances in a treadmill (constant speed 3.2 km/hr, slope 10°, temperature 25°C) were assessed before and after 20 weeks of treatment. Both groups were similar at random ization. Compared with baseline, policosanol increased significantly (p<0.01) the initial claudi cation distance (ICD) from 160.39 ±15.82 m to 211.31 ±21.48 m (+33.7%) and the absolute claudication distance (ACD) (p<0.001) from 236.39 ±25.44 m to 288.09 ±28.47 m (+24.3%); meanwhile both variables remained unchanged after lovastatin therapy. Changes in ICD and ACD were significantly larger in the policosanol than in the lovastatin group (p<0.01). Policosanol, but not lovastatin, significantly increased (p < 0.05) the ankle/arm index, although between-group differences were not significant. The frequency of patients reporting improve ment on quality of life domains was greater in the policosanol than in the lovastatin group. Policosanol significantly (p< 0.00 1 ) lowered total cholesterol (TC) and low-density lipoprotein- cholesterol (LDL-C) by 17.5% and 31.0%, respectively, and meanwhile increased (p<0.01) high- density lipoprotein-cholesterol (HDL-C) levels by 31.5%. Lovastatin reduced (p<0.01) TC (18.0%), LDL-C (22.6%), and (p<0.05) triglycerides (9.8%). In addition, policosanol, but not lovastatin, moderately, but significantly, reduced (p < 0.05) fibrinogen levels, so that final values and percent changes in both groups were different (p<0.01). Treatments were well tolerated. Only 1 lovastatin patient withdrew from the study because of a nonfatal myocardial infarction. Five lovastatin patients, but none from the policosanol group, experienced 6 adverse events (AE) (p<0.01). The present results indicate that policosanol, but not lovastatin, is a suitable alternative to manage patients with intermittent claudication because of pleiotropic properties beyond its cholesterol-lowering effects.