Cholesterol, High Cholesterol

Policosanol Adverse Reactions and Interactions:

• Policosanol was better tolerated that lovastatin with fewer adverse effects (106).
• Policosanol at a dose of 10 mg per day reduced fibrinogen levels about 10% after 10 weeks and about 20% after 20 weeks, but remained well above a normal range of 200 mg/dL and did not fall out of normal range (107).
• Policosanol at a dose of 10 mg per day did not significantly inhibit platelet aggregation until policosanol was increased to 20 mg daily. Once the dose was doubled to 40 mg daily, platelet aggregation was greatly reduced. Policosanol did not affect the time for blood coagulation to occur during several dose increases, even at a dose of 40 mg per day for 4 weeks (107).
• Patients should not take policosanol 2 weeks prior to surgery, avoid if history of bleeding disorder or fibrinogen deficiency.
• Policosanol may increase risk of bleeding when used with aspirin, NSAIDs, warfarin, or heparin. Monitoring by a physician should be considered with a coagulation profile and fibrinogen.
• According to Castano et al, Policosanol, 5 mg oral once per day has been determined safe in elderly patients also taking multiple medications including beta-blockers for 3 years and there is no expected p-450 interactions (108).
• Caution in patients taking blood pressure medications as policosanol may have additive effects of lowering blodd pressure. Policosanol has demonstrated reduction in systolic and diastolic blood pressure additive to beta-blockers (108).

Vitamin D, hyperlipidemia, and diabetes mellitus:

Maintain favorable levels of vitamin D in all patients with not only hyperlipidemia, but in all patients with any risk factors for cardiovascular disease. Vitamin D is not established as a direct cause of cardiovascular disease, but vitamin D deficiency is associated with a higher incidence of hypertension, hyperlipidemia, coronary artery disease, stroke, chronic kidney disease, and diabetes mellitus type 2 (109). A retrospective analysis showed that patients with diabetes mellitus have a very low 25-hydroxy vitamin D level, and also found that high levels of triglycerides, LDL cholesterol, and HbA1C had a consistent association with vitamin D deficiency in type 2 diabetes patients (110). Please see the section on vitamin D for further information.