Evidence Level
Policosanol is a mixture of long-chain alcohols derived from sugar cane and has been studied for its potential effects on lipid metabolism, blood pressure, and other health parameters. The evidence base surrounding policosanol is marked by significant controversy, particularly regarding its cholesterol-lowering effects. Cuban studies (Mas et al., 1999; Gouni-Berthold & Berthold, 2002) reported substantial reductions in LDL cholesterol (20-30%), but these findings have not been consistently replicated in independent trials. For instance, a German randomized controlled trial (RCT) by Berthold et al. (2006) involving 143 participants found no significant effect of Cuban-sourced policosanol on lipid parameters, directly contradicting the earlier positive results.
The Cochrane Database has highlighted concerns about publication bias and methodological issues in the body of research, noting that nearly all positive studies originate from a single Cuban research group. Despite this, recent systematic reviews and meta-analyses have explored other potential benefits of policosanol. For example, Askarpour et al. (2019) found that policosanol supplementation significantly lowers systolic (-3.42 mmHg, p<0.001) and diastolic (-1.47 mmHg, p=0.013) blood pressure in a meta-analysis of 19 RCTs. Additionally, Gholamrezayi et al. (2024) reported that policosanol supplementation significantly reduced ALT (-1.48 U/L, P=0.001) and AST (-1.10 U/L, P<0.001) levels in a systematic review of 23 RCTs.
However, other studies have found no significant effects on certain parameters. Amini et al. (2025) conducted a systematic review and meta-analysis of 21 RCTs involving 2427 participants and found no significant effect of policosanol supplementation on serum creatinine levels (WMD = 0.21 µmol/l; P = 0.70). Despite these mixed findings, policosanol is generally considered safe for use. While it may offer benefits beyond cholesterol management, its efficacy for lipid lowering remains uncertain and requires further investigation in independent, rigorously designed trials.