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Long-term therapy with policosanol improves treadmill exercise-ECG testing performance of coronary heart disease
Insights
Policosanol therapy, especially with aspirin, improved coronary heart disease (CHD) patient outcomes by reducing cardiac events and ischemia. Patients showed better exercise capacity and fewer symptoms, unlike the placebo group.
Area of Science:
- Cardiology
- Pharmacology
- Exercise Physiology
Background:
- Coronary heart disease (CHD) poses a significant health burden, necessitating effective long-term management strategies.
- Myocardial ischemia is a key complication in CHD, often assessed through exercise testing and perfusion scintigraphy.
- Lipid-lowering therapies are crucial for managing CHD, with ongoing research into novel agents like policosanol.
Purpose of the Study:
- To evaluate the long-term effects of policosanol on clinical outcomes and exercise-ECG responses in CHD patients with myocardial ischemia.
- To compare the efficacy of policosanol alone and in combination with aspirin against a placebo in this patient cohort.
Main Methods:
- A 20-month randomized, double-blind, placebo-controlled trial involving 45 CHD patients with documented myocardial ischemia.
- Patients received policosanol (5 mg twice daily), policosanol plus aspirin (125 mg), or placebo plus aspirin.
- Outcome measures included clinical evolution, treadmill exercise-ECG, myocardial perfusion scintigraphy, serum lipid levels, and cardiac events.
Main Results:
- Policosanol groups showed improved functional capacity, reduced angina, and fewer cardiac events compared to placebo.
- The combination of policosanol and aspirin demonstrated particularly significant reductions in ischemic ST segment response (p=0.04) and cardiac events (p=0.02).
- Policosanol treatment led to increased maximum oxygen uptake and decreased double product, indicating improved aerobic capacity and reduced cardiac workload, while the placebo group showed impairment.
Conclusions:
- Long-term policosanol therapy, particularly when combined with aspirin, significantly improves clinical outcomes and exercise-ECG responses in coronary heart disease patients.
- Policosanol effectively ameliorates myocardial ischemia, leading to enhanced aerobic functional capacity and reduced cardiac events.
- The study did not detect an ergogenic effect of octacosanol, policosanol's primary component, under the tested conditions.
Abstract:
This study examined the effects of long-term lipid-lowering therapy with policosanol on the clinical evolution, and exercise-ECG testing responses of 45 coronary heart disease (CHD) patients with myocardial ischemia, documented by exercise 201T1-myocardial perfusion scintigraphy, in an overall randomized, double-blind, placebo-controlled trial, made for different test endpoints. Fifteen patients were treated with 5 mg of policosanol twice daily; another 15 patients were administered the same drug dose plus 125 mg aspirin; and the other 15 patients received placebo plus equal aspirin dose. They were followed for 20 months, previous baseline observations, with treadmill exercise-ECG, besides serum lipid test. Beneficial changes on proportions among the 2 policosanol groups and the placebo group, showed an increment on functional capacity class, a decrement on rest and exercise angina, and a significant decrease in cardiac events, and in ischemic ST segment response, especially in the policosanol plus aspirin group (p = 0.05, X2(2df) = 5.8; p = 0.04, p = 0.02; Fisher). After treatment, sets of mean changes revealed an increase on maximum oxygen uptake, and a decline on double product simultaneously in both policosanol groups (p < or = 0.02, p < or = 0.002; Pillais, Hotellings' T2), while the placebo group was impaired. Aerobic functional capacity percent showed an increment in policosanol groups (p < or = 0.05, paired T). Lipid levels improved as other endpoints already reported. A supposed ergogenic effect of octacosanol, policosanol's main active compound, was not detected with this design. These results show that policosanol-treated CHD patients improved clinical evolution, and exercise-ECG responses, owing to the amelioration of myocardial ischemia, even more when administered with aspirin.