A systematic review including 52 studies was abstracted in DARE. There were 23 trials on plant stanols or sterols (17 parallel trials, 1 204 participants; 6 crossover trials, 229 participants) and 29 on policosanol (2 934 participants). For plant sterols or stanols, the weighted mean change in LDL levels were greater with treatment than placebo: -11% with plant sterol or stanols versus -2.3% with placebo (p< 0.0001). Compared with placebo, treatment significantly reduced total cholesterol and the LDL:HDL ratio, but there was no effect on triglycerides. For policosanol, the weighted mean change in LDL was greater than with placebo: -23.7% with policosanol versus -0.1% with placebo (p< 0.0001). Compared with placebo, treatment significantly reduced total cholesterol and the LDL:HDL ratio, significantly increased HDL, and caused some decrease in triglycerides. In indirect comparisons, the net reductions in lipid levels were significantly greater with policosanol than with plant sterols or stanols: the differences observed were -14% in LDL, -9.1% in total cholesterol, -22.1% in LDL:HDL ratio and -10.9% in triglycerides. Tolerability with both treatments was high.
Comment: The quality of evidence is downgraded by poor reporting of the included studies.