Although its exact mechanism is not known, Policosanol appears to work by blocking the body's synthesis of cholesterol. Unlike statin drugs that are usually used to treat patients with elevated cholesterol levels, Policosanol does not inhibit the HMG-CoA enzyme like the "statin" cholesterol-lowering drugs, but it may inhibit a different enzyme. What makes Policosanol exciting is that it has other actions against heart disease in addition to lowering cholesterol. Like statin drugs, Policosanol helps stop the formation of artery lesions.[13] Studies of rabbits fed a diet designed to create high cholesterol confirmed the benefits of Policosanol for preventing lesions. The animals that had been treated with policosanol showed no atherosclerotic lesions.[14]

Policosanol also appears to inhibit the oxidation of LDL.[15] Oxidized LDL creates a chronic inflammatory response that promotes the destruction of blood vessels. Oxidized LDL can also provoke metalloproteinase enzymes.[16] These enzymes promote blood vessel destruction and decrease the protective effects of HDL. Animal studies have shown that Policosanol decreases number of foam cells, reflecting less inflammatory response causing less blood vessel destruction.[17], [18]