Turning a controversial plant into a health asset: Policy options for harnessing Catha edulis against hyperlipidemia

Résumé

Cardiovascular diseases driven by hyperlipidemia are leading causes of death globally, with low- and middle-income countries carrying a disproportionate burden. Although statins continue to be the cornerstone of cholesterol therapy, unmet demands are sustained by cost, intolerance, and residual risk, especially in sub-Saharan Africa. When made as standardized extracts, Catha edulis, which has long been controversial due to its psychotropic alkaloids, is being explored more and more for its effects on metabolism. Improvements in lipid profiles (decreased low density lipoprotein-cholesterol and triglycerides, and increased high density lipoprotein-cholesterol), regulation of adipokines (decreased leptin and increased adiponectin) in high-fat diet animals are reported in preclinical study with lyophilized leaf extract. Gas chromatography–mass spectrometry and molecular docking implicate non-alkaloid phytochemicals that bind lipid-regulating targets, showing statin-like interactions with HMG-CoA Reductase. However, regular khat chewing is also linked to hepatic and cardiovascular problems in clinical and case-series research, highlighting an important difference between recreational exposures and regulated, standardized medication formulations. Standardization of extract manufacturing, regulatory pathways that distinguish medicinal from recreational use, ethically sound clinical trials, pharmacovigilance, and culturally sensitive communication are some of the policy options for African health systems that are outlined in this brief, which also summarizes the scientific evidence and clarifies the risks and benefits. With strict protections, Catha edulis may transform from a public health risk to a focused adjuvant in the treatment of dyslipidemia, particularly in areas where access to cutting-edge lipid-lowering medications is still a problem.

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