Statin Alternatives

Statins are the gold standard medicines for lowering cholesterol. Many have been available for over 30 years and have been extensively tested and studied. For several years, the most commonly prescribed medicine in the entire world was Lipitor (a statin). This is because they are very effective and generally safe.

High cholesterol can cause plaques to develop in blood vessels, like the coronary arteries of the heart. Lowering one’s cholesterol levels can help prevent heart attacks and strokes. Statins are often used to prevent these events. Statin medicines are almost always part of the treatment plan for common conditions, like diabetes and heart disease.

A healthy diet and regular exercise should always be part of the prevention and treatment for many diseases. High cholesterol, however, is a very genetically-programmed condition. Thus, non-drug treatment often is not enough to lower cholesterol to a safer level. Statins are the first line, most tested, and trusted class of medicines to treat high cholesterol.

Fears that statins cause liver or muscle damage, as well as have links to dementia, are over-hyped. There are even studies that suggest statins can help prevent some kinds of dementia.

Most statin side effects are mild and resolve as soon as the medicine is stopped. Generally, if a statin is recommended, it is because the risk of complications from not taking one is higher the potential risk from taking one. Your doctor can explain why.

Clinicians will monitor their statin-taking patient appropriately and adjust treatment as needed. The vast majority of patients who take statins have no side effects. But, there are some people who just cannot take statins. For them, there are alternatives. See list further below:

If you have any questions or would like more information, leave a note in the comments

Ezetimibe (Zetia)
– Script required? Yes
– Ability to lower cholesterol? Low
– Weak substitute to statins
Bile Acid Sequestrants
– Script required? Yes
– Ability to lower cholesterol? Very Low
– Constipating. Used as diarrhea medicine
PCSK9 Inhibitors (Praluent, Repatha)
– Script required? Yes
– Ability to lower cholesterol? Very high
– Very expensive. Injectable. Not first choice for cholesterol lowering
Bempedoic Acid (Nexletol)
– Script required? Yes
– Ability to lower cholesterol? High
– Less muscle-related side effects than statins. New.
Niacin (Vitamin B3)
– Script required? Some
– Ability to lower cholesterol? Low
– Can raise “good “cholesterol; risk of flushing, liver issues
Red Yeast Rice
– Script required? No
– Ability to lower cholesterol? Medium
– “Natural statin” not regulated; similar risks to statins
Plant Sterols/Stanols
– Script required? No
– Ability to lower cholesterol? Low
– Often added to fortified foods
Soluble Fiber
– Script required? No
– Ability to lower cholesterol? Low
– Found in oats, psyllium, legumes, fruits
Omega-3 Fatty Acids (Vascepa) Fiber
– Script required? No
– Ability to lower cholesterol? Low
– Found in fish oil, flaxseed; prescription forms