What Can I Take Instead of Statins to Lower Cholesterol? 7 Alternatives

Written by HaVy Ngo-Hamilton, Pharm.D.
Medically reviewed by Dr. Jyothi Shenoy | Updated Jan 22, 2024

Key Takeaways

Ezetimibe, colestipol, colesevelam, cholestyramine, fenofibrate, clofibrate, gemfibrozil, niacin, evolocumab (Repatha), alirocumab (Praluent), bempedoic acid (Nexletol), and omega-3 fatty acids are examples of cholesterol-lowering medications that are not statins.

According to the American Heart Association, high cholesterol levels are a significant risk factor for cardiovascular disease, including heart attacks and strokes. Lifestyle changes like a heart-healthy diet and exercise are the primary means to lowering high cholesterol naturally. However, when lifestyle modifications alone aren’t enough, your healthcare provider may prescribe medications. 

Statins are the most commonly prescribed medications for lowering cholesterol. However, some individuals cannot tolerate them due to side effects like muscle pain or underlying health issues, such as active liver disease. Some people can’t get to their goal cholesterol levels with statins and need a statin alternative in addition to or instead of statin. 

Many new non-statin medications have emerged as alternatives for managing high cholesterol. Read on to discover alternatives to reduce low-density lipoprotein (LDL) cholesterol (bad cholesterol) and triglycerides.

Yes, there are several other medications available to lower cholesterol without statins. Some of these medications lower your cholesterol by reducing cholesterol synthesis in the liver. Others reduce the absorption of cholesterol from the small intestine (gut). The following classes of cholesterol-lowering medications are not statins and can help in lowering LDL cholesterol and triglyceride levels in the body:

If you have medical conditions that prevent statin use or you cannot tolerate statins due to side effects, talk to your health care team about one of the above treatment options to reduce cholesterol. 

New cholesterol drugs that are not statins include the following:

The U.S. Food and Drug Administration (FDA) has approved two new drugs, evolocumab (Repatha) and alirocumab (Praluent), to help lower “bad” LDL cholesterol. They belong to a group called PCSK9 inhibitors that attach to LDL receptors and inactivate a protein in liver cells that is needed to make low-density lipoprotein (LDL). In clinical trials, PCSK9 inhibitors lowered the LDL cholesterol levels by up to 60% and reduced the risk of heart disease by 15%. 

These drugs are used to reduce low-density lipoprotein (LDL) in people with:

PCSK9 inhibitors are given by a subcutaneous (under the skin) injection in a doctor’s office or by self-injection every 2 or 4 weeks. Your care team will teach you the appropriate technique so you can administer this medication yourself. 

Possible side effects of PCSK9 inhibitors include injection site reaction (redness, soreness, swelling), flu-like symptoms (sore throat, runny nose), joint pain, and back pain.

The cost of PCSK9 inhibitors may be prohibitive for many patients, especially those without health insurance because treatment with these drugs can run into thousands of dollars each year. 

The FDA has approved an ACL inhibitor called bempedoic acid (Nexletol), which works by blocking cholesterol synthesis in the liver. A combination of bempedoic acid and ezetimibe is available under the trade name Nexlizet. 

Bempedoic acid is used, along with lifestyle changes and maximally tolerated statin therapy, to lower LDL cholesterol in adults with very high levels of cholesterol. ACL inhibitors are prescribed to people with familial hypercholesterolemia and those with heart disease who need further cholesterol lowering. 

The dose is bempedoic acid 180 mg (milligrams) by mouth once daily, taken with or without food.

Possible side effects of ACL inhibitors include upper respiratory infections, back pain, stomach pain, muscle spasms, pain in the limbs, anemia, elevated uric acid levels, and elevated liver enzymes.

Cholesterol absorption inhibitors such as ezetimibe (Zetia) and PCSK9 inhibitors such as alirocumab (Praluent) and evolocumab (Repatha) may be safer alternatives to statins if you are at a high risk of health complications from statins. 

Keep in mind that ezetimibe is not as effective as most statins. Also, while it works well when taken with a statin, it does not work well on its own to lower high cholesterol. Therefore, in many cases, ezetimibe is prescribed to be taken in addition to a statin. Additionally, ezetimibe can cause side effects such as stomach pain, diarrhea, gas, and fatigue. This medicine may not be safe for pregnant women and people with liver disease.

PCSK9 inhibitors are a new class of cholesterol-lowering drugs that are very effective in reducing the risk of cardiovascular disease in high-risk patients. They have an even better cholesterol-reducing effect when taken with a statin. 

PCSK9 inhibitors are recommended for patients who have had a heart attack or stroke and those with familial hypercholesterolemia. However, they are expensive as they are relatively new and do not have a generic version available. 

PCSK9 inhibitors can cause side effects such as flu-like symptoms and discomfort at the injection site.

Statins provide protection against coronary heart disease and are safe and well-tolerated by most people. They are the first-line treatment for lowering cholesterol. Statins have been around since the 1980s and have been studied extensively for safety and efficacy. 

Nonetheless, there continue to be discussions about the potential side effects of statins despite large and well-conducted studies showing that only a small number of people experience significant statin side effects. 

If you develop side effects such as muscle aches on statins, your doctor may suggest taking a lower dose or trying a different statin before considering other options.

If you continue to have high cholesterol levels even after taking a statin (this is more likely if you have a genetic condition called familial hypercholesterolemia), then your provider may recommend other cholesterol-lowering drugs in addition to statins or statin alternatives.

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References:

https://my.clevelandclinic.org/health/drugs/22550-pcsk9-inhibitors

https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/211616s000lbl.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9632934/

https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/statin-alternatives