Key takeaways

  • If statins aren’t suitable, medications like sequestrants, PCSK9 inhibitors, and ACL inhibitors can effectively lower cholesterol.
  • Lifestyle adjustments such as diet, exercise, and natural remedies can complement medical treatments for high cholesterol, especially if statins cause you side effects.
  • Managing triglycerides through medication or omega-3 supplements can also help lower overall cholesterol levels.

Statins are one of the most commonly prescribed medications for managing cholesterol, but these drugs might not be right for everyone.

Other treatment options, including different medications and lifestyle changes, may be incorporated into the treatment plan. Here are a few alternatives to statin therapy for high cholesterol.

A common alternative to statins is a cholesterol absorption inhibitor. These drugs prevent your small intestine from absorbing the cholesterol you consume.

The only cholesterol absorption inhibitor on the market is the drug ezetimibe. It is available as a generic medication or under the brand name Zetia. This drug can be combined with statins in some cases. However, many doctors prescribe ezetimibe alone and combine it with a low fat diet to help reduce cholesterol.

When statin therapy and lifestyle changes aren’t enough to lower cholesterol, a doctor may consider prescribing bempedoic acid (Nexletol), an adenosine triphosphate-citrate lyase (ACL) inhibitor.

The Food and Drug Administration (FDA) approved this medication in 2020 for use in adults with atherosclerotic cardiovascular disease (atherosclerosis) or heterozygous familial hypercholesterolemia (HeFH). HeFH is a hereditary condition that causes high levels of bad LDL cholesterol.

They later expanded approval in 2024 to reduce the risk of cardiovascular events and lower levels of LDL cholesterol in people who have had and have not had cardiovascular events. The updated approval also clarified that this drug can be used with or without statins.

There is no generic version of the drug at this time.

Side effects of bempedoic acid may include:

  • muscle cramps and pain
  • back pain
  • abdominal pain
  • gout
  • bronchitis
  • headache
  • nausea
  • weakness

Nexlizet is a combination of bempedoic acid and ezetimibe. Doctors can prescribe it to reduce the chance of heart attacks and the need for heart surgery in people with heart disease who can’t take statins.

It is only available as a brand name and not in generic form.

To lower high cholesterol, a doctor may use Nexlizet in combination with a statin drug, like Lipitor and Crestor, and also recommend a low fat diet.

Possible side effects of Nexlizet, from more to less common, may include:

  • respiratory infections
  • urinary tract infections (UTI)
  • fatigue
  • digestive changes
  • high levels of uric acid in the blood
  • muscle cramps
  • abdominal pain
  • tendon inflammation and other problems

Another alternative to statins is sequestrants. They work by binding to the bile in your intestines, blocking cholesterol absorption into your bloodstream.

These are the oldest drugs available to treat high cholesterol. They aren’t as effective as other drugs, so they’re often used by people with cholesterol levels that are only slightly higher than normal.

Some examples include:

  • cholestyramine
  • colestipol
  • colesevelam

The gene proprotein convertase subtilisin/kexin type 9 (PCSK9) determines the number of low-density lipoprotein (LDL) receptors in the body. These receptors then regulate how much LDL cholesterol (sometimes called “bad” cholesterol) enters the bloodstream.

In some people, the PCSK9 enzyme works in overdrive, leading to fewer LDL receptors and higher blood LDL levels. PCSK9 drugs work by suppressing the PCSK9 enzyme expressed by the gene.

PCSK9 inhibitors can serve as an alternative for people who cannot take statins, or those who have very high cholesterol levels and are at higher risk of coronary heart disease. They include:

Many people with high cholesterol also have high triglycerides. Triglycerides are a type of fat found in the blood. Some medications can help lower this type of fat directly. Once these levels go down, the total amount of cholesterol is often lowered.

A common prescription for high triglycerides is niacin or vitamin B3. Niacin can help lower bad cholesterol (LDL) and increase good cholesterol (HDL).

This is a good option for people who don’t respond well to other medications because the side effects of niacin are more mild. People taking this medication might experience the following:

  • flushing of the face
  • nausea and/or vomiting
  • rash
  • low blood pressure
  • elevated blood uric acid level
  • pins and needle sensation

When more aggressive treatment is necessary to treat high triglycerides, a class of medications called fibrates is often prescribed.

Dietary supplements of omega-3 fatty acids, found in fish oil, have been shown to reduce triglyceride levels.

A number of lifestyle changes can help lower your cholesterol. These play an important role in lowering high cholesterol.

To help lower cholesterol, managing your weight and eating heart-healthy foods is key. Eating a heart-healthy diet means decreasing the amount of saturated (animal) fat you eat and increasing:

  • fiber
  • fruits
  • vegetables
  • whole grains
  • fish

If you have overweight, losing as little as 5 to 10 pounds can help reduce your cholesterol levels.

Other important lifestyle strategies to consider are stopping smoking if you smoke, and reducing the amount of alcohol you consume.

Getting exercise every day is another way to lower high cholesterol. Exercise has other health benefits as well. To add exercise to your lifestyle, you can start with something as simple as taking a short walk each day.

Natural remedies may complement cholesterol-lowering efforts. They should always be used in addition to lifestyle changes. Some of these include:

These can be added to your diet with a doctor’s approval. It’s important to note that you should continue any medication you have been prescribed by a doctor.

There are several different types of statins and alternatives. The important thing is to talk openly with a doctor when deciding on the best treatment for you.

Changes to your diet and exercise, along with natural remedies, may help you if statins cause you to have uncomfortable side effects.

Once you start taking a medication, talk with a doctor if you’d like to make any changes. They can advise when you can lower your dosage or make any changes or additions to your medications.

It is important to note that sometimes high cholesterol is genetic. In these cases, natural remedies may not help.