Your best treatment option for high cholesterol depends on many factors.

Before your doctor recommends a prescription medication, they will look at several things, such as:

  • your family medical history
  • your risk for heart disease
  • your lifestyle

Many doctors prefer to start with changes to diet and exercise. If those changes don’t have enough effect, you might start taking medication to help the process along.

Statins are one commonly prescribed medication for controlling cholesterol, but these drugs might not be right for everyone. There are several treatment options for high cholesterol, including other medications and lifestyle changes.

Statins are prescription drugs designed to lower cholesterol. Statins function by inhibiting an enzyme needed to produce cholesterol in the liver. Without the help of that enzyme, your body cannot transform the fat you consume into cholesterol.

Having too much cholesterol circulating in your arteries is dangerous because it can build up plaque. A buildup of plaque can prevent blood from flowing properly and can increase the risk of a heart attack.

Types of statins available

There are several types of statins available. They include:

High intensity statins:

  • atorvastatin (Lipitor)
  • rosuvastatin (Crestor)

Moderate intensity statins:

  • fluvastatin (Lescol)
  • lovastatin (Altoprev)
  • pitavastatin (Livalo)
  • pravastatin (Pravachol)
  • simvastatin (Zocor)

Although all statins work in the same way, your body might respond better to one type than another. This is why doctors sometimes try several types of statins before they find the right one for you.

Some are more likely to interact with other drugs or organic compounds. For example, the statins Lipitor (atorvastatin) and Zocor (simvastatin) can interact with grapefruit juice, according to the Food and Drug Administration (FDA).

The interaction can be very dangerous. Mixing these drugs with grapefruit can increase the amount of medication in the bloodstream and cause serious side effects.

Risks and side effects

Although most people benefit from statins, these drugs can have side effects. The most serious side effects occur in people who are taking other medications or who have an underlying health condition. Many side effects go away as your body adapts to the medication.

The most common side effect of statins is muscle and joint aches and pains. The medication can also cause nausea and vomiting.

More serious side effects include liver and kidney damage, an increase in blood sugar, and neurological side effects. In some people, statins can cause a breakdown in muscle cells and lead to permanent muscle damage.

If statins are not an option or you experience side effects, your doctor can prescribe a different drug to treat high cholesterol. A common alternative is a cholesterol absorption inhibitor.

These drugs prevent your small intestine from properly absorbing the cholesterol you consume. If it can’t be absorbed, it won’t reach your bloodstream.

The only one on the market is the drug ezetimibe, available as a generic or as the name brand Zetia. This drug can be combined with statins to produce faster results. However, many doctors prescribe ezetimibe alone and combine it with a low fat diet to help reduce cholesterol.

Another alternative to statins is bile acid–binding resins, or sequestrants. These drugs work by binding to the bile in your intestines and thereby blocking cholesterol absorption into your bloodstream.

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

Sequestrants can also cause vitamin deficiencies when taken for a long time. Vitamin K deficiency is especially dangerous, because this is the vitamin that helps stop bleeding.

PCSK9 inhibitors, like statins, are effective in lowering cholesterol. These medications offer an alternative for those who can’t take statins.

People have a gene called proprotein convertase subtilisin/kexin type 9 (PCSK9). It determines the number of low-density lipoprotein (LDL) receptors in the body. These receptors then regulate how much LDL cholesterol goes into our bloodstream.

Changes in this gene can lower the amount of LDL receptors. PCSK9 drugs work by suppressing the PCSK9 enzyme expressed by the gene.

Many people who have high cholesterol also have high triglycerides (a type of fat found in your 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 B-3. 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 mild. People taking this medication might experience the following:

  • flushing of the face
  • headaches
  • liver damage
  • dizziness
  • itching
  • nausea

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

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

There are a number of lifestyle changes you can make that can help lower your cholesterol. These play an important role in fighting high cholesterol.

To help lower cholesterol, start by losing excess weight and eating heart-healthy foods. Eating a heart-healthy diet means decreasing the amount of saturated (animal) fat you eat. It also means increasing fiber, fruits, vegetables, whole grains, and fish in your diet.

If you’re overweight, losing as little as 5 to 10 pounds can help reduce your cholesterol levels. Other important lifestyle changes to consider are to stop smoking and to reduce the amount of alcohol you consume.

Getting exercise every day is another way to fight 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.

If a statin and lifestyle changes aren’t enough to lower your cholesterol, your doctor may consider prescribing a recently approved medication called bempedoic acid, or name brand Nexletol.

The FDA approved it in 2020 for use in adults with heart disease or heterozygous familial hypercholesterolemia (HeFH). HeFH is a hereditary condition that causes high levels of bad LDL cholesterol.

As an adenosine triphosphate-citrate lyase (ACL) inhibitor, this medication works by blocking a protein in your liver from making LDL cholesterol. It’s the first drug in the ACL inhibitor class to receive federal approval. There’s no generic at this time.

Side effects may include:

Natural remedies have been shown to have some cholesterol-lowering effects as well. However, they should be in addition to lifestyle changes. Some of these include:

  • garlic
  • oat bran
  • artichoke
  • barley
  • sitostanol
  • beta-sitosterol
  • blond psyllium

With your doctor’s approval, these can be easily added into your diet. It’s important to note that you should continue any medication you have been prescribed by your doctor.

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

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 your 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.