Cholesterol Medications Beyond Statins: What Are Your Options?

Updated July 2026

Statins are the first-line cholesterol drug for good reason, but they are far from the only option. Maybe you can't tolerate a statin, maybe it isn't enough on its own, or maybe you'd rather start with food. Whatever the reason, there are more ways than ever to lower cholesterol, and the good news is that the risk reduction is the same whether you get to a better number through food or drugs. Here's the full menu and how the pieces fit together.

Can you lower cholesterol without any medication?

Yes, and it's where everyone should start. Food is the most powerful lever most people never fully pull: fiber, plant sterols, and omega-3s all lower LDL, which is exactly what Step One Foods delivers and what we proved in a clinical trial. Fiber and plant sterol supplements (aim for at least 10 grams of fiber and 2 grams of sterols a day) can help too, though the evidence is strongest when these come from whole food. And to be clear, there's no good evidence that CoQ10, garlic, or cayenne lower LDL.

What non-statin drugs can lower cholesterol?

Several, working in different ways:

• Ezetimibe (Zetia) blocks cholesterol absorption in the gut. It's often added to a statin to boost the effect or allow a lower statin dose, and it lowers LDL modestly on its own.
• Bempedoic acid works in the liver much like a statin but tends not to cause muscle aches, which makes it useful for people who are statin-intolerant.
• PCSK9 inhibitors are the most powerful option, lowering LDL by 50 to 60%. They include the injectables Repatha and Praluent, the twice-yearly Leqvio, and now Lipfendra, an oral version.
• Niacin is an older option that works but comes with real side effects, is no longer recommended by the guidelines, and should be used with caution.

What about supplements like red yeast rice?

The active ingredient in red yeast rice is structurally similar to a statin (lovastatin), so it can lower LDL — but can also result in the same potential side effects as statins. And because supplements are unregulated, the active dose could vary from bottle to bottle – or even pill to pill. If you take it, you should be monitored just as you would on a prescription statin.

What's on the horizon?

The frontier is moving fast, all the way to one-time gene therapies that may someday lower LDL permanently with a single treatment. Though likely at an astronomical cost.

Which option is right for you?

That depends on your risk, what you tolerate, and your preferences, and it's a decision to make with your doctor. But whatever you land on, food is the foundation that makes every one of these work better and at lower doses. Medications treat the number. Only food and lifestyle treat the reasons the number is high in the first place. For the full picture on statins themselves, see the complete guide to statins.

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