4 over-the-counter options for high cholesterol

High cholesterol can limit blood flow due to a buildup of fats in the bloodstream. This can increase your risk of conditions like heart disease and stroke.

If you have high cholesterol, a healthcare professional will typically prescribe medications, such as statins, to help you manage your levels. Over-the-counter (OTC) options and lifestyle measures can also help you to maintain or achieve your cholesterol goals. 

Below are various OTC options and lifestyle measures that can help manage cholesterol levels.

Phytosterols

Phytosterols are compounds in plant foods that can help reduce cholesterol levels. They are also available in supplement form.

Examples include:

• Fruits: bananas, apricots, oranges, and pineapples
• Vegetables: sweet potatoes, green beans, cauliflower, and broccoli
• Seeds: sunflower seeds, pumpkin seeds, and watermelon seeds
• Nuts: hazelnuts, pistachios, and almonds

According to the National Center for Complementary and Integrative Health (NCCIH), eating foods with added phytosterols or taking phytosterol supplements with meals can be beneficial.

A 2022 practice statement from the American Society for Preventive Cardiology also noted that phytosterol supplements have the effect of lowering LDL, or “bad” cholesterol. Consuming 2 grams (g) per day of phytosterols is associated with an 8–10% reduction in LDL cholesterol levels.

Dietary food choices and supplements

The NCCIH reports that some foods and dietary supplements have clinical evidence of cholesterol-reducing properties.

Examples include:

• Soy: Foods like soybeans can help lower cholesterol levels. However, soy supplements did not have the same beneficial effects.
• Flaxseed: Some flaxseed supplements can benefit cholesterol levels, specifically whole flaxseed and flaxseed lignans.
• Green tea: Drinking green tea could help significantly reduce fats in the bloodstream.
• Oats and oat bran: Consuming oats over time may help reduce total cholesterol and LDL cholesterol.

According to the NCCIH, despite the potential for positive effects of these foods and supplements, they might not have the same effects as cholesterol-lowering drugs.

Omega-3 fatty acids

Various types of OTC omega-3 products are available to help with high cholesterol, like omega-3 fish oils. These are known as marine-derived omega-3 polyunsaturated fatty acids. 

Omega-3 fish oils can help reduce triglyceride cholesterol levels, but high amounts (2–4 g daily) are necessary to have this effect.

Getting enough omega-3 via your diet can be difficult, but supplements can help you consume more.

Niacin

Niacin (vitamin B3) can help with your cardiovascular health and cholesterol levels. It is available as an OTC supplement and by prescription.

The American Heart Association (AHA) recommends only taking niacin by prescription, as it can cause liver toxicity and can raise blood sugar levels. Side effects of niacin include:

• flushing
• stomach upset
• itching

Research from 2020 shows niacin can raise HDL, or “good,” cholesterol by 20% and lower triglycerides and LDL. The AHA notes that the Food and Drug Administration (FDA) does not regulate OTC niacin supplements, and products can contain varying amounts of the vitamin. 

Prescription medication options for high cholesterol

Prescription medications typically aim to lower LDL cholesterol. You should take them in addition to lifestyle measures that can help manage cholesterol levels. 

Some common drugs to treat cholesterol include:

• Statins: Statins work in the liver to reduce the production of cholesterol. Examples include atorvastatin (Lipitor), fluvastatin (Lescol), and simvastatin (Zocor).
• Cholesterol absorption inhibitors: These medications help stop the absorption of cholesterol in the intestine. Examples include ezetimibe (Zetia).
• Bile acid sequestrants: These are binding agents that help the intestine to get rid of cholesterol. Examples include cholestyramine (Questran) and colestipol (Colestid).
• PCSK9 inhibitors: These are injectable medications doctors prescribe to people with genetic high cholesterol (familial hypercholesterolemia). Examples include alirocumab (Praluent) and evolocumab (Repatha).  
• Adenosine triphosphate-citrate lyase (ACL) inhibitors: These work in the liver to block cholesterol production. Examples include bempedoic acid (Nexletol).

You can work with a healthcare team to choose the right prescription medication to help manage your cholesterol levels. 

If you need help covering the cost of medications, the free Optum Perks Discount Card could help you save up to 80% on prescription drugs. Follow the links on drug names for savings on that medication, or search for a specific drug here.

Why is it important to work with a doctor to manage cholesterol levels?

Too much LDL cholesterol in the blood can cause a buildup of fatty deposits called plaque in your blood vessels. This increases the risk of stroke, heart attack, and other health conditions. Working with a doctor can help put you in the best position to reduce these risks.

A doctor can help you:

• regularly monitor your blood cholesterol levels
• develop a program to make lifestyle changes that can reduce cholesterol
• prescribe medications that help you manage cholesterol
• monitor possible interactions between OTC and prescription medications

A doctor can also help determine the best combination of medications and lifestyle factors if you have any other health conditions, such as diabetes. 

Summary

Managing cholesterol levels can be important in lowering the risk of heart attack and stroke. Alongside prescription medication, OTC options, such as phytosterols, omega-3 fatty acids, and niacin, can help you reach your cholesterol management goals.

It is important to work with a doctor to avoid drug interactions and to ensure the safe use of both supplements and prescription drugs. 

Download the free Optum Perks Discount Card to save up to 80% on some prescription medications.