High cholesterol levels are a major concern for many people, as they can increase the risk of heart disease and stroke. There are two kinds of cholesterol found in your body: high-density lipoprotein (HDL) and low-density lipoprotein.
HDL cholesterol is the healthy form of cholesterol, and having more of this is beneficial. LDL cholesterol, on the other hand, is the harmful form that should be avoided.
While statins are commonly prescribed to help manage high cholesterol levels, they can come with unwanted side effects, such as muscle pain, weakness, and liver damage.
As a result, some people may be hesitant to take statins or may be unable to tolerate them. For these cases, several alternatives to statins can help lower cholesterol levels and reduce the risk of cardiovascular disease.
Alternatives to statins
Doctors often prescribe statins to help lower cholesterol levels in the blood. But they are not suitable for everyone due to potential side effects or interactions with other medications.
Some people may experience side effects such as muscle pain, weakness, liver damage, and memory loss. Others may be unable to take statins due to interactions with other medications or underlying health conditions.
Additionally, some people may prefer to take a more natural or lifestyle-based approach to managing their cholesterol levels.
Here are some statin alternatives you may want to consider:
Omega-3 fatty acids
These polyunsaturated fats are essential for good health and play an important role in brain function, immune system health, and heart health.
There are three main types of omega-3 fatty acids, namely:
- alpha-linolenic acid (ALA)
- docosahexaenoic acid (DHA)
- eicosapentaenoic acid (EPA)
EPA and DHA are found in fatty fish such as salmon, while ALA is present in plant-based sources such as flaxseeds, chia seeds, and walnuts.
How omega-3 fatty acids work to lower cholesterol levels is not fully understood. Some researchers think it is related to their ability to reduce inflammation in the body and improve the function of the cells lining your blood vessels. They may also reduce the production of cholesterol in the liver.
Plant sterols and stanols
Plant sterols and stanols are naturally occurring compounds in fruits, vegetables, nuts, seeds, and whole grains. They are structurally similar to cholesterol and can block cholesterol consumed in meals from being absorbed in the small intestine, leading to lower blood cholesterol levels.
When you consume enough (2 grams per day), plant sterols and stanols may lower LDL cholesterol levels by 8–10%. This is because they compete with cholesterol for absorption in the small intestine.
Red yeast rice is a supplement that may aid in lowering cholesterol. It contains trace amounts of monacolin K, which is what leads to the reduction in cholesterol levels. The amount of monacolin K varies between products.
However, the safety of red yeast rice is disputed. Also, some products are contaminated with citrinin, which can cause damage to your kidneys. You may want to seek advice from a professional before taking red yeast rice.
Diet
A healthy diet for managing cholesterol levels typically involves:
- reducing the intake of saturated and trans fats
- increasing the intake of fiber and whole grains
- consuming healthy fats such as monounsaturated and polyunsaturated fats
Foods high in fiber and whole grains, such as fruits, vegetables, beans, whole-grain bread, and cereals, can reduce LDL cholesterol levels. This is because fiber binds to cholesterol in the digestive tract, preventing its absorption into the bloodstream. Whole grains also contain compounds that can help reduce cholesterol levels.
Healthy fats, such as those found in olive oil, avocados, nuts, and fatty fish, may improve your cholesterol levels by increasing HDL cholesterol, known as the “good” cholesterol. HDL cholesterol helps remove LDL cholesterol from the bloodstream and reduces the risk of heart disease.
Exercise
Regular physical activity has been shown to improve cholesterol levels by increasing HDL cholesterol levels. Exercise helps increase the production of enzymes that break down fats and cholesterol in the bloodstream, which can help reduce plaque buildup in the arteries.
Exercise also helps improve blood flow and oxygen delivery to the heart, which can help reduce the risk of heart disease. The American Heart Association recommends at least 30 minutes of physical activity, like brisk walking or jogging for 5 days per week to achieve good heart health.
Ezetimibe
This medication is a common statin alternative for managing high cholesterol levels. It blocks cholesterol absorption in the small intestine, leading to lower LDL cholesterol levels in the bloodstream.
Ezetimibe (Zetia) is generally well-tolerated, with the most common side effects being diarrhea, abdominal pain, and headache.
Bile acid sequestrants
Bile acid sequestrants, also known as bile acid-binding resins, are a type of medication used as a statin alternative for managing high cholesterol levels.
Examples include cholestyramine (Questran), colesevelam (Welchol), and colestipol (Colestid)
These medications bind to bile acids in the digestive tract, preventing their absorption into the bloodstream and promoting their elimination from the body, thus reducing cholesterol levels.
Bile acid sequestrants can cause digestive (gastrointestinal) side effects, such as constipation, bloating, and nausea.
However, these drugs decrease the absorption of some vitamins. Therefore, if a patient has a deficiency in these vitamins (vitamins A, D, E, or K), bile acid sequestrants may not be the most appropriate option.
Niacin
Niacin, or nicotinic acid, is another alternative. It’s also known as vitamin B3. It lowers LDL cholesterol, which is the harmful form of cholesterol, and raises HDL cholesterol, which is the healthy form.
Forms of niacin (Niaspan) are available over the counter or on prescription, depending on the dosage. It can also be given in combination with statins, ezetimibe, or bile acid sequestrants.
Fibrates
These medications work by activating a receptor called peroxisome proliferator-activated receptor alpha (PPARα), which regulates the production and metabolism of lipids in the liver.
By activating this receptor, fibrates can help reduce triglyceride levels and increase HDL cholesterol levels. Fibrates are generally well-tolerated, although they can cause side effects such as nausea and diarrhea.
They may also interact with other medications, so consider discussing any concerns with a healthcare professional before starting treatment.
Examples include gemfibrozil (Lopid) and fenofibrate (Tricor).
According to researchers, people with liver, gallbladder, or kidney diseases should not take fibrates. They can also affect the muscles, causing myopathy.
PCSK9 inhibitors
These medications work by blocking the action of a protein called PCSK9, which regulates the number of LDL cholesterol receptors on the surface of liver cells.
PCSK9 inhibitors are injected by a healthcare professional, typically once or twice per month, and are generally well-tolerated. However, they can cause injection-site reactions, flu-like symptoms, and allergic reactions in some people.
Examples include alirocumab (Praluent) and evolocumab (Repatha).
This is one of the less common options because it is one of the most expensive.
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