I don't want to take a statin
That is your decision to make, and I will respect it. A statin is one way to lower your risk, not the only way. Here are the other medicines, what food and habits can do, which supplements are worth it, and how far each choice could take your LDL.
From Dr. Kenneth Civello, MD, MPH, cardiologist and electrophysiologist
Start with your real risk
How hard we need to push depends on your chance of a heart attack or stroke. Some people need no medicine at all.
Your 10 year risk
We estimate it from your age, blood pressure, cholesterol, blood sugar, kidney function, and smoking. A low risk often means healthy habits are enough.
A coronary calcium score
A quick CT scan that shows whether plaque has already formed. A score of zero, with few other risks, may mean you can wait. Calcium means plaque is there, and lowering LDL matters more.
Lp(a)
A blood test for an inherited, extra sticky type of LDL. A high level raises your risk and is a reason to lower LDL more firmly.
No other cholesterol medicine has as long a record as a statin. If your risk is high, lowering your LDL still matters a great deal. The medicines below can do that without a statin.
Food and habits
Food changes lower LDL a little. Together with other habits, they lower your overall heart risk a lot.
- Swap butter, fatty meat, and cheese for olive oil, nuts, seeds, avocado, and fish.
- Eat more oats, beans, lentils, and barley. Their fiber lowers LDL.
- Use a paper filter for coffee. French press and boiled coffee can raise LDL.
- Move most days, keep a healthy weight, and do not smoke.
- Keep your blood pressure and blood sugar at goal. They matter as much as cholesterol.
Some people eat very well and still have a high LDL because of their genes. That is not a failure. Eating for your heart and Lowering your blood pressure have the details.
Pills that are not statins
Two daily pills lower LDL without a statin. They can be taken alone or together.
Ezetimibe (Zetia)
Blocks cholesterol from food in your gut. It lowers LDL by about 20 to 25 percent. It is cheap, generic, and rarely causes side effects. Most of its proof of fewer heart attacks comes from studies where it was added to a statin.
Bempedoic acid (Nexletol)
Works in the liver like a statin, but not in muscle, so it rarely causes aches. It lowers LDL by about 15 to 25 percent. In a large trial of people who could not take statins, it lowered heart attacks and other heart events. It can raise uric acid and trigger gout, and rarely causes tendon problems.
The two together (Nexlizet)
Ezetimibe and bempedoic acid in one pill. The LDL drops add up. It costs more than the two generics would, and insurance coverage varies.
Shots
When LDL needs to come down a lot, a shot is the strongest option without a statin.
PCSK9 inhibitors (Repatha, Praluent)
A shot under the skin that you give yourself every two weeks or once a month. It lowers LDL by about 60 percent and lowers Lp(a) somewhat. In large trials, mostly in people also on statins, it lowered heart attacks and strokes. Side effects are uncommon, mostly redness where the shot goes in.
Inclisiran (Leqvio)
A shot given in the office. After the first two doses, you need it only twice a year. It lowers LDL by about 50 percent. Trials to prove it lowers heart attacks are still under way.
Are the shots safe long term?
PCSK9 inhibitors have been studied for years in tens of thousands of people. People who reached very low LDL did not have more side effects, and a trial that tested memory found no harm. Inclisiran is newer, so we have fewer years of data.
Supplements
The 2026 guideline recommends against using supplements to lower cholesterol. In studies, they lowered LDL little or not at all.
Psyllium
The fiber in Metamucil. It lowers LDL a little and helps blood sugar. I count it as food.
Citrus bergamot
Small studies show a modest LDL drop, with no proof of fewer heart attacks. I sometimes use it for people at lower risk who will not take medicine.
Red yeast rice
It works because it contains a natural statin, at a dose that varies from bottle to bottle. If you do not want a statin, red yeast rice is not a way around it.
I never use supplements in place of medicine when your risk is high. More on each supplement.
Plan your numbers
Pick your situation, enter your LDL, and see about how far each option could take you without a statin. Nothing you enter leaves this device.
These are typical drops from studies. Your own response may be larger or smaller. Food changes can add a little more.
Cost and insurance
Ezetimibe is a cheap generic. Bempedoic acid and the shots are brand name and cost more. Insurance often asks for proof that you tried a statin first, or a reason you cannot take one. Our office helps with that paperwork. Some makers offer savings cards that lower the copay for people with private insurance.
For your visit
- What is my chance of a heart attack or stroke over the next 10 years?
- What is my LDL goal, and how far am I from it?
- Would a calcium score or an Lp(a) test change your advice?
- Which option would get me to my goal, and what would it cost me?
- When should we recheck my LDL?
Common questions
Can diet alone get me to my goal?
Sometimes, if your LDL is only a little high and your risk is low. If your LDL is far above goal or your risk is high, diet alone usually is not enough.
Is ezetimibe alone enough?
It can be, if your LDL needs to drop by about a fifth. If you need more, we add bempedoic acid or a shot.
Do I have to take these forever?
Usually, yes. LDL goes back up when you stop, and the protection fades with it.
What if I change my mind about a statin?
That is fine too. We can start low and slow. Afraid to take a statin? walks through what the studies show about side effects.
This page is general education for my patients. It does not replace advice from your own doctor.
Based on: 2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia. J Am Coll Cardiol. 2026. Lloyd-Jones DM, et al. 2022 ACC Expert Consensus Decision Pathway on the Role of Nonstatin Therapies for LDL Cholesterol Lowering. J Am Coll Cardiol. 2022. Cannon CP, et al. Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med. 2015. Nissen SE, et al. Bempedoic Acid and Cardiovascular Outcomes in Statin Intolerant Patients. N Engl J Med. 2023. Sabatine MS, et al. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. N Engl J Med. 2017. Schwartz GG, et al. Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome. N Engl J Med. 2018. Giugliano RP, et al. Cognitive Function in a Randomized Trial of Evolocumab. N Engl J Med. 2017. Ray KK, et al. Two Phase 3 Trials of Inclisiran in Patients with Elevated LDL Cholesterol. N Engl J Med. 2020. Laffin LJ, et al. Comparative Effects of Low Dose Rosuvastatin, Placebo, and Dietary Supplements on Lipids and Inflammatory Biomarkers. J Am Coll Cardiol. 2023.