Non-statin therapies: Alternatives for cholesterol management when statins aren't enough

When statins don’t cut it — whether because of side effects, low effectiveness, or intolerance — non-statin therapies, cholesterol-lowering treatments that work differently than statins. Also known as alternative lipid-lowering agents, they’re not second-rate options. They’re science-backed tools used daily by millions to keep LDL in check and heart attacks at bay. These drugs don’t block the same enzyme as statins. Instead, they target cholesterol production, absorption, or removal in ways that can complement or replace statins entirely.

One of the most common ezetimibe, a drug that blocks cholesterol absorption in the gut. Also known as Zetia, it’s often paired with statins but works fine alone for people who can’t tolerate statins. Then there’s PCSK9 inhibitors, injectable drugs that help the liver remove more LDL from the blood. Also known as alirocumab and evolocumab, they can slash LDL by 50–60% — even in people with genetic high cholesterol. And let’s not forget bile acid sequestrants, oral resins that bind bile in the intestines, forcing the liver to use more cholesterol to make new bile. Also known as cholestyramine and colesevelam, they’re older but still useful, especially for people with mild elevations or those avoiding injections. These aren’t experimental. They’re in guidelines from the American Heart Association and European Society of Cardiology. And they’re backed by trials showing fewer heart attacks and strokes when used properly.

What you won’t find in most doctor’s offices are miracle supplements or unproven diets. The real non-statin options are pills and injections with decades of research behind them. If you’ve been told statins aren’t for you, you’re not out of options — you just need to know what else works. Below, you’ll find real posts that break down exactly how these drugs compare, what side effects to expect, how they stack up against each other, and which ones actually move the needle on your heart risk. No fluff. No hype. Just what you need to talk to your doctor with confidence.