Statins are one of the most prescribed treatments in the UK and are widely used to treat high cholesterol. However, they aren’t your only option. If you’ve been advised to lower your cholesterol but are not getting on with statins (or would prefer not to take them), there are both medical and lifestyle-based alternatives worth discussing with your GP.
Our guide covers the most common alternatives to statins, lifestyle changes you can make to help your health, and how you can reorder your repeat NHS prescriptions with Chemist4U.
Three key takeaways
Statins are not the only treatment for high cholesterol. Several non-statin medications are available on prescription for people who cannot tolerate them or need additional support.
Lifestyle changes like diet, exercise, and stopping smoking can meaningfully lower cholesterol and reduce cardiovascular risk.
You should always speak to your GP before stopping or switching any prescribed cholesterol treatment.
Do you have to take statins if you have high cholesterol?
No, you do not have to take statins if you have high cholesterol. However, if your GP has prescribed them, it's because they have assessed your cardiovascular risk and concluded that the benefits outweigh any potential risks. If you have concerns, speak to your GP before making any changes.
Statins are currently the most clinically studied and widely recommended treatment for lowering LDL (‘bad’) cholesterol. NICE guidelines recommend using statins as the first-line treatment for people at increased risk of cardiovascular disease. That said, some people can’t tolerate statins due to side effects like muscle aches, and for such patients, alternatives are available.
Whether you choose a medical alternative or focus on lifestyle changes, the goal remains the same: reducing your cholesterol and protecting your long-term heart health.
If statins are not suitable for you, your general practitioner may consider one of the following prescription treatments. These aren’t available to buy over the counter and will require a clinical assessment.
Ezetimibe
Ezetimibe is usually the first alternative considered when statins are not tolerated.
It works differently to statins. Rather than reducing the liver's production of cholesterol, it reduces how much cholesterol is absorbed from food in the gut. It's available as a tablet taken once daily and is generally well tolerated.
Ezetimibe can be prescribed alone or alongside a low-dose statin if a full statin dose is not tolerated.
Bempedoic acid
Bempedoic acid (brand name Nilemdo) is a newer treatment that lowers LDL cholesterol by reducing the liver's cholesterol production. This is similar in principle to statins but via a different mechanism. It’s taken as a tablet once daily. It’s licensed in the UK for adults who are unable to take statins or cannot tolerate the doses needed to reach their cholesterol targets.
Bempedoic acid is sometimes combined with ezetimibe in a single tablet (brand name Nustendi) for added effect.
PCSK9 inhibitors
PCSK9 inhibitors, like evolocumab (Repatha) and alirocumab (Praluent), are injectable medications given every 2-4 weeks. They work by inhibiting the PCSK9 protein, which normally promotes degradation of LDL receptors in the liver. By preserving these receptors, the liver can remove more LDL cholesterol from the bloodstream.
These treatments are highly effective at lowering LDL cholesterol and are typically reserved for people with familial hypercholesterolaemia (an inherited condition causing very high cholesterol), or those who have already had a heart attack or stroke and cannot reach their cholesterol targets with other treatments. These medications are prescribed by specialists rather than GPs in most cases.
Bile acid sequestrants
Bile acid sequestrants like colestyramine and colesevelam bind to bile acids in the gut, preventing them from being reabsorbed. This causes the liver to use more cholesterol to produce new bile acids, which lowers the amount of cholesterol in the blood.
Bile acid sequestrants are taken as a powder or tablet. It can cause digestive side effects, including bloating and constipation.
This is not as common as an alternative to statins, but is an option if all other methods fail.
Fibrates
Fibrates like fenofibrate are mainly used to lower triglycerides (another type of blood fat) rather than LDL cholesterol. They may be used alongside other cholesterol treatments in people with mixed dyslipidaemia, which is raised cholesterol and raised triglycerides. They’re less commonly used as a direct statin alternative.
Icosapent ethyl
Icosapent ethyl (brand name Vazkepa) is a highly purified form of an omega-3 fatty acid. It's licensed in the UK as an add-on treatment for adults who are already on a statin but remain at high cardiovascular risk. It's not a standalone statin alternative but may be considered as part of a broader treatment plan.
Natural alternatives to statins
Lifestyle and dietary changes can make a meaningful difference to cholesterol levels, particularly for people with mildly raised cholesterol or those looking to complement their prescribed treatment.
These are not a replacement for medication in higher-risk individuals, but they are an important part of any cholesterol management plan.
Diet
The NHS recommends reducing saturated fat as one of the most effective dietary changes for lowering LDL cholesterol. Replacing saturated fats (found in butter, full-fat dairy, and processed meats) with unsaturated fats (found in olive oil, avocados, and nuts) can help improve your cholesterol profile.
Foods that may actively help lower cholesterol include:
Oats and barley: Contain beta-glucan, a soluble fibre that reduces LDL absorption.
Nuts: Particularly almonds and walnuts, which have been associated with lower LDL levels.
Soya products: Tofu, soya milk, and edamame may modestly reduce LDL cholesterol.
Fatty fish: Salmon, mackerel, and sardines are rich in omega-3 fatty acids, which help lower triglycerides.
Fruit and vegetables: Particularly those high in soluble fibre like apples, oranges, and pulses.
Plant sterols and stanols
Plant sterols and stanols are compounds found naturally in small amounts in plants. When consumed in sufficient quantities, they can block the absorption of cholesterol in the gut. They are added to certain foods like fortified spreads and yoghurt drinks.
These products are not recommended for children, pregnant women, or those who do not have raised cholesterol.
Red yeast rice
Red yeast rice contains a naturally occurring compound called monacolin K, which works in a similar way to the statin lovastatin.
Some people use red yeast rice supplements as a ‘natural’ alternative to statins. However, red yeast rice products containing significant amounts of monacolin K carry similar risks to statins, including muscle problems. As a result, they should not be used without medical supervision. Always speak to your GP before taking these supplements.
Lifestyle changes that can help lower your cholesterol
Making changes to your daily habits is one of the most effective things you can do to manage your cholesterol, particularly if your levels are mildly raised or you are trying to reduce your cardiovascular risk before starting medication.
"Lifestyle changes are most effective when maintained over time. Even small changes, like swapping butter for olive oil or adding a daily 30-minute walk, can make a meaningful improvement in your cholesterol levels. The key is to make it sustainable for you. If you are unsure where to start, your GP or pharmacist can help you put together a realistic plan."
The NHS recommends at least 150 minutes of moderate-intensity exercise per week, split into five 30-minute blocks. This can include brisk walking, cycling, or swimming. Regular physical activity can raise HDL (‘good’) cholesterol and help lower triglycerides.
Maintain a healthy weight
Carrying excess weight, particularly around the abdomen, is associated with raised LDL cholesterol and triglycerides. Even a modest amount of weight losscan improve your cholesterol levels and reduce your overall cardiovascular risk.
Stop smoking
Smoking lowers HDL cholesterol and damages blood vessels, increasing the risk of atherosclerosis (narrowing of the arteries). Stopping smoking can raise HDL cholesterol to healthier levels and significantly reduce your risk of heart disease.
Limit alcohol
Drinking too much alcohol can raise triglyceride levels. The NHS advises keeping alcohol intake to no more than 14 units per week, spread across several days, with some alcohol-free days each week.
How to reorder your NHS prescriptions with Chemist4U
Whether you take statins, ezetimibe, or another cholesterol treatment, Chemist4U makes it easy to manage and order your NHS prescription without visiting your GP surgery or local pharmacy.
Simply create or log in to your Chemist4U account and submit your prescription details securely online. Our team will verify and dispense your medication, with your treatment delivered straight to your door.
Frequently asked questions about statin alternatives
What is the best non-statin drug for cholesterol?
Whilst there is no ‘best non-statin', Ezetimibe is a commonly prescribed non-statin drug for cholesterol in the UK. It’s usually the first alternative considered when statins are not tolerated and can be used alone or alongside a low-dose statin.
For people with very high LDL cholesterol or established cardiovascular disease, PCSK9 inhibitors may be more effective, though these are typically prescribed by specialists. The right option for you depends on your cholesterol levels, overall cardiovascular risk, and any other health conditions. Your GP is best placed to help advise you.
Should I take statins?
If your GP has recommended statins, it's because your cardiovascular risk has been assessed and treatment is considered beneficial. Statins are the most well-studied cholesterol-lowering medication available and have a strong safety record. If you have concerns about side effects or prefer to try lifestyle changes first, speak to your GP. They can help you weigh up the options based on your individual circumstances.
Can I lower my cholesterol without medication?
For some people with mildly raised cholesterol and low overall cardiovascular risk, it may be possible to manage cholesterol through diet, exercise, and lifestyle changes alone. However, for those with significantly raised LDL, familial hypercholesterolaemia, or a history of heart disease or stroke, medication is usually recommended alongside lifestyle changes. Always speak to your GP before deciding to manage cholesterol without medication.
Are natural alternatives to statins as effective?
In most cases, natural alternatives are not as effective as statins. While dietary changes, plant sterols, and lifestyle improvements can lower cholesterol meaningfully, they are unlikely to achieve the same LDL reductions as statins or other prescription treatments in people with significantly raised cholesterol. Natural approaches work best as a complement to medical treatment, or as a first step for people with mildly raised cholesterol and low cardiovascular risk. Please discuss this with your GP first, however.
Can I just stop taking my statins?
You should never stop taking statins without speaking to your GP first. Stopping abruptly does not cause immediate harm, but it does remove the cardiovascular protection the medication provides. If you’re experiencing side effects or want to explore alternatives, your GP can work with you to find a suitable approach.
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