Table of Contents
Statins are a class of drugs often prescribed as a first-line treatment for lowering cholesterol. They work by inhibiting enzymes responsible for cholesterol production in the liver with mild cardioprotective effects.
This isn’t a perfect science, though. While statins may lower your cholesterol, that may not translate to better heart outcomes. They may not even target low-density lipoprotein cholesterol (LDL-C), the “bad” type doctors like to blame for poor heart health. (We’ll get into all that.)
Statin therapies may also come with side effects that could have the opposite intended effect. The best approach to heart health is an individualized one, and exploring statin alternatives is a solid first step for anyone interested in true heart disease prevention.
1. Nattokinase
Nattokinase is a natural enzyme derived from natto, a Japanese fermented soybean dish. Unlike statins, which focus solely on cholesterol, nattokinase targets heart health in a few different ways.
Consuming it as natto or via supplements has been linked to blood clot prevention thanks to its effects on fibrinogen and fibrin, the proteins involved in blood clot formation. (1) This activity helps maintain clear, flexible arteries.
A reduced blood clot risk could mean a reduced risk of heart attacks, strokes, and deep vein thrombosis. It also means healthier circulation, which translates to supporting balanced blood pressure and healthier cholesterol levels. (2) All of this is essential to overall heart health.
Nattokinase is a more natural approach to cardiovascular support, so you can expect fewer side effects compared to statins. It also has a well-documented history of use as a heart-healthy tool. In Japan, natto is a cultural touchpoint that also symbolizes health and longevity.
If you’re not ready to boost your consumption of fermented foods, supplements can help you embrace the benefits of natto.
Read Next: The Top 9 Evidence-Based Supplements for Heart Health
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Toku Flow is a daily supplement that combines nattokinase with vitamin K2 and beta-glucan to support balanced cholesterol, optimal blood pressure, and more without any documented side effects.2. Vitamin K2
Vitamin K2 (menaquinone-7) is a fat-soluble vitamin that plays an important role in calcium balance. (3) Studies show it helps direct calcium to bones where it’s needed while preventing it from accumulating in arteries. This can reduce the risk of arterial calcification.
When paired with vitamin D and calcium, it supports healthy vascular function. (4) Unlike statins, which focus on cholesterol, vitamin K2 is part of a holistic approach to cardiovascular health to reduce your risk of atherosclerosis, or arterial plaque buildup.
Vitamin K2 is found naturally in fermented foods like natto and animal products like egg yolks, liver, and certain cheeses. Supplements come with a low risk of side effects.
Toku Flow, our supplement, includes vitamin K2 to boost positive impacts on heart health. One clinical study with over 1,000 participants found that nattokinase supplementation with K2 was associated with a healthier lipid profile and markers of vascular elasticity. There was also improvement in arterial flexibility and better coronary plaque scores.
At the same time, that combo increased high-density lipoprotein cholesterol (HDL-C), the preferred type, and the thickness of the median of the common carotid artery (CCA-IMT). This thickening is caused by plaque buildup and is linked to poor cardiovascular health.
3. Bempedoic Acid
Bempedoic acid (Nexletol) is one of several non-statin cholesterol-lowering medications. It lowers LDL-C by inhibiting ATP citrate lyase, an enzyme involved in cholesterol production. (5) It’s common to see this one prescribed with ezetimibe, a drug that reduces cholesterol absorption from food sources in the small intestine. (6)
Unlike statins, which work in the liver and muscles, bempedoic acid is activated only in the liver. This can mean less muscle pain and cramping, which are common side effects of statins.
It doesn’t come with zero side effects, though. This is still a prescribed drug. Possible side effects include signs of gout, tendon problems, back pain, stomach issues, and cold or flu-like symptoms.
4. Fibrates
Fibrates are another non-statin class of lipid-lowering compounds but are less effective against LDL cholesterol levels. These work by activating receptors that regulate fat metabolism to support a reduction in triglycerides and a boost in HDL-C. (7)
We’d argue this is even better than honing in on LDL-C only, especially for individuals with metabolic syndrome or diabetes. Fibrates may also help reduce inflammation and improve insulin sensitivity, further supporting heart health. (8)
Fibrates like fenofibrate (Tricor) and gemfibrozil (Lopid) may come with side effects, though, just like any medication. These include gastrointestinal symptoms, headaches, leg cramps, and dizziness.
Since their effect on LDL-C is modest, your doctor may try to prescribe a statin in addition to a fibrate to balance your levels anyway. It’s essential to be informed about what you actually need for improved heart health.
5. Niacin
Niacin (vitamin B3) is a water-soluble vitamin that has done well in clinical trials as a supplement that may lower triglycerides and raise HDL-C levels. (9) Higher HDL levels help remove excess cholesterol from the arteries, reducing the risk of plaque buildup and heart disease.
Niacin also has anti-inflammatory properties that may reduce symptoms of metabolic dysfunction, a big culprit behind bad heart outcomes. (10) The vitamin’s effects on LDL-C are more modest.
You can find niacin in food sources like poultry and fish, but some take niacin as a supplement. Too much niacin can lead to side effects like skin issues and an upset stomach. Avoid taking niacin if you’re already on a statin, as it could increase your risk of side effects from the drug.
6. Dietary Changes
Before we launch into suggestions about dietary changes for heart health, it’s important to note that for most, dietary cholesterol won’t impact blood cholesterol levels.
For those with familial hypercholesterolemia, an inherited defect in how your body deals with LDL-C, a specialized healthy diet may be more important, but that’s not the norm. Lean Mass Hyper-Responders (LMHRs) is another example.
These are people with high LDL-C, high HDL-C, and low triglycerides, often because they’re on low-carb or keto diets. (11) That doesn’t make them more prone to cardiovascular concerns down the line. In fact, their metabolisms are generally more efficient than most.
The dietary tips we’ll get into below are all multi-purpose. Much like nattokinase, they might have an effect on lowering LDL-C, but they may also have additional benefits like reduced inflammation and blood sugar balance. Let’s take a look at each suggestion:
Increase soluble fiber. Foods like oats, beans, lentils, and most fruits help remove excess cholesterol by binding to it in the digestive system and preventing its absorption. (12) They also support gut health and help regulate blood sugar levels. You could also take Toku Flow, which incorporates beta-glucan from organic oat bran, to further support these benefits.
Eat more healthy fats. Saturated fats aren’t the villain they’ve been made out to be, but trans fats affect HDL-C. Healthy fats found in olive oil, avocadoes, nuts, and fish are known for balancing cholesterol levels and reducing inflammation. (13)
Add more omega-3 fatty acids. If you’re not getting healthy fats from fatty fish, try a fish oil. Omega-3s reduce triglycerides, lower inflammation, and promote brain function. (14)
Skip processed foods. Fried foods and heavily processed snacks can mess with your metabolic health and contribute to weight gain. Obesity affects how your body manages lipoproteins. (15)
Incorporate plant sterols and stanols. Naturally found in nuts, seeds, and fortified foods, these compounds block cholesterol absorption in the intestines. (16) They also contribute to better immune function and overall heart health.
Seek out superfoods. Fruits and vegetables, especially leafy greens and berries, contain antioxidants that protect against LDL oxidation. (17) They’re also good at fighting inflammation and boosting your immune system.
Drink green tea. Green tea is rich in catechins, a polyphenol-rich in antioxidants linked to better cholesterol management, enhanced metabolism, and improved heart health. (18)
Reduce added sugar. Excess sugar intake can raise triglycerides and contribute to insulin resistance, increasing your risk of heart disease. (19) Cutting back on sugar stabilizes energy levels and supports a healthy weight.
7. Lifestyle Modifications
Much like dietary changes, there are lifestyle changes you can make that are good for both balanced cholesterol and overall heart health:
Exercise regularly. Shoot for at least 150 minutes of moderate-intensity exercise per week to raise HDL-C, improve circulation, and support weight management.
Maintain a healthy weight. On that note, excess body fat is linked to higher LDL-C and triglycerides. Losing even 5% of your body weight can improve things significantly. (20)
Quit smoking. Smoking damages blood vessels, lowers HDL-C, and increases the risk of plaque buildup in your arteries. (21)
Reduce alcohol intake. Drinking too much raises triglycerides and contributes to high blood pressure and liver strain.
Get quality sleep. Bad sleep is linked to a higher risk of developing heart disease. (22) It also increases inflammation and contributes to hormone imbalances.
Manage your stress. Chronic stress raises cortisol levels and inflammation. Practices like meditation, yoga, and spending time outside support overall heart health.
Get some sun. Low levels of vitamin D are linked to inflammation. Get moderate sun exposure (with sunscreen) or try a supplement for heart health and immune function.
A More Comprehensive Approach
For decades, LDL-C has been the main focus in assessing risk factors for heart disease, but we like to talk about the new truth about cholesterol: it’s not that big of a deal.
A more comprehensive approach considers biomarkers like ApoB, which directly measures LDL particle count, LDL particle size, and Lp(a), a lipoprotein that plays a critical role in blood clotting. These aren’t typical when you’re looking at lipid panels at your doctor’s office.
Reducing LDL-C with statins alone isn’t the magic bullet many healthcare professionals may have you believe.
We only need to consider the fact that many patients with cardiovascular disease symptoms have “normal” LDL-C. (23) A more effective approach is a holistic one that assesses the changes you make on biomarkers that matter more for overall heart health.
Consulting a Healthcare Professional
If you’re already on statin drugs, you should always start with your doctor before stopping your medications. Going cold turkey could lead to unintended side effects.
If your doctor tells you that you’re at high risk for heart disease and would like to reduce high levels of LDL-C with statins like atorvastatin or lovastatin, ask about your options.
You should feel comfortable enough with your doctor to explore natural approaches to reducing cardiovascular risk that don’t start with cholesterol-lowering drugs.
That includes trading statins for drugs like PCSK9 inhibitors (alirocumab or evolocumab), resins, and bile acid sequestrants (cholestyramine). Most of these drugs come with their own side effects.
The Takeaway
Many people put on statins didn’t know they had a choice in the matter. Statins and similar drugs are often the first response for physicians seeking a quick fix to cholesterol imbalances, even though there may be natural solutions available.
While cholesterol isn’t the big concern we’ve always believed it to be, managing your cholesterol in a holistic way can have positive benefits beyond lower cholesterol. Reduced inflammation, improved insulin resistance, and healthier habits are all great for your heart and overall wellness.
Want to learn a better predictor of heart disease? Check out our article Apolipoprotein B: A Key Heart Health Marker You Shouldn’t Ignore.
Read Next: LDL Particle Size: What It Is and Why It Matters
Sources
A single-dose of oral nattokinase potentiates thrombolysis and anti-coagulation profiles
Nattokinase: A Promising Alternative in Prevention and Treatment of Cardiovascular Diseases
The role of vitamin K2 in cognitive impairment: linking vascular health to brain health
New insights into the role of bempedoic acid and ezetimibe in the treatment of hypercholesterolemia
Carbohydrate Restriction-Induced Elevations in LDL-Cholesterol and Atherosclerosis: The KETO Trial
Obesity-Related Changes in High-Density Lipoprotein Metabolism and Function
Plant Sterols and Plant Stanols in Cholesterol Management and Cardiovascular Prevention
Effect of Natural Food Antioxidants against LDL and DNA Oxidative Changes
FAQs
What is siRNA therapy for high cholesterol?
Small interfering RNA (siRNA) therapies are treatments that target genetic pathways involved in cholesterol production. They work by silencing specific genes, like PCSK9, to lower LDL-C.
One example is inclisiran (Novartis’s Leqvio), initially approved by the U.S. Food and Drug Administration (FDA) for patients predisposed to cholesterol imbalances. (24) This one needs to be administered by a doctor as an injection after the first 2 doses, which can lead to pain at the injection site.
What are the side effects of statins?
Possible side effects of statins include:
Muscle pain and weakness
Liver damage
Increased risk of diabetes
Digestive issues
Headaches and dizziness
Brain fog and fatigue
Sleep problems
Cold or flu-like symptoms
