Alternatives for people who cannot take statins
For some, the side effects of statins are so severe that their doctors take them off the medicine. These patients are left to use old-style cholesterol management methods such as diet and exercise.
A study published in the Annals of Internal Medicine found that red yeast rice supplements resulted in lower serum cholesterol levels in a portion of patients enrolled in the study. These patients had discontinued statin therapy after experiencing myalgias (muscle pain). While this suggests possible use of red yeast rice as a therapeutic option, there are a couple big concerns with this idea. One is the problem with the available red yeast rice isn't necessarily safe in itself, and could be of varying potency or contaminated with toxins. The other concern is that even if the yeast reduces hypercholesterolemia that doesn't necessarily mean it reduces the risk of heart attacks as much as statins do, because there are doubts that statins' effects are entirely due to their reducing cholesterol levels.
Bempedoic acid is a mew drug under investigation. It has shown some good results and if approved, may someday be a viable alternative for those who cannot tolerate statins. A class of drug called PCSK9 inhibitors >a href="https://www.medpagetoday.com/Cardiology/Hypertension/52780">are under investigation and may also be an alternative some day. Neither of these medicines has yet been approved by the FDA.