Most Americans Unaware of Non-Statin Cholesterol Treatments: Survey

Most Americans recognize statins as a common medication for lowering cholesterol, but a new survey reveals a significant gap in public awareness regarding alternative treatments and key diagnostic tools for assessing heart disease risk. The survey, commissioned by The Ohio State University Wexner Medical Center, highlights a need for improved patient education about the full spectrum of options available for managing cholesterol and preventing cardiovascular events.

Conducted in December, the survey of 1,006 American adults found that while 60% were familiar with statins, 61% were unaware of the existence of non-statin medications designed to lower cholesterol. A substantial majority – 73% – had never heard of lipoprotein(a), a genetically determined type of cholesterol linked to increased cardiovascular risk and 67% were unfamiliar with coronary artery calcium (CAC) scoring, a non-invasive test that can detect early signs of plaque buildup in the arteries.

These findings underscore a potential disconnect between medical advancements and public understanding, according to Dr. Laxmi Mehta, director of Preventative Cardiology and Women’s Cardiovascular Health at The Ohio State University Wexner Medical Center. “Statins often get a bad reputation, but the evidence consistently shows they are highly effective and remain the cornerstone of cholesterol treatment and lowering heart disease risk,” Dr. Mehta explained. “At the same time, we now have non-statin medication options that can also help lower LDL – the ‘bad’ cholesterol – for patients who need alternative therapies.”

The need for alternative therapies arises because statins aren’t universally effective or tolerated. Some patients may not achieve desired LDL cholesterol levels even with statin treatment, while others experience side effects that limit their ability to take the medication. In these cases, other options become crucial.

Several non-statin medications are available, each with its own mechanism of action and potential benefits. Ezetimibe, for example, works by reducing the absorption of cholesterol in the small intestine, leading to a modest reduction in LDL levels (approximately 18-25%) and has been shown to reduce cardiovascular events. Bempedoic acid is a newer oral agent that also lowers LDL cholesterol and has demonstrated potential cardiovascular benefits, though it can increase serum uric acid levels and is associated with a risk of tendon disorders in some individuals.

Perhaps the most potent non-statin options are the PCSK9 inhibitors. These injectable medications dramatically reduce LDL cholesterol levels (by 45-65%) and have demonstrated significant cardiovascular benefits in clinical trials. However, they are administered via subcutaneous injection every two to four weeks, which may be a barrier for some patients. A newer agent, inclisiran, offers a less frequent dosing schedule – an initial injection followed by one every six months – potentially improving adherence.

Beyond medication, understanding individual risk factors and utilizing appropriate diagnostic tools is paramount. Lipoprotein(a), a genetically determined lipid, is increasingly recognized as an independent risk factor for cardiovascular disease. While currently there are limited agents to reduce Lp(a), awareness and testing are growing. Coronary artery calcium (CAC) scoring provides a snapshot of existing plaque buildup in the arteries, allowing for more personalized risk assessment and treatment decisions.

Dr. Mehta emphasized the importance of individualized treatment plans. “When we treat a patient, we really do it individualistically,” she stated. “First-line for all patients is going to be an appropriate lifestyle: eating a heart-healthy diet, exercising, avoiding tobacco use, limiting alcohol. And then it really depends on whether they are primary or secondary prevention, which determines what LDL goal to seek for them.”

The approach to cholesterol management is evolving, with ongoing research exploring novel therapies, including gene-editing techniques and vaccination-like agents aimed at lowering cholesterol. Updates to the American College of Cardiology/American Heart Association cholesterol guidelines are anticipated in 2026, which may further refine treatment recommendations.

the survey results highlight the need for proactive communication between healthcare providers and patients. Ensuring that individuals are informed about all available options – lifestyle modifications, statins, non-statin medications, and diagnostic tools – empowers them to make informed decisions about their cardiovascular health.