A national survey from Ohio State University reveals most Americans do not know about non-statin cholesterol medications or key heart risk tests, even as heart disease strikes at younger ages. Experts say routine screening and tailored treatment could save lives.
After decades of eating well and staying active, 69-year-old personal trainer Toni Gundling thought she was doing everything possible to protect her heart. High cholesterol ran in her family, but she believed her healthy lifestyle would be enough to outrun that risk.
Then her doctors at The Ohio State University Wexner Medical Center told her that genetics were working against her — and that she needed medication, too.
Gundling’s story underscores a larger national problem: Many Americans do not realize that lifestyle changes alone may not be enough to control cholesterol or that there are multiple medication options beyond the well-known statin drugs.
A new national survey commissioned by the Ohio State Wexner Medical Center found that while a majority of Americans have heard of statins, most do not know there are other types of cholesterol-lowering medications. The survey of 1,006 U.S. adults also revealed low awareness of certain inherited cholesterol risks and heart scans that can detect disease early, even in people who feel healthy.
Laxmi Mehta, director of Preventative Cardiology and Women’s Cardiovascular Health at the Ohio State Wexner Medical Center and Sarah Ross Soter Endowed Chair for Women’s Cardiovascular Health Research, noted that misunderstanding around cholesterol treatment is happening against a backdrop of rising heart disease in younger adults.
“Cardiovascular disease is the No. 1 killer of Americans. It’s also impacting people in their 20s and 30s much sooner than it has in the past for various reasons including a surge in risk factors such as high blood pressure, diabetes and high cholesterol. Lifestyle contributors like poor diet, physical inactivity, substance use and vaping are also playing a significant role,” Mehta said in a news release.
The survey found that 60% of respondents had heard of statins, the most commonly prescribed cholesterol-lowering drugs. But 61% did not know that non-statin medicines exist, even though several options are now available in pill or injection form.
Only 44% believed statins are an effective and proven treatment for lowering cholesterol, despite decades of research showing they reduce the risk of heart attack and stroke.
“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. 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,” Mehta added.
Non-statin medications can be used for people who cannot tolerate statin side effects, who need more LDL reduction than statins alone can provide, or who have additional risk factors such as elevated levels of certain inherited cholesterol particles. In some cases, they are combined with statins to achieve optimal control.
Examples include ezetimibe, an oral drug that reduces cholesterol absorption in the intestines; PCSK9 inhibitors, powerful injectable medications given every two to four weeks; inclisiran, an injectable given twice a year after initial doses; and bempedoic acid, an oral option often used for people who are statin-intolerant. These drugs have been shown to lower LDL cholesterol and reduce cardiovascular events in high-risk patients.
The Ohio State survey also highlighted major gaps in awareness of lipoprotein(a), or Lp(a), an inherited form of cholesterol that affects about 1 in 5 people worldwide. Seventy-three percent of respondents had never heard of Lp(a), which cannot be lowered through typical lifestyle changes or standard cholesterol medications.
High Lp(a) levels can promote plaque buildup in arteries, increase inflammation and make blood more likely to clot, all of which raise the risk of heart attack and stroke. Because Lp(a) is inherited, it tends to run in families and can affect people who otherwise appear healthy.
“If someone has an elevated Lp(a) level, their children have a 50% chance of inheriting it,” added Mehta. “If patients have elevated Lp(a) levels, they need to be on LDL lowering therapies to reduce their overall cardiovascular disease risk.”
New drugs specifically targeting Lp(a) are currently being studied in clinical trials, but for now, doctors focus on aggressively lowering LDL cholesterol and managing other risk factors in patients with high Lp(a).
The survey further found that 67% of Americans did not know about the coronary artery calcium score, or CAC, a type of CT scan that measures calcium deposits in the heart’s arteries. This scan can reveal early signs of coronary artery disease — the hardening and narrowing of arteries that can lead to heart attacks — even before symptoms appear.
A coronary calcium scan is often considered for adults ages 40 to 65 who do not have clear signs of heart problems but have multiple risk factors, such as high cholesterol, diabetes, smoking or a strong family history of heart disease. The results can help doctors and patients decide how aggressively to treat cholesterol and other risks.
Mehta noted one of the biggest challenges is that many people feel fine and assume their hearts are healthy, even when their numbers tell a different story.
“Most people don’t know their cholesterol or other heart numbers unless they are checked. They may feel normal but be at risk, which is why routine testing is so important,” she said.
That was the case for Gundling. Despite her years of prioritizing exercise and healthy eating, her family history was striking. Her father had two quadruple bypass surgeries, starting in his 40s, and her younger brother needed a triple bypass. Mehta noted Gundling has underlying coronary artery calcification and elevated Lp(a) levels.
“We can’t run away from our genetics,” Gundling said in the news release.
For years, she resisted going on medication, influenced in part by what she had heard from her own clients about side effects from statins.
“I tried everything – exercise and healthy eating – but it wasn’t enough. I’m a personal trainer and had clients talk about the reactions they had from statins. But going on medication helped reduce what I can’t fix on my own, and I’ve had no reaction to the statin I’m on,” she added.
When a statin alone did not lower Gundling’s LDL cholesterol enough, Mehta added the non-statin drug ezetimibe. It helped, but caused some side effects, so Gundling and her care team have been working together to adjust and find the best combination.
“Not everyone can take the same pill. You have to find what works for you,” added Gundling.
Her experience has changed how she talks about cholesterol medications with others.
“I would wholeheartedly tell somebody to go on a statin because it’s not what you may think it is. It’s given me peace of mind to know that not only am I doing something to help my health but the medication is helping reduce what I physically can’t do,” she added.
For students and young adults, the message from this survey is that heart health is not just an issue for older people. Risk factors like high cholesterol, high blood pressure, diabetes, smoking and vaping can start early, and so can artery damage.
Experts say the most important steps are to know your numbers — including cholesterol, blood pressure and, when appropriate, Lp(a) and coronary calcium score — and to talk with a health care provider about the right mix of lifestyle changes and medications for your individual risk.
The Ohio State researchers say that improving public awareness of non-statin options, inherited risks like Lp(a) and early-detection tools such as coronary calcium scans could help more people get the treatment they need before a heart attack or stroke occurs.