Watching your cholesterol levels is a smart idea, especially since one in three people have high levels of “bad” cholesterol: low-density lipoprotein (LDL). If you’re facing an increased risk for high cholesterol and you’re struggling to manage it, you might consider reaching for supplements or other over-the-counter products. But you should think twice before you do that, says Seth Martin, M.D., M.H.S ., Johns Hopkins cardiologist and co-director of the Advanced Lipid Disorders Center. 

“Some people try supplements instead of prescription medications because they think it’s a safer way to address health issues,” he says. “But many of those supplements don’t benefit the heart like people think.”

Fish Oil

Advocates of fish oil supplements containing omega-3 fatty acids (nutrients found in foods such as fish that are important for normal metabolism) say they’re good for heart health and prevent heart attacks , strokes , heart failure and coronary heart disease . But there is no substantial evidence that proves over-the-counter fish oil supplements can do any of those things.

Prescription fish oils are used in medical practice. However, they’re prescribed to help people with severe triglyceride disorders, not high cholesterol. Omega-3 therapy with prescription fish oil can reduce triglycerides by 30 to 50 percent in those with levels that are at 500 mg/dL or more, and who are at an increased risk of getting pancreatitis.

“Typically, you wouldn’t get that kind of triglyceride lowering with over-the-counter supplements. That’s because the dose of active ingredients is substantially less than what’s in prescription fish oil and can even be less than advertised,” Martin says. “Over-the-counter fish oil supplements may also contain large amounts of other unwanted saturated fats, which could increase your bad cholesterol.”

Over-the-counter supplements aren’t regulated for quality and contents, so you don’t know what you’re really getting. Rather than taking a supplement, Martin notes that eating a heart-healthy diet that includes fish, unsaturated fats and limited simple sugars, and performing regular physical activity, is the safest way to control triglycerides and cholesterol.

Red Yeast Rice

Red yeast rice is used in foods such as Peking duck and in Chinese medicine. When red rice is fermented with certain strains of yeast, it creates a very low-dose statin. Statin drugs are commonly prescribed for reducing high levels of bad cholesterol.

Although some people want to take red yeast rice because they feel it’s more natural and safer than prescription statin drugs, it’s not regulated by the FDA or tested in any way to make sure it’s safe.

“I don’t feel comfortable recommending red yeast rice because each formulation may vary in strength and have other unknown contaminants that could be toxic,” says Martin.

An analysis of red yeast rice supplements found that four out of 11 products contained a substance called citrinin. This develops during the culturing process if the environment isn’t carefully controlled. Citrinin has been found to cause kidney failure in animals and genetic damage in human cells.

On the other hand, prescription statins are heavily regulated and have a proven track record of being safe and well tolerated by the vast majority of people.

CoQ10 Supplements

Coenzyme Q10 (CoQ10), a nutrient produced by the body and used for cellular energy, is often touted as being vital if you’re taking statin drugs to lower cholesterol. Proponents of CoQ10 say it helps reduce muscle pain, which can be a side effect of statin use, and is an important energy source that the body needs.

“No solid evidence supports benefits of taking CoQ10 supplementation while taking statins,” Martin says. “If you’re taking statin drugs and have muscle aches, the next step is talking to your doctor about changing your prescription.”

There are several different statin drugs and they can be given at various doses. Finding the one that works for you is a better route than taking a supplement to try to counteract ill effects of your current prescription.

Aspirin

When cholesterol and other substances build up on your artery walls, they create something called plaque, which narrows the passageways and restricts blood flow. Even worse is when a blood clot forms on a ruptured plaque and blocks the artery entirely, cutting off the flow of oxygen to part of your body. A heart attack occurs when blood flow to your heart is cut off. When the blocked artery leads to your brain, a stroke is the result.

Studies show that aspirin can help prevent heart attacks and strokes caused by blood clots because it reduces your blood’s ability to form clots. “Taking a low-dose aspirin is most effective if you’ve already had a heart attack or stroke. Also, if you’ve had a stent or heart surgery, you should be on platelet blocking therapy,” advises Martin. “But if you’re someone who is more likely to have heart disease because of certain risk factors, you may or may not need aspirin therapy. It’s an individualized decision to make together with your health care provider.”

Talking to your doctor before starting any new supplement or taking aspirin is always advised. Your health care provider can offer insight about whether they are right for you.