Fish oil vs. statins for cholesterol: How do they compare?

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Statins are drugs that doctors prescribe to help people:

• decrease total blood cholesterol
• lower triglycerides
• reduce low-density lipoprotein (LDL), or “bad” cholesterol
• raise high-density lipoprotein (HDL), or “good” cholesterol

Doctors also call statin medications hydroxymethylglutaryl-CoA (HMG-CoA) reductase inhibitors.

Statins bind to HMG-CoA reductase, which is a protein involved in the production of cholesterol in the liver. By reducing the production of cholesterol in the liver, the body produces more LDL receptors.

This means the liver can store more LDL, removing it from the bloodstream.

Fish oil is a dietary supplement that companies can make from a range of different oily fish, such as herring, mackerel, or anchovies. It contains two important omega-3 fatty acids: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

Some studies suggest that EPA and DHA may have a beneficial effect on general health. However, OTC fish oil supplements vary widely in their quality, purity, and chemical composition. They can provide very different levels of EPA and DHA depending on the type and brand.

As a result, they are not a reliable treatment for any medical condition, including high cholesterol.

The Food and Drug Administration (FDA) have approved specific omega-3 products for lowering triglycerides. These are different from OTC fish oil, as they must adhere to strict guidelines to ensure their chemical composition is consistent. They are only available via prescription.

OTC fish oil supplements are not better for treating high cholesterol than statins.

People can use OTC fish oil supplements to support their general health. However, the FDA have not approved fish oil dietary supplements to treat any specific medical condition.

A 2020 review comparing dietary fish oil with prescription omega-3 found that there was little evidence supporting the use of OTC fish oil for medical conditions.

By contrast, statins are effective in improving cholesterol levels. Different medications in the statin family of drugs are effective at treating atherosclerosis and preventing heart attacks and strokes.

Some people may be able to take fish oil alongside statins. However, EPA and DHA have different effects on LDL. Some studies suggest that combining statins with DHA may increase LDL, which can be a problem for people who are taking statins to lower their LDL levels.

EPA has no effect or a slight lowering effect on LDL. If DHA could be harmful, people should check with a doctor before taking fish oil or other products that contain it.

There are also prescription-only omega-3 formulas that are more potent than standard fish oil. Examples include icosapent ethyl (Vascepa), which contains only EPA, and omega-3-acid ethyl esters (Lovaza), which contains EPA and DHA.

People over 18 years old with very high triglyceride levels (500 milligrams/deciliter) can take these products while also following a healthful diet.

Both statins and fish oil supplements can cause side effects. However, people usually tolerate both well.

The side effects for fish oil are typically mild. They include:

• burping
• indigestion or heartburn
• nausea
• diarrhea
• bad breath or unpleasant-smelling sweat

The following table lists potential side effects of prescription omega-3 products:

Side effects of statins can be more serious. Some of the most common adverse reactions include:

• muscle disease
• liver toxicity
• type 2 diabetes
• rhabdomyolysis, a severe muscle injury

While these are some of the more common reactions to statins, they rarely occur. People who experience muscle pain, tenderness, or weakness will find these side effects go away once they stop taking the medication.

If people are experiencing side effects while taking statins, they should contact a doctor.

Some people cannot tolerate statins and may require an alternative. Doctors may suggest a combination of dietary changes and one or more lipid-lowering medications, such as:

• ezetimibe
• fibrates
• nicotinic acid
• bile acid sequestrants
• proprotein convertase subtilisin/kexin type 9 inhibitors

Each of these medications has different effects, and not all of them are a direct replacement for statins. Some people may need to take more than one lipid-lowering prescription medication to control their cholesterol.

Diet can also play a role in treating those who are intolerant to statins. Doctors may recommend a diet that:

• is low in saturated fat
• is rich in fiber
• contains plant sterols, which people can get from fruits, vegetables, seeds, and nuts

Chinese red yeast rice may also be an additional option for some people. This dietary supplement produces substances that also inhibit the HMG-CoA reductase enzyme, the target of statin medications.

However, statins have greater cholesterol-lowering potential, and as an OTC supplement, Chinese red yeast rice can vary in potency and quality, just as OTC fish oil supplements can. Also, some products may contain harmful contaminants.

Because of this, it is important to speak with a doctor before using Chinese red yeast rice for any health condition.

While OTC fish oil has a reputation for aiding heart health, it is not a medical treatment for the conditions that statins can treat. Most fish oils are dietary supplements that can vary in potency.

There are prescription omega-3 products that can help treat high triglyceride levels, as statins can. However, depending on the product, they can work in different ways.

People with high triglycerides or high cholesterol levels should consult a doctor before trying any additional supplements or if they want to try prescription omega-3.