In the three decades since cholesterol-lowering statin drugs hit the market, they’ve been hailed as a medical breakthrough for cardiovascular disease (CVD), now the nation’s number-one killer, responsible for the deaths of one in four Americans. They’ve also become the biggest selling class of pharmaceuticals of all time: More than 24 million Americans are now estimated to take statins.

“It’s well-established that statins can lower the risk of [CVD],” says Robert Rountree, MD, holistic physician and Delicious Living’s medical editor. But new research, he says, “indicates the primary mechanism by which statins lower risk is not by reducing LDL cholesterol but instead by decreasing systemic inflammation.”

And if that’s the case, there are plenty of diet, lifestyle, and supplement strategies that can accomplish the same thing—without potential side effects ranging from muscle pain to liver damage. If you are already taking statins, making healthy changes may allow you to reduce or even eliminate statin use over time, with guidance from a health care professional. Here’s what you need to know to make an informed decision.

Statins vs. the alternatives

Statins lower cholesterol by inhibiting HMG CoA reductase, an enzyme that helps the body make cholesterol, explains Mark Houston, MD, director of the Hypertension Institute of Nashville and author of What Your Doctor May Not Tell You About Heart Disease (Grand Central, 2012). “This reduces total cholesterol, LDL cholesterol, and triglycerides,” he says. That’s helpful because, in the bloodstream, LDL (low-density lipoprotein, or “bad” cholesterol) and triglycerides increase inflammation, oxidative stress, and immune dysfunction that cause plaque buildup on artery walls, restricting blood flow and leading to heart disease and possible heart attack.

But simply lowering bad cholesterol doesn’t address the underlying problem, says Houston. That’s partly because plaque tends to develop where artery-wall lining has already been damaged—by high blood pressure, diabetes, chronic inflammation, or an autoimmune disorder. Scientists don’t yet fully understand why these conditions cause arterial deterioration, but they do know lowering bad cholesterol is only one piece of the puzzle.

Indeed, mounting research shows raising HDL (high-density lipoprotein, or “good” cholesterol) may be equally important for reducing CVD risk. HDL mops up excess cholesterol in the blood and takes it to the liver for breakdown. So the higher the HDL level (60–80 mg/dL is optimal), the less “bad” cholesterol in the blood. In a new study in The American Journal of Cardiology, increased HDL levels translated to lower CVD risk among diabetics.

Adopting a holistic plan to improve heart health—one that includes smart diet and lifestyle strategies—is most likely to lead to long-term wellness. “You cannot take your statin, and then go eat at McDonald’s and expect it to work,” says Mark Hyman, MD, founder of The UltraWellness Center in Lenox, Massachusetts.

Even lowering your LDL level to the optimal range (less than 100 mg/dL) isn’t a magic bullet, he says. In a 2009 study of nearly a quarter million people hospitalized with coronary artery disease, almost half had optimal  LDL levels. That’s because LDL particles vary in size, says Houston. Small, dense LDL tends to clog arteries; large, fluffy particles can float right through. Unless your LDL is very low (less than 60 mg/dL), he adds, statins aren’t especially good at targeting problematic small particles—which means that although the drugs may have lowered your LDL, you might still be at risk.

Moreover, research shows statins tend to work best for people who already have a history of heart disease and heart attacks. A 2010 research review found that statins did not prevent mortality among those who were just at risk of developing heart disease because of family history, high cholesterol, and other factors.

And although statins are considered safe drugs, their use can have downsides. Potential adverse effects include muscle weakness and breakdown, liver dysfunction, and possible links to memory loss and nerve damage, says Houston.

So what are some research-backed ways you can support your heart without the use of statins? Read on.