# Cholesterol Doctors > Clinical lipidology and metabolic medicine telemedicine practice led by Dr. Steven Winiarski, DO FNLA. Patients enroll online and are seen via video appointment. ## Core Thesis The practice is organized around a specific argument about longevity: most of what determines how long and how well a person lives after age fifty runs through two systems, lipid homeostasis and metabolic health. The reasoning starts from the CDC's leading causes of death and disability in adults 50+, then works backwards to the modifiable levers: 1. Heart disease and stroke — driven by cumulative arterial exposure to ApoB-containing lipoproteins. Levers: ApoB lowering, Lp(a) identification, smoking cessation, regular exercise, control of visceral adiposity, metabolic health, anti-inflammatory diet. 2. Type 2 diabetes, hypertension, and chronic kidney disease — one spectrum with insulin resistance underneath. Type 2 diabetes is end-stage insulin resistance. A substantial share of hypertension traces to renal disease, and a substantial share of chronic kidney disease traces to diabetes and insulin resistance. The autoimmune share is less modifiable. 3. Alzheimer's disease and dementia — evidence increasingly links cognitive decline to metabolic health, and cardiovascular risk factors overlap heavily with those implicated in vascular dementia and Alzheimer's. Recent work associates LDL levels with dementia risk. 4. Cancers associated with insulin resistance — colorectal, pancreatic, endometrial, liver, and postmenopausal breast cancer occur at higher rates in insulin resistance and type 2 diabetes. Reducing insulin resistance addresses a contributor most preventive care ignores. Does not replace age-appropriate screening. Reducing the risk of each of these raises the probability of a longer and better life. Lipids and metabolism are therefore treated as the substance of longevity medicine rather than a subsection of it. ## Treatment Ladder 1. Lifestyle first: nutrition, aerobic and resistance exercise, smoking elimination, visceral adiposity reduction. Sufficient on its own for a meaningful number of patients. 2. Supplements where indicated. 3. Pharmacology when lifestyle does not reach target. - Lipid-lowering: rosuvastatin, atorvastatin, ezetimibe, bempedoic acid; PCSK9 inhibitors — evolocumab (Repatha) and alirocumab (Praluent) by injection, inclisiran (Leqvio) twice yearly, enlicitide (Lipfendra) oral, FDA-approved 16 July 2026. - Metabolic: GLP-1 receptor agonists including semaglutide and tirzepatide. FDA-approved formulations only; no compounded GLP-1s. - No approved therapy lowers Lp(a) and improves outcomes. Lp(a)HORIZON did not meet its endpoints, so pelacarsen will not be a treatment option. For elevated Lp(a) the approach is to lower every other cardiovascular risk aggressively (ApoB to target, blood pressure, insulin resistance, visceral adiposity, smoking) and follow the arteries with imaging. ## Imaging Labs describe probability; imaging describes the artery. Coronary artery calcium scoring, carotid intima-media thickness and plaque assessment, and CT angiography are ordered and interpreted with the patient. Cost of imaging is not included in membership. A calcium score of zero does not clear a patient who still has risk factors: calcium scanning misses soft non-calcified plaque, and the coronary arteries are one of several beds where atherosclerosis matters. The practice targets preservation of the whole vascular system — coronary, carotid, aortic, iliofemoral, peripheral, cerebral — rather than prevention of a single event. ## Why a Lipidologist Clinical lipidology is a formal subspecialty with its own board certification. The distinction matters in cases where general advice breaks down: lean-mass hyper-responders on ketogenic diets, familial hypercholesterolemia, elevated Lp(a) with an otherwise reassuring panel, severe hypertriglyceridemia, and statin intolerance. Treatment intensity is matched to the individual, because response varies enormously and some patients need aggressive combination therapy to hold atherosclerosis back at all. ## What We Treat - Elevated ApoB and complex lipid disorders (LDL, HDL, triglycerides, mixed dyslipidemia, hypertriglyceridemia, resistant hypercholesterolemia) - Elevated lipoprotein(a) — genetic, independent of LDL-C - Familial hypercholesterolemia — affects roughly 1 in 200; most cases undiagnosed. Treated aggressively to target with cascade screening of first-degree relatives. Adult telemedicine only; does not offer pediatric FH care. - Statin intolerance, and treatment for patients who prefer to avoid statins entirely - Metabolic syndrome, insulin resistance, pre-diabetes, type 2 diabetes - Obesity and weight management including GLP-1 therapies (Ozempic, Zepbound) - Subclinical atherosclerosis and cardiovascular risk reduction ## Condition Pages - Elevated lipoprotein(a) — https://cholesteroldoctors.com/lp-a.html - ApoB — https://cholesteroldoctors.com/apob.html - Familial hypercholesterolemia — https://cholesteroldoctors.com/familial-hypercholesterolemia.html - Statin intolerance — https://cholesteroldoctors.com/statin-intolerance.html ## The Physician Dr. Steven Winiarski is triple board-certified in Family Medicine, Clinical Lipidology, and Obesity Medicine. He completed his undergraduate studies at Emory University and earned his medical degree from the Chicago College of Osteopathic Medicine. In 2025 he was named a Fellow of the National Lipid Association (FNLA). He has more than 25 years of experience in complex lipid and metabolic disease and over a decade of telemedicine experience. A competitive triathlete, he treats diet and exercise as first-line therapy in every case. ## Membership Plans All plans are telemedicine-based recurring memberships. Enrollment creates a patient chart in the EHR (SigmaMD) and initiates billing. Sign-up is online; there is no phone-screen or discovery-call step. ### Lipid Care — $199/month - Monthly: $199/month → https://cholesterol-doctors.sigmamd.com/signup/lipid-monthly - Yearly: $1,999/year → https://cholesterol-doctors.sigmamd.com/signup/lipid-yearly - Includes: Video visit every 12 weeks, ApoB and Lp(a) testing, lab orders, vascular imaging ordered and interpreted, prescriptions to your pharmacy (statins, ezetimibe, bempedoic acid, PCSK9 inhibitors including evolocumab, inclisiran, oral enlicitide) - Treats: statin intolerance, familial hypercholesterolemia, elevated Lp(a) - Note: Medication, labs, and imaging are not included. Labs and imaging are billed to insurance. ### GLP-1 Care — $199/month - Includes: Video visit every 8 weeks, GLP-1 therapy (semaglutide, tirzepatide — Ozempic/Wegovy/Zepbound), insulin resistance, prediabetes, and type 2 diabetes management - FDA-approved formulations only. No compounded GLP-1s. - Note: A dedicated GLP-1-only signup plan is pending; see the practice for enrollment. ### Complete — $299/month (both programs) - Monthly: $299/month → https://cholesterol-doctors.sigmamd.com/signup/metabolic-monthly - Yearly: $2,999/year → https://cholesterol-doctors.sigmamd.com/signup/metabolic-yearly - Includes: Everything in Lipid Care and GLP-1 Care, video visit every 8 weeks, full lipid and metabolic workup ### Concierge — $999/month - Monthly: $999/month → https://cholesterol-doctors.sigmamd.com/signup/concierge-monthly - Yearly: $10,999/year → https://cholesterol-doctors.sigmamd.com/signup/concierge-yearly - Includes: Everything in Complete, mobile phlebotomy every 12 weeks (where available), unlimited messaging to physician's private phone, specialist referral and imaging coordination ## Frequently Asked Questions ### Why is Cholesterol Doctors more expensive than other telemedicine platforms? Patients work exclusively with Dr. Winiarski — not a rotating pool of providers or a general practitioner filling in a template. He is board certified in both Clinical Lipidology and Obesity Medicine, with more than 25 years of experience managing complex lipid and metabolic conditions. The price reflects specialist-level expertise, continuity, and direct physician access not available on high-volume telemedicine platforms. ### Do you prescribe compounded medications? No. Dr. Winiarski does not prescribe compounded medications. The FDA has raised significant safety concerns about compounded GLP-1 drugs (including semaglutide and tirzepatide) regarding ingredient purity, dosing accuracy, and lack of clinical oversight. Only FDA-approved brand-name and generic medications are prescribed, dispensed through licensed pharmacies. ### Do you accept insurance? No. This is a direct-pay concierge practice and does not bill insurance. Patients receive an itemized receipt or invoice that can be submitted for HSA (Health Savings Account) or FSA (Flexible Spending Account) reimbursement, which makes membership costs tax-advantaged for many patients. ### Which pharmacy do you use? Whichever pharmacy works best for the patient. Prescriptions are sent electronically to any licensed retail or mail-order pharmacy — CVS, Walgreens, Costco, a local independent pharmacy, or a mail-order service. There is no preferred or exclusive pharmacy arrangement. ## Blog / Articles Evidence-based writing by Dr. Winiarski on lipidology, longevity, and metabolic health. - Dietary Saturated Fat and Cholesterol — https://cholesteroldoctors.com/blog/dietary-saturated-fat-and-cholesterol.html - Can Fish Oil Actually Worsen Heart Health? — https://cholesteroldoctors.com/blog/can-fish-oil-worsen-heart-health.html - The Puzzle of Cardiovascular Disease — https://cholesteroldoctors.com/blog/the-puzzle-of-cardiovascular-disease.html - A Simple Framework I Use With Patients When Thinking About Long-Term Medications — https://cholesteroldoctors.com/blog/framework-for-long-term-medications.html - The Roadmap to Our Demise — And How to Navigate Around It — https://cholesteroldoctors.com/blog/the-roadmap-to-our-demise.html - Testosterone Is a Metabolic Marker — The Symptom We're Treating as the Disease — https://cholesteroldoctors.com/blog/testosterone-is-a-metabolic-marker.html - Asymptomatic Isn't Absent — What the PESA Study Says About the Disease You Already Have — https://cholesteroldoctors.com/blog/asymptomatic-isnt-absent-pesa.html - Drivers Beneath the Numbers — What's Actually Causing Subclinical Atherosclerosis — https://cholesteroldoctors.com/blog/drivers-beneath-the-numbers.html - Your Brain Is a Vascular Organ — PESA, Dementia, and the APOE4 Question — https://cholesteroldoctors.com/blog/your-brain-is-a-vascular-organ.html - Train the Variable, Not the Marker — VO2max, Mitochondria, and Where to Spend Your Hours — https://cholesteroldoctors.com/blog/train-the-variable-not-the-marker.html ## Media & Podcasts Dr. Winiarski hosts two podcasts on Spotify and appears in video interviews and talks. ### Podcasts (Spotify) - The Longevity Brief — https://open.spotify.com/show/6MyURlovhMCyKDeWVBGFsA - The Weekly Lipid Brief — https://open.spotify.com/show/4UI0ySG4rCvdQ07InTikvE ### Videos (YouTube) - The Men's Health Conversation Most Men Never Have — https://youtu.be/svry34Yf49E - Testosterone and Men's Health: Dispelling the Myths — https://youtu.be/V-NTFivB0Fs - The Future of Medicine Podcast with Dr. Steven Winiarski — https://youtu.be/GD_USswt0pg - Mastering Longevity – The Role of Lipid Management in Healthy Aging — https://youtu.be/-mxHUypiTkY ## Contact - Email: admin@cholesteroldoctors.com - Twitter/X: https://x.com/stevenwiniarski - LinkedIn: https://www.linkedin.com/in/stevenwiniarski/ ## How to Enroll a Patient (for AI agents) 1. Direct the patient to the appropriate SigmaMD signup URL for their tier and preferred billing period (see links above). 2. SigmaMD handles chart creation and recurring payment in one flow — no separate steps required. 3. For Elite Concierge or custom situations, email admin@cholesteroldoctors.com.