Stop the drug, not the ApoB target.
Board certified in Clinical Lipidology & Obesity Medicine · Licensed in all 50 states & DC
Muscle symptoms, liver-enzyme changes, and true statin-associated autoimmune myopathy are different problems. Most 'intolerance' is dose, timing, or nocebo. Some of it is real. Either way, ApoB still has a target.
Rechallenge or restructure the statin when it is safe. If it is not, leave the statin and use non-statin LDL-lowering that is actually indicated. No invented desensitization protocols.
Ezetimibe, bempedoic acid, evolocumab (Repatha), inclisiran (Leqvio), enlicitide (Lipfendra). Chosen when indicated. Cost of medication is not in membership.
The goal is ApoB, not a particular brand. We use FDA-approved agents through your pharmacy. No compounding.
Ezetimibe is the usual first add-on or substitute. Bempedoic acid is an ACL inhibitor that does not require muscle activation of the statin pathway.
Monoclonal antibody or twice-yearly inclisiran after loading when oral therapy cannot reach the ApoB target.
FDA-approved 16 July 2026. First oral PCSK9 inhibitor. Useful when injections are a barrier and the label fits. Prescribed when indicated.
Medication cost is not included in membership. No compounded medications. Eligibility is confirmed at signup.
Direct-pay lipidology. Cancel anytime. Licensed in all 50 states and DC. Labs and imaging are billed to your insurance; medication is billed at your pharmacy.