01 — Clinic Overview
Table of Contents
1.0 Mission Statement
The Sandusky Dyslipidemia Model is a specialized outpatient clinic dedicated to the evidence-based management of dyslipidemia and associated cardiovascular risk. The clinic serves as a regional referral center for patients requiring focused evaluation and treatment of lipid disorders.
Our mission is to reduce atherosclerotic cardiovascular disease (ASCVD) events through rigorous application of the 2026 ACC/AHA/Multisociety Guidelines on the Management of Dyslipidemia [1], enhanced by advanced diagnostic tools and a “lower is better” treatment philosophy.
1.1 Treatment Philosophy
The clinic adheres to a “lower is better” philosophy for atherogenic lipoproteins, supported by the totality of evidence from randomized controlled trials and Mendelian randomization studies demonstrating that the relationship between LDL-C exposure and ASCVD risk is log-linear and that lower achieved levels of atherogenic lipoproteins translate to lower cardiovascular event rates [2, 3].
1.1.1 Guideline Adherence
All clinical decisions are grounded in the 2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia [1]. Guideline-recommended LDL-C thresholds are maintained as the minimum treatment targets.
1.1.2 Beyond-Guideline Intensification
Where advanced tools — including apolipoprotein B (ApoB), lipoprotein(a) [Lp(a)], coronary artery calcium (CAC) scoring, and advanced lipid fractionation — reveal residual or under-recognized risk, more aggressive lipid-lowering is pursued even in patients who have achieved standard guideline targets.
2.0 Scope of Practice
2.1 Services Provided
- Comprehensive lipid evaluation and risk assessment
- ASCVD risk stratification using the AHA PREVENT equations [4]
- Advanced lipid testing (ApoB, NMR LipoProfile, Lp(a))
- In-house coronary artery calcium (CAC) scoring
- Carotid duplex ultrasonography (standard indications)
- Coronary computed tomography angiography (CCTA) for selected patients (see Section 2.1.1)
- Pharmacotherapy initiation, optimization, and escalation
- Familial hypercholesterolemia (FH) evaluation, genetic testing, and cascade screening
- Statin intolerance evaluation and management
- Secondary dyslipidemia screening
- Prior authorization support for advanced therapies (PCSK9 inhibitors, inclisiran)
2.1.1 CCTA Eligibility
CCTA is available for patients meeting all of the following criteria:
- Symptomatic with low-to-intermediate pre-test probability of coronary artery disease
- Not in atrial fibrillation
- BMI ≤ 40 kg/m²
- No prior coronary stents
2.2 Services Not Provided
The following services are outside the scope of this clinic:
| Service | Notes |
|---|---|
| Management of diabetes, CKD, or other comorbidities | These conditions are documented as risk modifiers but managed by the referring provider |
| Dietary counseling services | Diet and exercise are discussed as adjuncts; formal counseling is referred out |
| Telemedicine visits | Not currently offered; may be added in future versions to expand access |
| EHR-integrated decision support | Not currently available |
| Pediatric lipid management | Adults ≥ 18 years only; pediatric patients are referred to appropriate specialists |
3.0 Staffing Model
The clinic is staffed by:
| Role | Count | Responsibilities |
|---|---|---|
| Physician (MD/DO) | 1 | Clinical oversight, complex cases, FH evaluation, advanced imaging interpretation |
| Nurse Practitioner (NP) | 1 | Follow-up visits, medication titration, prior authorizations, patient education |
| Nursing Staff (RN/MA) | As needed | Patient intake, vital signs, scheduling, lab coordination |
4.0 Visit Structure
4.1 New Patient Visit — 40 Minutes
| Phase | Duration | Activities |
|---|---|---|
| Nursing intake | 10 min | Vital signs, medication reconciliation, chief complaint |
| Provider encounter | 25 min | History, physical exam, review of records/labs, risk assessment, treatment plan discussion |
| Wrap-up | 5 min | Orders placed, follow-up scheduled, patient education materials provided |
4.2 Follow-Up Visit — 20 Minutes
| Phase | Duration | Activities |
|---|---|---|
| Nursing intake | 5 min | Vital signs, medication reconciliation, interval history |
| Provider encounter | 12 min | Lab review, medication tolerance/efficacy, treatment adjustment |
| Wrap-up | 3 min | Orders placed, follow-up scheduled |
4.3 Lab Timing
Laboratories are ordered at the conclusion of each visit to be completed prior to the next scheduled visit. This ensures that results are available for review at the time of the encounter. The specific laboratory panel is at the provider’s discretion (see 03 — Initial Assessment, Section 3.0).
5.0 Follow-Up Cadence
| Patient Status | Follow-Up Interval |
|---|---|
| New medication start or dose change | 4–8 weeks |
| Titrating to goal, not yet stable | Every 3–6 months |
| At goal, stable on therapy | Annually |
6.0 Excluded Therapies
The following therapies are not included in this clinic’s therapeutic plan:
6.1 Bile Acid Sequestrants
Bile acid sequestrants (cholestyramine, colestipol, colesevelam) are not used due to gastrointestinal tolerability concerns, drug interaction burden, and the availability of better-tolerated alternatives with stronger outcomes data.
6.2 Nutraceuticals
Nutraceuticals such as plant sterols/stanols, red yeast rice, bergamot, berberine, and omega-3 supplements are not included in this clinic’s therapeutic plan. These agents lack sufficient randomized controlled trial evidence for ASCVD event reduction and may provide false reassurance, delay initiation of proven therapies, or introduce unmonitored drug interactions.
6.3 Emerging Investigational Agents
Lp(a)-targeted therapies (muvalaplin, lepodisiran, olpasiran) and CETP inhibitors (obicetrapib) are not currently included. These may be incorporated in future versions as trial data mature and regulatory approvals are obtained.
7.0 Referral Process
Patients are referred through the standard referral processes of the referring provider’s clinic or health system. No custom referral form is required. The clinic accepts referrals from:
- Primary care providers
- Cardiologists
- Neurologists
- Endocrinologists
- Other specialists as appropriate
Upon receipt of a referral, the clinic applies eligibility criteria (see 02 — Patient Eligibility) and schedules the patient for a new patient visit.
8.0 Version History
| Version | Date | Description |
|---|---|---|
| 1.0.0 | 2026-03-30 | Initial release |
References
- 2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia. J Am Coll Cardiol. 2026.
- Ference BA, Ginsberg HN, Graham I, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2017;38(32):2459–2472.
- Cholesterol Treatment Trialists’ (CTT) Collaboration. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010;376(9753):1670–1681.
- Khan SS, Matsushita K, Sang Y, et al. Development and validation of the American Heart Association’s PREVENT equations. Circulation. 2024;149(6):e430–e449.