Frequently Asked Questions
Common questions from patients of The Sandusky Dyslipidemia Model clinic
Table of Contents
About Cholesterol and Risk
Why is high cholesterol dangerous if I feel fine?
High cholesterol causes no symptoms. Plaque builds up in your arteries silently over years and decades. By the time symptoms appear — a heart attack or stroke — significant damage has already occurred. Treating cholesterol now prevents those events from happening in the future.
My cholesterol has always been high. Does it still matter?
Yes — in fact, it matters even more. The longer your arteries are exposed to high LDL cholesterol, the greater your risk. Bringing your levels down now can still reduce your chance of a heart attack or stroke, even if they have been high for years.
What is my “risk score” and how is it calculated?
Your provider uses a tool called the PREVENT calculator developed by the American Heart Association. It takes into account your age, sex, blood pressure, cholesterol levels, whether you have diabetes, whether you smoke, your kidney function, and your weight. The result is an estimate of your chance of having a heart attack, stroke, or heart failure over the next 10 to 30 years.
What does my coronary calcium score mean?
A coronary calcium score measures the amount of plaque buildup in the arteries of your heart using a quick CT scan. A score of 0 means no detectable calcium — this is very reassuring. Higher scores mean more plaque is present and that treatment to lower your cholesterol is more important. Your provider will explain what your specific score means for you.
About Your Medications
Do I have to take statins forever?
In most cases, yes. Cholesterol medications work by keeping your LDL low while you take them. If you stop, your cholesterol will go back up and plaque can start building again. Think of it like blood pressure medication — it works as long as you take it.
I have heard statins are dangerous. Is that true?
Statins are among the most studied medications in history. Large clinical trials involving hundreds of thousands of patients have shown they are safe and effective at preventing heart attacks and strokes. Some patients experience muscle aches, but serious side effects are very rare. The benefits far outweigh the risks for the vast majority of patients.
I had muscle aches on a statin. What now?
Muscle aches are the most common reason people stop statins, but many times these symptoms have other causes. At this clinic, we will:
- Check for other causes of muscle pain (thyroid problems, vitamin D deficiency, drug interactions)
- Try you on a different statin at a low dose — many people who cannot tolerate one statin do fine on another
- If you still cannot tolerate any statin, we have effective non-statin alternatives (pills and injections) that can lower your cholesterol
What are PCSK9 inhibitors?
These are newer injectable medications that dramatically lower LDL cholesterol — often by 50–60% on top of what other medications achieve. They are given as a small injection under the skin every 2 weeks or once a month. They have been proven to reduce heart attacks and strokes.
What is inclisiran?
Inclisiran is a newer medication that works in a similar way to PCSK9 inhibitors but is given as an injection at the clinic only twice a year (after an initial start-up period). This can be a good option if you have difficulty remembering daily pills or doing injections at home.
Do these medications require insurance approval?
PCSK9 inhibitors and inclisiran usually require prior authorization, which means your insurance company needs to approve coverage before you can start. Your care team will handle all the paperwork. This process typically takes 1–4 weeks. If your insurance denies coverage, we will appeal the decision and explore other options including manufacturer assistance programs.
About Advanced Tests
What is ApoB and why is it important?
ApoB (apolipoprotein B) is a blood test that counts the number of harmful cholesterol particles in your blood. Sometimes your LDL cholesterol number can look fine, but you actually have too many cholesterol particles — each one capable of getting stuck in your artery wall. ApoB catches this mismatch and helps your provider decide if your treatment needs to be stronger.
What is Lp(a) and why did my provider test it?
Lp(a), pronounced “L-P-little-a,” is a type of cholesterol particle that is almost entirely determined by your genes. You inherited your Lp(a) level from your parents, and it does not change much with diet, exercise, or most medications.
If your Lp(a) is high (125 nmol/L or more), it adds extra risk for heart disease on top of your other cholesterol numbers. This is why we test it once — it only needs to be checked a single time in your life.
If your Lp(a) is high:
- It is not your fault — this is genetic
- Your first-degree family members (parents, siblings, children) should also be tested
- We will lower your other risk factors more aggressively to compensate
- New medications that specifically lower Lp(a) are being studied and may become available in the future
What is an NMR LipoProfile?
This is a detailed blood test that measures the size and number of your cholesterol particles. It helps your provider identify a pattern of small, dense LDL particles that are particularly harmful. Not everyone needs this test — your provider will order it if the information would help guide your treatment.
About Familial Hypercholesterolemia (FH)
What is FH?
Familial hypercholesterolemia (FH) is an inherited condition that causes very high LDL cholesterol from birth. It is caused by a change (mutation) in a gene that controls how your body removes cholesterol from the blood. About 1 in 250 people has FH, but most do not know it.
How is FH diagnosed?
Your provider may suspect FH if your LDL cholesterol is very high (190 mg/dL or above), especially if you have a family history of high cholesterol or early heart disease. A scoring system and sometimes a genetic test (blood test sent to a lab) are used to confirm the diagnosis.
If I have FH, does my family need to be tested?
Yes. If you have FH, there is a 50% chance that each of your parents, siblings, and children also has it. We call this cascade screening. Early detection and treatment in family members can prevent heart disease. If a specific gene mutation was found in your blood, your family members can be tested for that exact mutation — this is a simple blood test.
Children under 18 should be evaluated by a pediatric specialist.
About This Clinic
How often will I need to come in?
- After starting or changing a medication: 4–8 weeks for a follow-up
- While we are adjusting your treatment: every 3–6 months
- Once your cholesterol is at goal and stable: once a year
Will I always need to come to this clinic?
Not necessarily. Once your cholesterol is well controlled and your medication regimen is stable, you may be able to return to your primary care provider for ongoing management. Some patients with more complex needs (FH, injectable medications, multi-drug regimens) will continue to be followed here.
Can I do my visits by video or phone?
Telemedicine is not currently available at this clinic. This may be added in a future version of our care model to improve access for patients who travel long distances.
Can I get supplements instead of prescription medications?
No. 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 have not been proven to prevent heart attacks or strokes in clinical trials. We only prescribe medications with strong scientific evidence behind them.
This material is for informational purposes only and does not replace advice from your healthcare provider.
Patient materials are currently available in English only. Additional languages may be added in future versions to expand access.