Preval HealthOur Approach
How we lower your LDL and ApoB
We lower LDL cholesterol (LDL-C) and ApoB with prescription medicine, online, until you reach the goal set for your risk, and then we keep them there. Care runs in three steps: measure ApoB and Lp(a) along with a full lipid panel, prescribe the right FDA-approved medicine, and recheck labs about every 90 days.
Licensed clinicians prescribe and follow up, using protocols written by a board-certified preventive cardiologist. Start with advanced lipid testing, or read our guide on how to lower ApoB.
Three Principles
We recheck and adjust to reach goal and keep you there.
Measure ApoB and Lp(a)
Beyond the standard lipid panel
LDL-C alone misses some of your risk. We measure ApoB, the count of particles that can enter the artery wall, and Lp(a), an inherited risk factor that routine panels don't include. When a calcium score would change your plan, your clinician may recommend one from a local imaging center.
Prescribe the Right Medicine
FDA-approved medicines, matched to you
Licensed clinicians prescribe from the full range of FDA-approved options: high-intensity statins, ezetimibe, bempedoic acid, highly purified EPA, and PCSK9 inhibitors (Repatha, Praluent, the daily pill Lipfendra and the once-monthly injection Lerochol). We're working with infusion centers to offer inclisiran (Leqvio).
Treat to a Goal
Adjust, then keep you there
We retest every 90 days. If your numbers haven't reached your goal, the plan changes to a new medicine, an adjusted dose or a combination. After you reach goal, we keep following your labs so you stay there. Your goal often sits below the lab's "normal" range.
Advanced Lipid Profiling
The markers that track your risk most closely.
A standard lipid panel gives you four useful numbers, and routine panels often don't include ApoB or Lp(a) yet. With advanced lipid testing, we add the markers research ties most closely to plaque, so your plan fits your risk.
ApoB
Apolipoprotein B
A direct count of the particles that build plaque. Each one carries a single ApoB molecule and can enter the artery wall and start plaque.
Why it matters
LDL-C measures cholesterol mass; ApoB counts the particles. Two people with the same LDL-C can have very different ApoB levels, and different risk.
Lp(a)
Lipoprotein(a)
An inherited lipoprotein that raises the risk of plaque and blood clots on its own. Your level is set at birth, stays about the same for life, and standard panels leave it out.
Why it matters
About 1 in 5 people have high Lp(a) (EAS consensus, 2022), and diet, exercise and statins don't lower it much. Because it's inherited and stable, the 2026 guideline recommends testing it at least once in adulthood.
LDL-C
Low-Density Lipoprotein Cholesterol
The traditional cholesterol number, and still the main treatment goal in the 2026 guideline. We read it alongside ApoB and Lp(a).
Why it matters
Almost half of people hospitalized with coronary artery disease had an LDL-C under 100 mg/dL (Sachdeva, American Heart Journal, 2009, 136,905 hospitalizations). Your goal depends on your risk.
hs-CRP
High-Sensitivity C-Reactive Protein
A blood marker of low-grade inflammation, which plays a part in how plaque grows and becomes unstable.
Why it matters
Some risk from inflammation remains even when LDL-C is at goal. hs-CRP helps show whether inflammation is adding to your risk and whether more treatment makes sense.
The Preval Formulary
Six classes of medicine, aimed at one goal.
Clinicians choose from the full range of FDA-approved cholesterol and heart-protective medicines, and fit the plan to your lab results, risk factors and how you respond. See how we handle PCSK9 inhibitor prescriptions and statin intolerance.
High-Intensity Statins
Atorvastatin 40 to 80 mg, Rosuvastatin 20 to 40 mg
The foundation of cholesterol treatment, with the most outcomes data. We usually start here and adjust the dose to reach your goal. If statins don't agree with you, our statin intolerance plan finds another route.
Ezetimibe
Ezetimibe 10mg
Blocks cholesterol absorption in the gut. An inexpensive pill that adds to a statin; in IMPROVE-IT it lowered LDL further and reduced cardiovascular events. Our usual next step when a statin alone isn't enough.
PCSK9 Inhibitors
Repatha, Praluent, Lerochol (injections); Lipfendra (daily pill)
Medicines that block PCSK9 so the liver clears more LDL. In FOURIER, evolocumab lowered LDL by 59% and reduced heart attacks and strokes; in GLAGOV, 64% of patients on evolocumab had plaque regression, versus 47% on a statin alone.
Inclisiran
Inclisiran (Leqvio)
An siRNA that switches off PCSK9 production in the liver. It's a shot given in a clinic twice a year after the first two doses. We're working with infusion centers to offer it, so ask about availability in your area.
Bempedoic Acid
Bempedoic acid (Nexletol)
An ACL inhibitor that works upstream of statins in the cholesterol synthesis pathway. Especially useful for people with statin-associated muscle symptoms.
Highly Purified EPA
Icosapent ethyl (Vascepa)
For people with high triglycerides already on a statin. In the REDUCE-IT trial it lowered major cardiovascular events by 25%.
All medications are FDA-approved and prescribed by licensed clinicians following protocols a cardiologist wrote. Clinicians prescribe them only for FDA-approved uses.
Sources: IMPROVE-IT (Cannon, NEJM, 2015); FOURIER (Sabatine, NEJM, 2017); GLAGOV (Nicholls, JAMA, 2016); ORION-10 and ORION-11 (Ray, NEJM, 2020); bempedoic acid phase 3 pooled analysis (JAHA, 2026); REDUCE-IT (Bhatt, NEJM, 2019). More in our guide to prescription cholesterol medications.
Routine Care and Preval, Side by Side
How Preval Fits In
Your primary care clinician looks after all of your health. We focus on cholesterol alone and work alongside them.
Lipid testing
Standard lipid panel; ApoB and Lp(a) when ordered
Lipid panel plus ApoB, Lp(a) and hs-CRP for everyone
Risk assessment
Risk calculator plus your history
Risk calculator plus ApoB, Lp(a) and family history
Medication options
Usually starts with a statin, with other options as needed
Statins, ezetimibe, bempedoic acid and PCSK9 inhibitors, combined as needed
Calcium score
Ordered when it would help a decision
Your clinician may recommend one from a local imaging center when it would change your plan
Follow-up
Rechecked during routine visits that cover many health topics
Labs and a plan review about every 90 days, to reach goal and stay there
Treatment goals
Set by your clinician
2026 ACC/AHA goals by risk: LDL-C below 100, 70 or 55; ApoB below 90, 70 or 55
Paying for treatment
Insurance, often with prior authorization and step therapy first
Cash pay: generics at low pharmacy prices, PCSK9 inhibitors through manufacturer cash programs, with no step therapy
| Metric | Routine Care | Preval Protocol |
|---|---|---|
| Lipid testing | Standard lipid panel; ApoB and Lp(a) when ordered | Lipid panel plus ApoB, Lp(a) and hs-CRP for everyone |
| Risk assessment | Risk calculator plus your history | Risk calculator plus ApoB, Lp(a) and family history |
| Medication options | Usually starts with a statin, with other options as needed | Statins, ezetimibe, bempedoic acid and PCSK9 inhibitors, combined as needed |
| Calcium score | Ordered when it would help a decision | Your clinician may recommend one from a local imaging center when it would change your plan |
| Follow-up | Rechecked during routine visits that cover many health topics | Labs and a plan review about every 90 days, to reach goal and stay there |
| Treatment goals | Set by your clinician | 2026 ACC/AHA goals by risk: LDL-C below 100, 70 or 55; ApoB below 90, 70 or 55 |
| Paying for treatment | Insurance, often with prior authorization and step therapy first | Cash pay: generics at low pharmacy prices, PCSK9 inhibitors through manufacturer cash programs, with no step therapy |
Step by Step
From first lab to goal, and staying there.
Risk Assessment
- We order advanced lipid testing. Recent results work too.
- ApoB, Lp(a), LDL-C, hs-CRP, triglycerides, full panel
- Heart and family history questionnaire
- Review of current medications and prior treatment
Clinician Visit
- Telehealth visit with a licensed clinician, following protocols a cardiologist wrote
- Review of your lipid results and overall risk
- Your goal and your medicine options
- You and your clinician choose the plan together
Prescription and Start
- Prescriptions sent to your pharmacy or specialty pharmacy
- What to expect from your medicine, and when to message us
- A plan to watch for side effects
- Messaging access to your care team for questions
First Recheck
- Follow-up labs to see how much your numbers dropped
- A dose change or an added medicine if you're above goal
- A check for side effects
- An updated risk assessment from the new labs
Ongoing Management
- Labs every quarter, with changes as needed
- Plan updates as new medicines are approved
- A yearly review of your overall risk
- Coordination with your primary care physician
Start with your numbers.
We're rolling out services gradually and accepting a limited number of patients. Join the waitlist for an early spot.
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