Our Approach
Lower cholesterol. Lower risk.
We use prescription medicine to reduce your cholesterol and cardiovascular risk factors as low as safely possible. Then we keep them there.
Three Principles
We keep at it until we find what works for you.
Measure What Matters
Beyond the standard lipid panel
Standard LDL-C is a blunt instrument. We profile ApoB - the actual atherogenic particle count - and Lp(a), a genetically determined risk factor that most physicians never order. If you have detectable plaque, we deploy CCTA imaging to see it directly. We don't guess. We see.
Prescribe What Works
Clinical-grade pharmacology, not half-measures
We utilize the full arsenal of FDA-approved lipid-lowering therapies: high-intensity statins, ezetimibe, PCSK9 inhibitors, inclisiran, bempedoic acid, and highly purified EPA. Clinical guidelines are a decade behind pharmaceutical reality. We close that gap for every patient.
Treat to Target
Iterate until optimized
Every 90 days, we retest. If your numbers haven't reached target, the protocol changes - new agents, adjusted doses, combination strategies. We do not accept "normal." We pursue optimal.
Advanced Lipid Profiling
The markers that actually reflect your risk.
A standard lipid panel gives you four numbers and a false sense of security. We measure the biomarkers that peer-reviewed literature has proven to be the true drivers of cardiovascular disease.
ApoB
Apolipoprotein B
The single best measure of atherogenic particle burden. Each ApoB molecule represents one particle capable of entering the arterial wall and initiating plaque.
Why it matters
LDL-C measures cholesterol mass, not particle count. Two patients with identical LDL-C can have vastly different ApoB levels - and vastly different risk.
Lp(a)
Lipoprotein(a)
A genetically determined lipoprotein that independently drives atherosclerosis and thrombosis. Present from birth, stable across your lifetime, and invisible on standard panels.
Why it matters
Elevated Lp(a) affects 1 in 5 people and cannot be lowered by diet, exercise, or statins. Most patients have never been tested. Once measured, it permanently changes the risk calculation.
LDL-C
Low-Density Lipoprotein Cholesterol
The traditional marker of cardiovascular risk. Still relevant, but insufficient alone. We treat it as one data point in a larger constellation, not the only one.
Why it matters
Half of heart attacks occur in people with 'normal' LDL-C. We use it alongside ApoB and Lp(a) to build the complete picture.
hs-CRP
High-Sensitivity C-Reactive Protein
A marker of systemic vascular inflammation. Elevated hs-CRP signals active inflammatory processes in vessel walls that accelerate plaque instability.
Why it matters
Residual inflammatory risk persists even after LDL-C is optimized. This marker helps determine whether anti-inflammatory or additional lipid strategies are warranted.
The Preval Formulary
Six classes of therapy. One objective.
We draw from the complete spectrum of FDA-approved lipid-lowering and cardioprotective agents. Each protocol is tailored to the individual patient's biomarker profile, risk factors, and treatment response.
High-Intensity Statins
Atorvastatin 40-80mg, Rosuvastatin 20-40mg
The cornerstone of lipid-lowering therapy. We start here and titrate aggressively. Most patients are undertreated - on low or moderate doses when high-intensity is indicated.
Ezetimibe
Ezetimibe 10mg
Blocks intestinal cholesterol absorption. Simple, inexpensive, and additive to statin therapy. Standard practice at Preval when statins alone are insufficient.
PCSK9 Inhibitors
Evolocumab, Alirocumab
Monoclonal antibodies that dramatically reduce LDL-C and are proven to regress coronary plaque. The GLAGOV trial showed measurable plaque reduction in 64% of patients.
Inclisiran
Inclisiran (Leqvio)
An siRNA that silences PCSK9 production at the mRNA level. Two injections per year - administered in the clinic - deliver sustained LDL-C reduction without daily medication burden.
Bempedoic Acid
Bempedoic acid (Nexletol)
An ACL inhibitor that works upstream of statins in the cholesterol synthesis pathway. Particularly valuable for patients with statin-associated muscle symptoms.
Highly Purified EPA
Icosapent ethyl (Vascepa)
Addresses residual triglyceride-mediated risk. The REDUCE-IT trial demonstrated a 25% reduction in major adverse cardiovascular events on top of optimized statin therapy.
All medications are FDA-approved and prescribed under cardiologist oversight. Protocol selection is based on individual biomarker profile, comorbidities, and treatment response. We do not prescribe off-label therapies.
Standard Care vs. Preval Protocol
The Guideline Gap
Side by side, the difference between conventional care and what the evidence actually supports.
Lipid Screening
Standard LDL-C only
ApoB, Lp(a), LDL-C, hs-CRP, triglycerides
Intervention Threshold
Wait for 10-year risk score to justify treatment
Immediate correction of elevated atherogenic markers
Medication Strategy
Low-dose generic statin
Multi-modal: high-intensity statin + ezetimibe + PCSK9i as needed
Cardiac Imaging
Only after symptoms or events
CCTA referral when clinically indicated for plaque assessment
Follow-up Frequency
Annual, if remembered
Every 90 days with lab re-testing and protocol adjustment
Treatment Targets
"Below 100" is fine
ApoB < 60, LDL-C < 55, lowest achievable with tolerability
Provider Access
6-8 week wait for specialist appointment
Virtual consultation within days, async messaging anytime
| Metric | Standard Care | Preval Protocol |
|---|---|---|
| Lipid Screening | Standard LDL-C only | ApoB, Lp(a), LDL-C, hs-CRP, triglycerides |
| Intervention Threshold | Wait for 10-year risk score to justify treatment | Immediate correction of elevated atherogenic markers |
| Medication Strategy | Low-dose generic statin | Multi-modal: high-intensity statin + ezetimibe + PCSK9i as needed |
| Cardiac Imaging | Only after symptoms or events | CCTA referral when clinically indicated for plaque assessment |
| Follow-up Frequency | Annual, if remembered | Every 90 days with lab re-testing and protocol adjustment |
| Treatment Targets | "Below 100" is fine | ApoB < 60, LDL-C < 55, lowest achievable with tolerability |
| Provider Access | 6-8 week wait for specialist appointment | Virtual consultation within days, async messaging anytime |
Patient Journey
From first lab to sustained optimization.
Risk Assessment
- Upload existing labs or we order advanced lipid testing
- ApoB, Lp(a), LDL-C, hs-CRP, triglycerides, full panel
- Comprehensive cardiac and family history intake
- Review of current medications and prior treatment
Expert Consultation
- Video visit with a cardiology-trained provider
- Full review of your lipid profile and risk stratification
- Discussion of treatment goals and therapy options
- Shared decision-making on your personalized protocol
Prescription & Initiation
- Prescriptions sent to your pharmacy or specialty pharmacy
- Medication onboarding - what to expect, when to escalate
- Side effect monitoring plan established
- Messaging access to your care team for questions
First Optimization
- Follow-up labs to measure treatment response
- Dose adjustments or therapy additions if targets not met
- Side effect review and mitigation if needed
- Updated risk assessment based on new biomarkers
Ongoing Management
- Continued quarterly lab monitoring and optimization
- Protocol adjustments as new therapies become available
- Annual comprehensive review with full risk recalculation
- Coordination with your primary care physician
Ready for a different standard?
We are gradually rolling out services and accepting a limited number of patients. Join the waitlist to be among the first.
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