Preval HealthStatin Intolerance
Can't take statins? Other medicines can still lower your LDL.
For adults who stopped a statin or couldn't start one. Licensed clinicians check whether the statin caused your symptoms, retry one only if it makes sense, and step through non-statin medicines to bring your LDL cholesterol (LDL-C) and ApoB to target and keep them there, all by telehealth.
Online, nationwide in the US. Protocols written by a board-certified preventive cardiologist.
What is statin intolerance, and how do you treat it?
Statin intolerance means side effects from a statin, most often muscle aches or weakness, that improve when the dose drops or the statin stops. Treatment steps through non-statin medicines (ezetimibe, bempedoic acid, then PCSK9 inhibitors or inclisiran) until your LDL reaches target. Several well-studied options, including pills with outcomes data, lower LDL when a statin isn't working for you.
Sometimes the statin causes the aches. Often, as the blinded SAMSON and StatinWISE trials showed, the same symptoms appear on a placebo. Either way, you still need a plan to lower your LDL.
If you stop a statin without a replacement, your LDL goes back to where it started. Several non-statin medicines can lower it instead.
How It Works
How to treat statin intolerance, step by step
Four steps: confirm the cause, retry a statin only if it makes sense, move through non-statin medicines, and keep following your labs to reach goal and stay there. A board-certified preventive cardiologist wrote it, and licensed clinicians in our partner telehealth network deliver it.
Find out what's causing the symptoms
We start with your history: which statins, what doses, what symptoms, and how long they lasted. Labs check for things that make statin side effects more likely, like an underactive thyroid, and confirm where your LDL, ApoB, and Lp(a) stand off treatment. The National Lipid Association defines statin intolerance as symptoms that improve when the statin is reduced or stopped, after at least two statins have been tried, including one at the lowest approved dose.
A rechallenge, when it makes sense
In blinded trials, most muscle symptoms blamed on statins also showed up on placebo. So if you have only tried one statin, a short, defined retry is often worthwhile: a different statin, a lower dose, or less frequent dosing. If your history is already well documented, or you had a serious reaction, we skip this step.
Non-statin medicines, one step at a time
Ezetimibe (a daily pill that blocks cholesterol absorption) and bempedoic acid (a daily pill with outcomes data in statin-intolerant patients from the CLEAR Outcomes trial) come next, alone or together. If LDL stays above target, the next step is a PCSK9 inhibitor (an injection every 2 to 4 weeks, the once-monthly injection Lerochol, or the daily pill Lipfendra) or inclisiran (Leqvio), a twice-yearly injection given in person. We are working with infusion centers to offer Leqvio, so ask about availability in your area.
A complete record of what you tried
We record every trial, symptom, and lab value as it happens. You and any future clinician can see exactly which medicines you took, at what dose, and what happened, which lets everyone skip trials that already failed.
Labs every quarter, so you can see it working
Your plan aims at a clear LDL and ApoB target. We repeat labs about every three months, and after any medication change. If a step falls short of target, or a medicine disagrees with you, the protocol moves to the next option right away.
How You Pay
Cash pay, with no insurance wait
Preval runs as a cash practice. Without step therapy or prior authorization, you move to the next medicine as soon as you need it.
Medicines at cash prices
Generic ezetimibe and statins cost little at pharmacy cash prices. PCSK9 inhibitors, including Lerochol and Lipfendra, come through manufacturer cash programs.
How cash pay worksTurned down by your insurer?
If your insurer denied a PCSK9 inhibitor, you can start here. Care costs $99 a month, medicines cost their cash price, and treatment starts without an appeal.
Why we skip insuranceThis program is a good fit if you
- Stopped a statin because of muscle aches and have not found a replacement
- Have tried two or more statins and want to move on to non-statin options
- Take a low statin dose you tolerate but your LDL is still above target
- Were told you need a PCSK9 inhibitor but your insurer said no, or you'd rather not wait
Common questions
How long do statin side effects last after stopping?
Muscle symptoms caused by a statin usually fade within a few weeks of stopping it. If they haven't improved after about two months off the statin, another cause is more likely and worth checking.
Is statin intolerance hereditary?
Partly, for some people. Certain gene variants, such as in SLCO1B1, raise the risk of muscle side effects with some statins, especially simvastatin. Most statin intolerance isn't explained by a single gene, but optional longevity genetic testing, which your clinician can order at your first visit, checks the best-studied ones, including SLCO1B1.
What is complete statin intolerance?
Complete statin intolerance means you can't tolerate any statin dose. Partial intolerance means you tolerate only a dose too low to reach your LDL target. Both count under the National Lipid Association's 2022 definition, which requires that at least two statins have been tried, including one at the lowest approved daily dose.
What is statin intolerance?
Statin intolerance means side effects from a statin, most often muscle aches or weakness, that improve when the dose is lowered or the statin is stopped. The National Lipid Association's 2022 definition also requires that at least two statins have been tried, including one at the lowest approved daily dose. It can be complete (no statin dose is tolerated) or partial (only a dose too low to reach your LDL target is tolerated).
Do I have to try statins again?
Not always. If you have already tried two or more statins and the history is documented, or you had a serious reaction, a rechallenge is usually skipped. If you have only tried one statin at one dose, a short, structured retry is often worth it, because blinded trials show many symptoms blamed on statins also occur on placebo.
What cholesterol medication can I take if I can't take statins?
The main prescription options are ezetimibe, bempedoic acid (Nexletol), PCSK9 inhibitors (Repatha, Praluent, the once-monthly injection Lerochol, or the oral pill Lipfendra), and inclisiran (Leqvio), which we are working with infusion centers to offer. Bempedoic acid reduced major cardiovascular events by 13% in statin-intolerant patients in the CLEAR Outcomes trial. PCSK9 inhibitors lower LDL by roughly 50 to 60%.
Does Preval use insurance for PCSK9 inhibitors?
Preval runs as a cash practice, so we don't file prior authorizations. Insurers often require documented trials of statins and ezetimibe before they cover a PCSK9 inhibitor, which can take months. Paying cash through a manufacturer program lets your clinician prescribe the medicine that fits you without that wait. If your insurer already denied a PCSK9 inhibitor, you're welcome here.
Who provides my care?
A board-certified preventive cardiologist wrote Preval Health's treatment protocols. Licensed clinicians in our partner telehealth network handle your visits, prescriptions, and follow-up, using those protocols.
How often are labs checked?
We repeat labs about every quarter, and after any medication change, so you and your clinician can see whether your LDL and ApoB are moving toward target and adjust the plan.
Find a cholesterol medicine you can stay on.
We're rolling out slowly and taking a limited number of patients. Join the waitlist to get an early spot.
Join the Waitlist