High Cholesterol Treatment in Southlake, TX

We treat cholesterol as one input into your overall cardiovascular risk, not as a number to chase in isolation. An LDL of 145 means something very different in a 32-year-old with no other risk factors than in a 58-year-old smoker with diabetes, and the treatment should reflect that difference.

What we measure

A standard lipid panel gives total cholesterol, LDL, HDL and triglycerides. We usually add:

• Non-HDL cholesterol, which captures every particle capable of forming plaque and predicts risk better than LDL alone. It is free, it is on every panel already, and it is routinely ignored.
• Lipoprotein(a), once in your life. Genetic, common, invisible on a routine panel, and it identifies people whose family history finally makes sense.
• A1c or fasting glucose, because insulin resistance drives the high-triglyceride low-HDL pattern we see most often.
• TSH, since an underactive thyroid raises cholesterol and treating the thyroid fixes the lipids without a statin.
• Liver enzymes, because fatty liver travels with this picture constantly. See fatty liver disease.

Apolipoprotein B is worth adding when triglycerides are high or LDL looks deceptively reassuring, because it counts the actual particles rather than the cholesterol inside them.

Deciding whether to treat

We calculate your 10-year risk from age, sex, blood pressure, cholesterol, smoking status and diabetes. Then we talk about it.

Some people at borderline risk want three to six months of diet and exercise first, which is entirely reasonable. Others have a family history that makes waiting a poor idea.

Standard calculators undercount some people. A parent or sibling with early heart disease, chronic inflammatory conditions like rheumatoid arthritis or psoriasis, chronic kidney disease, and a history of preeclampsia all raise risk beyond what the number shows. We ask about all of them.

Coronary artery calcium scoring settles a genuinely uncertain case better than anything else available. A score of zero in a borderline-risk patient is reassuring enough to defer treatment and recheck in five years. A high score changes the conversation in about thirty seconds.

When statins do not work out

Muscle aches are the most common reason people stop, and most of those people can take a statin again with a different drug or a different schedule.

It is worth the effort, because statins have the strongest outcome evidence of anything we prescribe in primary care. Rosuvastatin dosed twice weekly works for a surprising number of people who could not tolerate daily atorvastatin.

If they genuinely do not work for you, ezetimibe, bempedoic acid and injectable PCSK9 inhibitors all lower LDL substantially and all have outcome data behind them. Nobody has to simply live with it.

We also take the nocebo effect seriously without being dismissive. Blinded trials show many statin symptoms occur equally on placebo, which is worth knowing, but your muscle aches are still your muscle aches and we will work through them rather than telling you they are imaginary.

Triglycerides

Very high triglycerides, above 500, are a pancreatitis risk and get treated on their own terms with fibrates, omega-3s, alcohol reduction and tight glucose control.

Moderately high triglycerides are usually a signal about insulin resistance and weight rather than a target in themselves. Treating the underlying prediabetes or obesity fixes them more reliably than adding a drug.

Follow-up

We recheck lipids six to twelve weeks after starting or changing a medication, then annually once you are stable. Liver enzymes get checked at baseline and after that only if something changes, because routine repeat monitoring was abandoned years ago for good reason.

Cholesterol is one piece of the picture on our heart disease prevention page, and it travels with high blood pressure more often than not.

Lipid management runs through our preventive screening program. See our primary care Southlake practice overview.