Health Guide — Hyperlipidemia (Cholesterol) Refills (Adult)
Cholesterol Refills Online — Simple Rules That Prevent Hard Events
Bring your latest lipid panel (≤12 months), ASCVD history (if any), and a side‑effect diary. High‑intensity statins for ASCVD or LDL ≥190 mg/dL; moderate‑to‑high intensity for diabetes age 40–75; use ezetimibe/PCSK9/bempedoic acid when LDL‑C stays above thresholds despite maximally tolerated statin. Repeat lipids 4–12 weeks after any change, then every 3–12 months.
Who this guide is for
Adults with known hyperlipidemia who are already on a statin or nonstatin therapy and need maintenance refills, not brand‑new risk diagnosis in the absence of labs.
Know your risk category first
Clinical ASCVD (prior MI, stroke/TIA, symptomatic PAD): usually high‑intensity statin aiming for ≥50% LDL‑C reduction; add ezetimibe if LDL‑C ≥70 mg/dL; consider PCSK9 inhibitor if still above threshold or very high risk.
Severe hypercholesterolemia (LDL‑C ≥190 mg/dL): start high‑intensity statin; add ezetimibe, then PCSK9 if needed.
Diabetes, age 40–75: at least moderate‑intensity statin; escalate to high‑intensity with multiple risk factors or age 50–75.
Primary prevention without diabetes/ASCVD: use pooled cohort risk (plus risk enhancers) to choose moderate‑ to high‑intensity statin.
Medication options & when refills make sense
Statins (first‑line): atorvastatin 40–80 mg or rosuvastatin 20–40 mg for high‑intensity; monitor ALT at baseline and CK only if symptomatic. Review drug interactions (CYP3A4 for simvastatin/atorvastatin; grapefruit). Absolute contraindication in pregnancy.
Ezetimibe: add if LDL‑C remains above threshold on maximally tolerated statin; minimal side effects.
PCSK9 monoclonal antibodies (alirocumab, evolocumab): consider in very‑high‑risk ASCVD not at goal; large LDL‑C reduction and outcomes benefit.
Bempedoic acid: useful for statin‑intolerant or as add‑on; outcomes benefit shown in statin‑intolerant populations. Watch for gout or tendon issues.
Inclisiran: small‑interfering RNA given twice yearly after loading; potent LDL‑C lowering; outcomes data maturing.
Follow‑up cadence & labs
Lipid panel 4–12 weeks after starting or changing therapy; then every 3–12 months if stable.
ALT at baseline and if symptoms arise; CK only for muscle symptoms.
Track adherence and lifestyle (dietary pattern, exercise, weight trend).
Troubleshooting statin intolerance (without losing risk protection)
Confirm temporal relationship and rule out other causes (hypothyroidism, drug interactions, heavy exercise).
Try lower dose, alternate‑day dosing, or switch to hydrophilic statin (rosuvastatin).
Layer in ezetimibe or bempedoic acid; consider PCSK9 for very high risk.
Document clearly for insurance when using nonstatin agents.
Lifestyle steps that compound medication benefit
Dietary pattern: Mediterranean‑style or DASH; reduce saturated fat; add viscous fiber (oats, barley, psyllium) and plant sterols if desired.
Weight & activity: 150 minutes/week aerobic + resistance; 5–10% weight loss if overweight.
Smoking: quitting dramatically lowers ASCVD risk—pair meds with a plan (see Smoking Cessation).
BP & glucose: control synergistically lowers risk (see Hypertension & T2D guides).
When to get in‑person care
Chest pain, exertional dyspnea, or TIA/stroke symptoms.
ALT/AST persistently elevated >3× ULN or severe myopathy symptoms.
Pregnancy or planning pregnancy (stop statins; discuss alternatives).
How TeleDirectMD handles refills
We verify risk category, confirm med tolerance, and tailor a step‑up plan (statin → add ezetimibe → consider PCSK9/bempedoic acid as appropriate). We coordinate labs and send same‑day e‑Rx when safe.
Internal links
Hypertension refills online → /treatments/hypertension-blood-pressure-medication-refills-online
Type 2 diabetes refills online → /treatments/type-2-diabetes-medication-refills-online
Smoking cessation maintenance → /treatments/smoking-cessation-refills-online
Book your $49 MD video visit to renew your cholesterol medications and fine‑tune your plan.
References (selected): 2018 AHA/ACC Cholesterol Guideline; 2022 ACC Expert Consensus (nonstatins); CLEAR Outcomes 2023 (bempedoic acid).
