Specialty · Clinical pathway

Traditional Hyperlipidemia Treatment

Physician-supervised hyperlipidemia care using rosuvastatin alone, dosed to ACC/AHA intensity categories. Enrollment and a visit are required before any prescription.

Shared foundation (2026 guideline)

The 2026 ACC/AHA/Multisociety Dyslipidemia Guideline (Circulation/JACC, 13 Mar 2026) replaced the 2018 guideline. Care here uses PREVENT-ASCVD risk estimation, a once-in-a-lifetime Lp(a), ApoB when it adds clarity, LDL goals matched to risk, screening for secondary causes, and lifestyle as the foundation. Lipids are typically rechecked 4–12 weeks after a change.

Approach

This pathway uses rosuvastatin only. Intensity (high vs moderate) follows ACC/AHA dosing categories and your ASCVD risk profile, not a one-size cash-pay package.

Who usually starts high-intensity

Clinical ASCVD where high-intensity statin is indicated and tolerated
LDL-C ≥190 mg/dL in adults for whom high-intensity therapy is appropriate
Diabetes with multiple ASCVD risk enhancers when high-intensity is preferred
Very high PREVENT-ASCVD risk when the expected benefit favors high-intensity therapy

Who usually starts moderate-intensity

Primary prevention when moderate intensity is the guideline-preferred starting point
Patients unlikely to tolerate high-intensity dosing at initiation
Situations where a lower starting dose is safer, with a plan to reassess lipids and symptoms

Lower starting dose considerations

Asian ancestry — often start lower and titrate based on response and tolerability
Reduced eGFR / chronic kidney disease — dose thoughtfully and monitor
Drug–drug interaction risk or prior statin intolerance — individualized start

Do not use this pathway if

Pregnancy or planning pregnancy
Breastfeeding
Active liver disease
Concomitant cyclosporine
Concomitant gemfibrozil

Monitoring

Baseline lipids, liver enzymes, and kidney function as clinically indicated
Recheck lipids typically 4–12 weeks after starting or changing dose
Assess muscle symptoms, adherence, and secondary causes at follow-up
Ongoing labs timed to dose changes and risk category

Expected path

Enroll and complete a visit → confirm indication and safety screens → start rosuvastatin at the agreed intensity → recheck lipids in 4–12 weeks → adjust dose or pathway if goals are not met or side effects appear. Cash drug prices are not listed here; pharmacy cost varies by plan and pharmacy.

Related hyperlipidemia pathways

Traditional Hyperlipidemia Treatment without a Statin Statin-intolerant or statin-not-preferred pathway: ezetimibe → bempedoic acid → PCSK9 → inclisiran. Functional Health Hyperlipidemia Treatment without Traditional Medications Diet and lifestyle first — soluble fiber, plant sterols, berberine, and emerging bergamot; medications if goals are not met.

Educational information only — not personalized medical advice and not for emergencies. Call 911 for life-threatening situations. Prescriptions require a visit with Dr. Owens. Dietary supplements are not FDA-approved to diagnose, treat, cure, or prevent hyperlipidemia or any disease. Do not start, stop, or change a statin or other lipid medication without discussing it with your clinician.