Advanced Primary Care & Lipid Management in Spokane
Included in our Direct Primary Care membership.
When your cholesterol isn't at goal, you have family risk factors, your lipids aren’t responding the way they should, or you need a more thorough look-through than a traditional 15-minute visit allows.
When Standard Cholesterol Care Isn't Enough
Our lipid management may be a good fit if you:
Have LDL cholesterol that stays above goal despite taking a statin
Have a strong family history of early heart attack, stroke, or high cholesterol
Have had side effects from statins and were told there were no other options
Have been told you have a "genetic" cholesterol problem but never had it formally evaluated
Have diabetes, prediabetes, or metabolic syndrome alongside abnormal lipids
Want a clearer picture of your actual cardiovascular risk, not just a single number
Have never had advanced lipid markers like Lp(a) or ApoB checked
What Our Lipid Management Includes:
We take the time to look past a standard cholesterol panel and build a plan that fits your actual risk and your actual life.
A full lipid workup (See our specialized lab pricing)
Personalized cardiovascular risk assessment
Initial evaluation for inherited lipid disorders
Statin intolerance management
Non-statin therapy options
Ongoing monitoring
Elevated LDL & PCSK9 Inhibitors
For individuals who need additional lipid control when diet, exercise, and other therapies are not sufficient/tolerated, then a targeted medication that lowers LDL may be warranted. Depending on insurance coverage, this may be an injectable or a oral tablet. They both help prevent vascular disease and are usually well tolerated in individuals.
Elevated Triglycerides and Vascepa
High triglycerides can potentiate vascular disease, but also contribute to the possibility of pancreatic disease and other problems. For individuals whose diet, lifestyle, along with statin and/or fibrates were not tolerated or insufficient, a fish oil derivative (Vascepa) may be an option.
Other Lipid Lowering Options
Other options exist, as well.
We try to always layer these with lifestyle modifications to treat any modifiable underlying problems. We also run comprehensive lipids/vascular labs, and sometimes imaging to understand the degree in which your lipids and other health needs are being affected.
Brief Frequently Asked Questions About Lipids
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No. Some patients come in with a known diagnosis and want a second look; others just want a more complete picture than a standard annual panel gives them.
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Lipoprotein(a), or Lp(a), is a genetically determined particle that can raise cardiovascular risk independent of your regular cholesterol numbers. It's rarely checked in routine primary care, but it's a one-time test that can meaningfully change how aggressively your risk should be managed.
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There are several strategies before assuming statins aren't an option for you — different statins, different dosing schedules, and non-statin medications, including PCSK9 inhibitors for appropriate candidates. We'll walk through this with you rather than stopping at "statin intolerant."
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Yes, for patients who meet appropriate criteria. We'll discuss whether you're a candidate, how insurance coverage typically works for these medications, and what to expect.
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Advanced lipid management is provided as part of DPC membership, which is paid directly rather than billed to insurance. Related medications and specialty labs may be billed to insurance separately when applicable — we'll walk you through what to expect before ordering anything.
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Collaborative, honest, and straightforward. We're here to guide the process, bring ideas to the table, and keep things moving.