High Cholesterol

If your cholesterol hasn’t responded to standard treatment, or if you’ve been told you can’t tolerate statins, you may need more than a routine approach. Arjun Makam, DO, FACC, is one of a select few physicians in California board-certified in both Interventional Cardiology and Clinical Lipidology (ABCL) — a credential held by fewer than 1,000 physicians in the United States. At our Anaheim and Corona, CA offices, we specialize in complex lipid disorders including Familial Hypercholesterolemia, elevated Lipoprotein(a), statin intolerance, and patients requiring PCSK9 inhibitor or siRNA therapy. We handle all prior authorizations in-house. Call us or request an appointment online today.

What is cholesterol, and why does it matter?

Cholesterol is a waxy substance produced by your liver and used by your body to build cell membranes, produce hormones, and synthesize vitamin D. Your liver makes all the cholesterol your body needs — dietary cholesterol from food plays a smaller role than most people think.

The problem isn't cholesterol itself. The problem is when specific types of cholesterol particles — particularly LDL ("bad") cholesterol — accumulate in the walls of your arteries, triggering inflammation and the buildup of plaque. Over time, this process, called atherosclerosis, narrows and stiffens your arteries, restricting blood flow to your heart, brain, and other organs. The result is an elevated risk of heart attack, stroke, and peripheral vascular disease.

What most patients don't know is that a standard cholesterol panel only tells part of the story. Lipoprotein(a), apolipoprotein B, LDL particle size, and inflammatory markers like hs-CRP can all significantly affect cardiovascular risk — and most of these are never checked in routine care.

When does high cholesterol require a specialist?

Standard cholesterol management — a statin and annual labs — is appropriate for many patients. But some situations require a higher level of expertise:

• Your LDL remains above 190 mg/dL despite treatment, suggesting a possible genetic disorder
• You have a strong family history of heart attacks, strokes, or cardiac procedures before age 55 (men) or 65 (women)
• You've been told you have — or may have — Familial Hypercholesterolemia (FH), a genetic condition that causes severely elevated LDL from birth
• Your Lipoprotein(a) is elevated — a hereditary risk factor that statins do not lower
• You cannot tolerate statins due to muscle pain, weakness, or other side effects
• Your triglycerides are above 500 mg/dL
• Your cholesterol hasn't improved despite a healthy diet and medication

These are the patients Dr. Makam, DO, FACC, specializes in. As one of a select few physicians in California to hold board certification in both Interventional Cardiology and Clinical Lipidology (ABCL) — a credential held by fewer than 1,000 physicians in the United States — Dr. Makam brings a level of lipid expertise that goes well beyond what is available in standard cardiology or primary care.

What is Familial Hypercholesterolemia?

Familial Hypercholesterolemia (FH) is a genetic disorder that causes dangerously elevated LDL cholesterol from birth, regardless of diet or lifestyle. It affects approximately 1 in 250 people — yet the majority are never diagnosed. Without treatment, FH dramatically accelerates atherosclerosis and is a leading cause of heart attacks in people in their 30s and 40s.

If you or a first-degree relative has been diagnosed with FH, or has had a heart attack or cardiac procedure at a young age, your entire family may benefit from evaluation and cascade screening.

What is Lipoprotein(a)?

Lipoprotein(a) — also written as Lp(a) — is a genetically determined cholesterol particle that significantly increases the risk of heart attack, stroke, and aortic valve disease. Unlike LDL, it is not lowered by statins, diet, or exercise. Lp(a) is not included in a standard lipid panel, which means most patients with elevated levels don't know it.

Dr. Makam routinely checks Lp(a) as part of a comprehensive lipid evaluation and incorporates it into your cardiovascular risk and treatment plan.

What if I can't tolerate statins?

Statin intolerance — most commonly experienced as muscle pain, weakness, or fatigue — is one of the most common reasons high cholesterol goes untreated for years. Many patients have been told they have no good options. That is rarely true.

Dr. Makam specializes in managing patients who cannot tolerate statins. Depending on your situation, your treatment plan may include:

• Alternate-day or low-dose statin strategies
• Ezetimibe or bempedoic acid (non-statin oral options)
• PCSK9 inhibitors — injectable biologics that can lower LDL by 50–60% on top of other therapies
• Inclisiran (siRNA therapy) — a twice-yearly injection that lowers LDL by silencing the gene responsible for excess cholesterol production

We handle all insurance prior authorizations for specialty lipid therapies in-house, so your treatment isn't delayed by paperwork.

What can I expect at a high cholesterol consultation?

Dr. Makam conducts a comprehensive lipid evaluation that goes well beyond a standard cholesterol check. This includes a detailed review of your lipid history, family cardiovascular history, prior medication trials, and any symptoms you've experienced. Depending on your case, advanced testing may include Lp(a), apolipoprotein B, inflammatory markers, and imaging such as Coronary Artery Calcium (CAC) scoring to quantify how much plaque has already accumulated.

The goal is to understand your true cardiovascular risk — not just your LDL number — and build a precision treatment plan around it.

For advanced lipid management at our Anaheim or Corona, CA offices, call Makam Medical or request an appointment online today.