Introduction <p>Understanding patient preferences for injectable lipid-lowering therapies (LLTs) is crucial for optimizing adherence and outcomes for preventing atherosclerotic cardiovascular diseases (ASCVDs). This study aimed to quantify patient preferences for injectable LLTs among Japanese patients with ASCVDs.</p> Methods <p>This cross-sectional study was conducted from January to February 2024 using an online discrete choice experiment. Participants were recruited from the Rakuten Insight Disease Panel. A total of 59,611 individuals accessed the survey, and eligible adults aged ≥ 18 years with a history of dyslipidemia and currently receiving statin treatment were included. Participants were categorized into primary (<i>n</i> = 110) or secondary (<i>n</i> = 415) prevention groups based on their history of coronary artery disease or cerebral infarction.</p> Results <p>In the secondary prevention group, out-of-pocket costs was the most significant attribute (relative importance, 64.2%), followed by injection frequency (18.4%), administration method (12.1%), and efficacy (5.2%). Consistent attribute rankings were observed across subgroups. In the primary prevention group, out-of-pocket costs remained the most critical attribute (66.7%), followed by injection frequency (19.5%), efficacy (7.0%), and administration method (6.8%). After educational intervention, out-of-pocket costs remained the most important attribute (59.6%) in the secondary prevention group, followed by injection frequency (19.2%), administration method (11.8%), and efficacy (9.4%).</p> Conclusion <p>These findings highlight the importance of considering patient preferences in shared decision-making when selecting LLTs to enhance adherence and clinical outcomes.</p>