This Figure shows a table of the risk factors that should be emphasized for both physicians and their patients. In general these are the same risk factors as for everyone, whether they have FH or not, and regardless of their baseline cholesterol levels. Thus the factors that increase the risk of coronary disease include increasing age, male sex, smoking, family history, clustering of metabolic abnormalities and the metabolic syndrome, a low HDL level, and hypertension. In addition, certain physical findings can also raise suspicion of increased risk – for example, visible accumulation of xanthomas in the skin or tendons, which would suggest that there is also accumulation in the arteries, and/or very high serum LDL levels (>250 mg/dL) should certainly be considered as an indication for intensification of therapy in FH patients.
Patients who have high LDL levels even after their initial therapy – eg, patients who still have an LDL level >150 or 160 mg/dL, even after achieving a 50% reduction in serum LDL level – should certainly be considered for more aggressive therapy. In addition, many authorities in this field believe that elevated lipoprotein(a) (Lp(a), “lipoprotein little a”) levels are also a particularly potent risk factor in FH patients; therefore, although the data are not quite as extensive in this area, many physicians will want to treat these patients to a very low LDL level, <100 mg/dL, regardless of the presence of other risk factors as well. J Clin Lipidol. 2011; 5(6).
