Difficulties in Gauging Atherosclerotic Cardiovascular Disease Risk Heterogeneity in Familial Hypercholesterolemia

Familial hypercholesterolemia (FH), an autosomal co-dominant disease affecting overall 1:250–300 people, causes early atherosclerotic cardiovascular disease (ASCVD) and mortality [1]. Even recognizing that the risk attributable to FH is higher than the one of the general population [2], a fact seen even among those with severe hypercholesterolemia (i.e., LDL-cholesterol > 190 mg/dL) [3], the onset of ASCVD is heterogenous among people with the disease [1,4–7]. This is especially seen in contemporary heterozygous FH populations in use of statin therapy [2,7–9].