Suspicion of familial dyslipidemia

In what patients should we suspect familial dyslipidemia?

Ian Graham: The guidelines recommend to use one of the scoring systems. There is a table showing, for example, the Dutch Lipid Clinic Network diagnostic criteria. But trying to simplify that a little bit, familial hyperlipidemia should be suspected in patients who have coronary heart disease before the age of 55 in men or 60 years in women, in subjects with relatives with premature vascular disease, in subjects with tendon xanthomas, and in subjects with very high low-density lipoprotein (LDL) levels, for example, above 190 mg/dL or 5 mmol/L or in children above 150 mg/dL or 4 mmol/L. In some people the diagnosis can be confirmed by DNA testing and this may be useful not because it affects treatment so much but because it allows the identification of familial hyperlipidemia in childhood. For those who are likely to have familial hyperlipidemia, family cascade screening to check the relatives is recommended.