In individuals with familial hypercholesterolemia, immune cells like monocytes and macrophages may have upregulated LDL receptor related proteins, potentially leading to increased LDL uptake and accelerated atherosclerosis.

“macrophages of genetically characterized familial hypercholesterolemia patients show upregulation of LDL receptor related proteins well do we think that maybe if these immune cells that we know are critically involved in the formation of foam cells and taking up LDL particles if they have more LDL receptors are they more likely to take up LDL particles could that lead to accelerated atherosclerosis absolutely but this is never discussed it's just a myopic focus on the fact that these FH patients have elevated LDL and so I think this is a really really important point to make is that when you are looking at someone with familial hyperemia and you see an elevated LDL the question then has to be which type of FH do they have which is sometimes an unanswerable question because there are so many different types of genetics and secondly are other parts of their as you've said so eloquently Dave metabolism the metabolism at the level of their monocytes maccrage is affected negatively and I believe there are also polymorphisms with FH that associate with hypercoagulability so there are often co-occurring polymorphisms uh or co-occurring metabolic defects or metabolic changes that make these people more likely to get atherosclerosis as we're pointing out”