The evidence is convergent. Multiple independent sources reach the same conclusion, the underlying mechanism is well-characterized, and even the field's most cautious voices treat it as worth doing.
so FH or familial hypercholesterolemia is a very genetic heterogeneous condition going back to that mallan randomization study these are the people on the far end that show us how high lipid levels cause atherosclerosis so these people have very high cholesterol levels typically north of 300 milligrams per deciliter their LDL cholesterol alone is by definition at least 190 milligrams per deciliter
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the FH pH phenotype LDL above 190 you know there are different scoring systems that you can look with additional criteria based on family personal family history of ascvd and genetic tests are available and there's apps that you can download to determine the likelihood that your patient has you know definitely a probable FH just even having the phenotype of having an LDL above 190 which is not all monogenic FH that is still associated with increased lifetime risk with a 20 to 30 year earlier onset of ascbd and females
women with FH have an earlier onset of ascvd about 20 to 30 years earlier than women without FH and they continue to be under treated but notably in the FH population women have the same age early age of onset as CBD as men do so they are not protected they don't have this premenopausal advantage
and are we using by the way an ldlc cutoff of 190 milligrams per deciliter yes that's what we are mostly using
in the same way that you know familial hypercholesterolemia is a familial is a phenotypic diagnosis it's a diagnosis in the case of FH where LDL cholesterol has to be above 190 milligrams per deciliter off treatment
at the High Extreme you have the people who have what's called familial hyper cholesterolemia which is um a genetically heterogeneous disease meaning there are literally thousands of mutations that result in a similar phenotype the phenotype is defined as having an LDL cholesterol off medication of more than 190 milligram per deciliter