Genetic polymorphisms associated with familial hyperlipidemia can affect immune cells and clotting or immunologic pathways involved in plaque formation.

“And so many of those have associated polymorphisms that you mentioned either with um at the level of the immune cells, the macrophages, which are in that subendothelial space, and they change the scavenger receptor in in crazy ways. And so, people with FH have an increased tendency to uh have these macrophages within our blood vessels consume the cholesterol and become foam cells. Or they're hypercoagulable in so many ways. And on the on the other end, which you briefly mentioned, people with low genetic cholesterol may have polymorphisms which are not at all related to cholesterol, but maybe related to clotting or immunologic um the immunologic roots of how a plaque forms, how a fatty streak forms in the arteries.”